Hospital Admission Status Research Articles

Hospital Admissions Due to Norovirus in Adult and Elderly Patients in England

Norovirus generally causes a mild illness in the community. However, modeling routine hospital admission statistics, we estimate that approximately 3000 norovirus admissions to English hospitals occur per year, accounting for 0.3% and 0.1% of emergency admissions among elderly and adult patients, respectively, at times of peak activity. These admissions pose a risk for subsequent nosocomial infection outbreaks.

Seasonal variation in hospital admission for road traffic injuries in England: analysis of hospital statistics

Objective:To report on seasonal variation in hospital admissions for traffic injuries to car and truck occupants, motorcyclists, cyclists, and pedestrians.Methods:Descriptive study of hospital admission statistics in England, 1999–2004. Main outcome...

Involuntary Outpatient Commitment in Florida: Case Information and Provider Experience and Opinions

The use of involuntary outpatient commitment (IOC) is a significant international issue. Variations can be found in Australia, New Zealand, Scotland, Ontario (Canada), Switzerland, and the United States. Its use varies considerably by country and in the United States, between states. In Florida, the IOC statute has been used sparingly. This paper first presents information about the first fifty IOC cases in Florida including a description of the pre- and post-IOC order emergency commitments and state hospital admissions of these individuals. It then provides results from a survey of mental health professionals about their experience with and opinions about IOC. The majority of the individuals with IOC orders had at least one emergency commitment in the two years pre-IOC order (n = 46; range 1–7) and in the two years post-IOC order (n = 41; range 1–13). While 41 individuals experienced 68 total emergency commitments in the 180 days prior to the IOC order, 18 individuals had 24 emergency commitments in the 180 days after the order. Eleven had at least one state hospital admission pre-IOC order, with eight having such an admission post-IOC order. Results from the survey suggest that a number of issues have reduced the use of IOC, including difficulties in applying the statute, inadequate clinical resources, and skepticism regarding the practical effect of an IOC order on positive clinical outcomes. The implications of these results for policy development are discussed.

Surveillance of the short-term impact of fine particle air pollution on cardiovascular disease hospitalizations in New York State

BackgroundStudies have shown that the effects of particulate matter on health vary based on factors including the vulnerability of the population, health care practices, exposure factors, and the pollutant mix.MethodsWe used time-stratified case-crossover to estimate differences in the short-term impacts of PM2.5 on cardiovascular disease hospital admissions in New York State by geographic area, year, age, gender, co-morbid conditions, and area poverty rates.ResultsPM2.5 had a stronger impact on heart failure than other cardiovascular diagnoses, with 3.1% of heart failure admissions attributable to short-term PM2.5 exposure over background levels of 5 ug/m3. Older adults were significantly more susceptible to heart failure after short-term ambient PM2.5 exposure than younger adults.ConclusionThe short-term impact of PM2.5 on cardiovascular disease admissions, and modifications of that impact, are small and difficult to measure with precision. Multi-state collaborations will be necessary to attain more precision to describe spatiotemporal differences in health impacts.

How Dosing of Ziprasidone in a State Hospital System Differs From Product Labeling

The purpose of this article is to review the utilization and dosing of ziprasidone in a state hospital system and to compare the dosing to dosing recommendations contained in product labeling that suggest a starting dose of 40 mg/day and a target dose range of 40 to 160 mg/day for schizophrenia. Dosing of ziprasidone was examined from the time when it was first marketed in 2001 up to and including calendar year 2006 using a database that contains patient information and drug prescription information for every inpatient within the adult civil facilities of the New York State psychiatric hospital system operated by the New York State Office of Mental Health. Supporting evidence for a therapeutic dose response for ziprasidone was examined by conducting a PubMed search for the period January 1, 1990, to June 1, 2008, identifying English-language articles related to ziprasidone dose in schizophrenia using the search terms ziprasidone, dose, and schizophrenia. Although the highest efficacious dose of ziprasidone recommended in the manufacturer's product label is 160 mg/day, the mean dose of ziprasidone prescribed among patients hospitalized in New York State in calendar year 2006 and receiving antipsychotic medication (N = 7154) was 179 mg/day (N = 709), with 51.6% receiving doses in excess of 160 mg/day (N = 366). Patients discharged on treatment with ziprasidone (N = 189) received a mean dose of 206 mg/day. Patients with schizophrenia with a history of prior state hospital admission were more likely to receive doses greater than 160 mg/day. Clinicians in hospitals with the highest prescribing rates for ziprasidone were more likely to prescribe ziprasidone in excess of 160 mg/day. The initial dose on the first day for new starts on treatment with ziprasidone was 91 mg/day (N = 112). Published anecdotal reports describe the use of ziprasidone in excess of 160 mg/day and up to 640 mg/day among patients not responding to lower doses, but, currently, there are no published reports from double-blind randomized clinical trials establishing the utility of this high-dose treatment strategy. Dosing of ziprasidone in a large state hospital system is higher than what has been established in the registration program for schizophrenia. Although there is anecdotal evidence describing the use of ziprasidone in excess of 160 mg/day, controlled clinical trials are needed to determine if these higher doses are more effective.

Analysis of Nonfatal Dog Bites in Children

Dog bites are a significant public health problem among children. The purpose of this study was to examine the hospital incidence, hospital charges, and characteristics of dog bite injuries among children by age group and hospitalization status who were treated at our health care system to guide prevention programs and policies. An electronic hospital database identified all patients younger than 18 years who were treated for dog bites from 1999 to 2006. Demographics, injury information, hospital admission status, length of stay, hospital charges, and payer source were collected. A further review of the narrative part of the inpatient electronic database was examined to identify owner of the dog, type of dog, and circumstances surrounding the incident. During 8 years, 1,347 children younger than 18 years were treated for dog bites. The majority were treated and released from the emergency department (91%). Of the 66 children (4.9%) requiring inpatient admission, the median length of stay was 2 days. Victims were frequently male (56.9%) and <8 years (55.2%). Children younger than 5 years represented 34% of all dog bite victims, but 50% of all children requiring hospitalization. Thirty-seven percent of all children admitted to the hospital were bitten by a family dog. The cost of direct medical care during the study was $2.15 million. Dog bite visits comprised 1.5% of all pediatric injuries treated in our hospital system during the study period. The majority (91%) of all dog bite visits were treated and released from the emergency department. Injuries to the head/neck region increased the odds of requiring 23 hour observation (OR, 1.95) and age less than 5 years increased the odds of being admitted as an inpatient (OR, 3.3).

State Hospital Admissions on Unexpected Upswing

State Hospital Admissions on Unexpected Upswing

Population-Based Examination of the Relationship Between Type of First Admission for Schizophrenia and Outcomes

Population-Based Examination of the Relationship Between Type of First Admission for Schizophrenia and Outcomes

Systemic Inflammatory Response Syndrome (SIRS) as Predictor of Severe Sepsis (SS) in Hospitalized Patients (pts) with Hematologic Malignancies.

Pts with hematologic malignancies (HM) are at high risk of developing SS and sepsis-related mortality. The diagnosis of sepsis requires suspicion of infection accompanied by at least two signs of systemic inflammation. The SIRS criteria were devised to improve the early bedside detection of sepsis and provide objective inclusion criteria for clinical research. Cut-point values based on consensus opinion are: HR >90, Temp > 100.4 or <96.8, RR>20, and WBC >12k or <4k. SIRS is defined by the presence of ≥2 abnormalities. Although widely used, SIRS criteria have not been studied in pts with HM because factors such as immunosuppression and other disease characteristics result in clinical and laboratory changes which are thought to potentially invalidate the SIRS criteria. Since HM pts have been excluded from pivotal sepsis trials, clinicians must extrapolate data from other populations to make diagnostic and treatment decisions for HM patients with SS. The purpose of this study was to evaluate the SIRS criteria as predictors of development of SS in pts with HM.Methods: The association between the SIRS and SS was evaluated in hospitalized adult pts (age 18–83) with HM in a prospective single-center, nested case-control study. The primary outcome was SS, defined as an infection resulting in cardiovascular or respiratory failure. Vital signs were performed every eight hours. Of the 547 pts who consented for the study, 54 developed SS (9.9% CI 7.7–12.7%). Using incidence density sampling, 211 controls were selected by matching on length of stay at time of SS. Evidence-based cut-points were then derived for the individual SIRS variables by examining risk estimates based on variable percentiles.Results: At hospital admission, HR, RR, BP, WBC, ANC, age, diagnosis, and transplant status were similar between the groups. In univariable analysis (24° prior to SS), significance of the four individual SIRS variables were: HR (p=.001), RR (p<.001), Temp (p<.001) and WBC (p=.218). Sensitivity, specificity and LR(+) for SIRS scores (1–4) are reported in the Table. In multivariable logistic regression, HR (OR 2.0, CI 1.0–4.1 p=.047), RR (OR 8.3, CI 2.8–24.4 p<.001) and Temp (OR 3.8, CI 1.8–8.0 p=.001) remained significant (ROC area=0.75). Age, diagnosis and transplant status did not modify these risks. WBC and hypothermia did not contribute to the model. Empirically derived cut-points for HR, Temp and RR were: HR (≥109, OR 5.5 2.64–11.5 p <.001), Temp (≥100.2°F, OR 2.71, CI 1.2–6.2, P<.001), (RR> 20, OR 8.3, CI 2.8–24.4 p<.001), ROC area= 0.79 (24° prior to SS).Conclusions: This study is the first to evaluate and define the test characteristics of the SIRS criteria in hospitalized pts with HM. The rationale for excluding HM patients from SS clinical trials based on diagnostic concerns should be revisited when planning future SS studies. Fever, tachycardia and tachypnea seem most predictive in this population. These results suggest that cut-points for significant SIRS variables can be redefined to improve the specificity of the SIRS score. Additional markers for the early detection of SS may further improve upon SIRS in HM pts.SIRS ScoreSensitivity % (95 CI)SpecificityLR(+)198 (97–99)12 (8–18)1.1276 (71–81)60 (54–66)1.9339 (33–45)91 (88–94)4.347 (4–11)99 (99–100)15.6

The Effects of Childbirth Self‐Efficacy and Anxiety During Pregnancy on Prehospitalization Labor

To describe levels of anxiety and self-efficacy for childbirth in nulliparous women during the late third trimester and to identify relationships among those variables, prehospitalization labor pain, management strategies, and hospital admission status. A longitudinal, descriptive study. Thirty-five English-speaking nulliparous women, 18 to 40 years of age, more than or equal to 38 week's gestation, with uncomplicated pregnancies. All participants had a significant other (husband or partner) and attended childbirth education programs. Spielberger Trait Anxiety Inventory, Prenatal Self-Evaluation Questionnaire, Childbirth Self-Efficacy Inventory, McGill Pain Questionnaire-Short Form, postpartum interviews, and medical records review. Prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor, and admitting cervical dilation. The number of management strategies used was related to pain scores during labor before hospital admission. Women who spent longer periods of time at home in labor arrived at the hospital with a greater cervical dilation. Antenatal characteristics influence intrapartal outcomes in nulliparas. Labor environment, at home and in the hospital, is recognized as an important component of the first childbirth experience.

Increasing United States Hospital Admissions for Acute Pancreatitis, 1988–2003

To examine the epidemiology of hospital admissions for acute pancreatitis in the United States. We compiled data from the 1988-2003 National Hospital Discharge Survey and analyzed it with respect to patient demographics, hospital type and region, procedures performed, length of hospital stay, and inpatient mortality. Hospital admissions for acute pancreatitis increased from a 1988 low of 101,000 (95% confidence interval [CI]: 87,000-116,000) to a 2002 peak of 210,000 (95% CI: 186,000-234,000). The corresponding admission rate increased from 0.4 to 0.7 hospitalizations per 1000 U.S. population (p = 0.001). The patients' average age was 53 years, 51% were male, and 23% were black. The hospitalization rate was higher among blacks (0.9; 95% CI, 0.6-1.1) than among whites (0.4; 95% CI, 0.3-0.5). The mean length of stay was 6.9 days and decreased over the study period. Overall mortality was 2%, with increasing age and male gender comprising independent risk factors for death. The hospitalization rate for acute pancreatitis in the United States is rising and is higher in blacks than in whites. Further research is necessary to identify the cause(s) of increasing pancreatitis admissions, the observed racial disparity, and the cost of these admissions.

Adult mental health care in England

The policy background and current overall provision of mental health services for working age and older adults in England are described. Following the introduction of a new National Service Framework in 1999, an annual service mapping exercise was introduced. Data presented draw heavily on the mapping for 2003. This is supplemented by hospital admission statistics data from the new patient-based mental health minimum data set, introduced from April 2003, and a number of other corroborative sources. Data about services for older people are more restricted in scope and detail. Close attention is given to the extent to which data from these routine sources can be considered accurate.

Use of case fatality and readmission measures to compare hospital performance in gynaecology

To identify suitable outcome measures for comparing gynaecology performance between hospitals. Analysis of routinely collected statistics. England. POPULATION A total of 1.45 million gynaecology admissions in 1999/2001. The database used was a linked file of English NHS hospital admission statistics and death certificate data. Case fatality rates (CFRs)and emergency readmission (ERA) rates were calculated for different components of gynaecology workload. Funnel plots, using age-sex standardised measures, were displayed to compare the outcomes. CFRs and ERA rates. The CFR within 30 days after admission for patients with cancer was 5.1%. These patients accounted for only 3% of all the admissions but for 73% of all 30-day deaths. All other 30-day CFRs were extremely low-below 0.5%. The 30-day ERA rates ranged from 1.8% after day case care to 17.4% after emergency admissions for people who did not have an operation. Funnel plots showed considerable variation between hospitals for ERA after day case care but not after elective abdominal hysterectomy. There are no measures of mortality that could be used routinely and meaningfully to compare the performance of gynaecology units. We suggest that two suitable comparative measures of outcome, derivable from routine hospital statistics, are 30-day ERA rates after day case admissions and after elective abdominal hysterectomy, excluding those records with a cancer diagnosis. These measures are relatively homogeneous with respect to their likely rates of adverse events and have sufficient numbers to produce potentially useful comparative results.

Dosing of Quetiapine in Schizophrenia

A substantial number of patients with psychosis receive quetiapine in amounts that are greater than what is recommended in the product labeling approved by drug regulatory agencies. The purpose of this article is to review the past and present dosing patterns of quetiapine for the treatment of schizophrenia. A PubMed search for the period January 1, 1990, to July 1, 2005, was conducted to identify English-language articles related to quetiapine dose in schizophrenia using the search terms quetiapine, dose, and schizophrenia. Trends in dosing of quetiapine in a large, state-operated psychiatric hospital system and the anecdotal evidence describing the use of quetiapine in excess of 800 mg/day were also reviewed. The registration studies of quetiapine suggest a target dose range of 300 to 500 mg/day for schizophrenia. In contrast, among inpatients hospitalized in New York State in the period of April 1, 2004, to June 30, 2004, the mean dose of quetiapine prescribed was 620 mg/day, with 33.6% receiving doses in excess of 750 mg/day. Patients with nonwhite ethnicity, length of stay of at least 1 year, or history of prior state hospital admission were more likely to receive doses greater than 750 mg/day. Patients receiving quetiapine as antipsychotic monotherapy or in combination with other antipsychotics were equally likely to receive doses greater than 750 mg/day. Published anecdotal reports describe the use of quetiapine in excess of 800 mg/day and up to 2400 mg/day among patients not responding to lower doses, but currently there are no published reports from double-blind randomized clinical trials establishing the utility of this high-dose treatment strategy. Dosing of quetiapine in clinical practice is higher than what has been established in the registration program for schizophrenia. Although there is anecdotal evidence describing the use of quetiapine in excess of 800 mg/day, double-blind randomized clinical trials are needed.

All-Terrain Vehicle–Related Nonfatal Injuries Among Young Riders: United States, 2001–2003

All-terrain vehicles (ATVs) have gained in popularity in recent years, and this rise in use has been accompanied by increases in the number of ATV-related injuries. Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate ATVs properly, their risk for injury is greater. Furthermore, most children ride adult-sized ATVs. To estimate the numbers and rates of ATV-related nonfatal injuries to riders aged < or =15 years who were treated in hospital emergency departments (EDs) in the United States from 2001 through 2003. Estimates of ATV-related injuries were obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System-All Injury Program. The database is a nationally representative, stratified probability sample of 66 US hospitals with > or =6 beds and a 24-hour ED. ATV-related nonfatal injuries to riders aged < or =15 years who were treated in hospital EDs were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. From 2001 through 2003, an estimated 108724 children aged < or =15 years were treated in hospital EDs for nonfatal injuries sustained while riding ATVs. The number of ATV-related injuries increased by 25% over the 3-year period. Males aged 11 to 15 years accounted for 52% of all ATV-related ED visits and hospitalizations among young riders. Children aged 0 to 5 years were more likely than the older children to have facial injuries, whereas the older children were more likely to sustain lower trunk and leg or foot injuries. Fractures were the most common diagnosis, accounting for 27% of ED visits and 45% of hospitalizations. Current legal and regulatory standards have been ineffective in reducing injuries among young ATV riders. Renewed efforts by health care providers to counsel parents about the injury risk to children who ride ATVs and advocate for more stringent state-level minimum age requirements may help reduce the escalating rates of ATV-related injuries among young riders.

The Unholy Darkness: An Autobiography Sightlines: The View of a Valley Through the Voice of Depression How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention The Thief of Happiness: The Story of an Extraordinary Psychotherapy Detour: My Bipolar Road Trip in 4-D

The Unholy Darkness: An Autobiography Sightlines: The View of a Valley Through the Voice of Depression How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention The Thief of Happiness: The Story of an Extraordinary Psychotherapy Detour: My Bipolar Road Trip in 4-D

Neurocognition and community outcome in schizophrenia: long-term predictive validity

The present study examined the predictive validity of neuropsychological measures to functional outcome in 26 schizophrenic patients 15-plus year post-testing. Outcome measures included score on the Resource Associated Functional Level Scale (RAFLS), number of state hospital admissions, and total duration of state hospital inpatient stay. Results of several stepwise multiple regressions revealed that verbal memory significantly predicted RAFLS score, accounting for nearly half of the variance. Trails B significantly predicted duration of state hospital inpatient status. Discussion focused on the utility of these measures for clinicians and system planners.

Primary care and emergency department decision making.

To determine the effect of primary care status on decision making in the pediatric emergency department (ED). Urban tertiary care children's hospital. Examining physicians prospectively completed questionnaires describing the presence of and their familiarity with patients' primary care providers (PCPs), as well as several relevant clinical factors. We prospectively surveyed care for patients with triage temperature of 38.5 degrees C or higher or symptoms of gastroenteritis between August 1, 1999, and February 15, 2000. Intravenous fluid use, hospital admission status, rates of diagnostic testing and interventions, mean total costs, and length of ED stay. Among 1166 nonreferred patients, no PCP was identified for 164 patients and PCPs for 1002. The groups did not differ on ethnicity, mean age-adjusted vital signs, triage category, initial appearance, patient care setting (main ED or urgent care clinic), time of day, day of week, certainty of diagnosis, or perceived importance of follow-up. Mean unadjusted direct hospital costs for diagnostic testing were significantly higher for the group without PCPs, $23 vs $16. In regression models controlling for age, ethnicity, insurance status, patient care setting, ED attending physician, temperature, and initial appearance, the absence of a PCP was associated with an increased likelihood of diagnostic testing. Compared with a subset of the cohort with PCPs who were familiar to the treating physicians, the group without PCPs also had a significantly higher rate of intravenous fluid administration. In this patient population, ED physicians may vary their assessment and management decisions based on primary care status.

A new assessment for elders admitted to acute care: Reliabilityofthe MDS-AC

Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care (MDS-AC). Content was developed by literature review and consultation with professionals working in acute areas. Dual independent assessments were conducted on hospital in-patients in 4 countries. Inter-assessor reliability coefficients were calculated for each item. Kappa was calculated for all binary and multi-level nominal variables. Quadratically weighted Kappa was estimated for all ordinal multi-level variables. Where one level of the variable contained 90% or more of the subjects, total observed agreement is reported. Separate reliability estimates were calculated for pre-hospitalization and inpatient items. Subjects had a mean age of 78. Completion of pre-hospitalization and hospital period assessment (combined) required 20 and 30 minutes. Excluding items for which 90% or more of subjects were classified into a single scoring level, average inter-assessor reliability coefficient for the pre-hospital period items was 0.57 and for in hospital 0.58. Overall exact agreement was 83% for pre-hospitalization assessment items, and 79% for the in-hospital items. The reliability achieved in the highly unstable situation of the acute admission phase is sufficient for use in clinical care and research. Differences in pre-hospital and admission status necessary for case-mix adjusted comparison of outcomes were illustrated. Development of a means for systematically comparing changes in older people during the course of illness is of increasing importance when addressing questions of the appropriate and inappropriate use of medical technology.

Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case-control study.

# Risk of suicide in relation to income level in people admitted to hospital with mental illness: nested case-control study {#article-title-2} People at higher risk of suicide, such as those...