Hospital Discharge Reports Research Articles

Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil

Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.

Cross-sectional analysis of retrospective case series of hospitalisations for gastropathy caused by non-steroidal anti-inflammatory treatment: risk factors and gastroprotection use

ObjectivesTo analyse the risk factors of gastropathy caused by using non-steroidal anti-inflammatory drugs (NSAIDs) in detected hospital admissions and to analyse the use of gastroprotective treatment concerning these risk factors.MethodsA...

MON-P128: The Inclusion of the Diagnosis of Malnutrition in Hospital Discharge Reports and its Influence on the Case Mix Index of Atertiary Level Hospital in the South East of Spain

MON-P128: The Inclusion of the Diagnosis of Malnutrition in Hospital Discharge Reports and its Influence on the Case Mix Index of Atertiary Level Hospital in the South East of Spain

Outcomes and Costs of Poisoned Patients Admitted to an Adult Emergency Department of a Spanish Tertiary Hospital: Evaluation through a Toxicovigilance Program.

Toxicovigilance is the active process of identifying and evaluating the toxic risks existing in a community, and evaluating the measures taken to reduce or eliminate them.ObjectiveThrough a validated toxicovigilance program (SAT-HULP) we examined the characteristics of acute poisoning cases (APC) attended in the Emergency Department (ED) of La Paz Hospital (Madrid, Spain) and assessed their economic impact on the health system.Material and MethodsThe active poisoning surveillance system performs a daily search for cases in the hospital´s computerized case records. Found cases are entered into a database for recording of type of poisoning episode, reasons for exposure, causative agent, signs and symptoms and treatment. We carried out a cross-sectional epidemiological study with analytical projection, based on an impact study on cost per survivor. The data for the costs attributable to cases of APC observed at HULP (outpatients and inpatients) was obtained from the based on the information provided by the diagnosis-related groups (DRG) through the corresponding hospital discharge reports (available through SAT-HULP).ResultsDuring the first 30 month of SAT-HULP operation we found a total of 3,195 APC, a cumulative incidence rate of 1.75% of patients attended in the ED. The mean (SD) patient age was 40.9 (17.8) years and 51.2% were men. Drug abuse accounted for 47.5% of the cases. Suicide attempt was the second most frequent category (38.1%) and other causes accounted for 14.5% of APC. The total cost of hospital care for our hospital rose to €1,825,263.24 (approximately €730,105.30/year) resulting in a permanent occupation of 4 beds/year.ConclusionsSAT-HULP constitutes a validated toxicovigilance tool, which continuously integrates available data in real-time and helps health services manage APC data flexibly, including the consumption of resources from the health system.

Benchmarking in Thoracic Surgery. Third Edition

IntroductionBenchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. ObjectiveTo analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. MethodsStudy data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labeled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. ResultsGeneral parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. ConclusionsAs in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed.

Ensayos clínicos y consentimiento informado: visión de investigadores, pacientes y médicos de familia

ObjectiveAdequate information for patients and respect for their autonomy are mandatory in research. This article examined insights of researchers, patients and general practitioners (GPs) on the informed consent process in clinical trials, and the role of the GP. DesignA cross-sectional study using three questionnaires, informed consent reviews, medical records, and hospital discharge reports. SettingGPs, researchers and patients involved in clinical trials. ParticipantsIncluded, 504 GPs, 108 researchers, and 71 patients. ResultsConsulting the GP was recommended in 50% of the informed consents. Participation in clinical trials was shown in 33% of the medical records and 3% of the hospital discharge reports. GPs scored 3.54 points (on a 1-10 scale) on the assessment of the information received by the principal investigator. The readability of the informed consent sheet was rated 8.03 points by researchers, and the understanding was rated 7.68 points by patients. Patient satisfaction was positively associated with more time for reflection. ConclusionsGPs were not satisfied with the information received on the participation of patients under their in clinical trials. Researchers were satisfied with the information they offered to patients, and were aware of the need to improve the information GPs received. Patients collaborated greatly towards biomedical research, expressed satisfaction with the overall process, and minimised the difficulties associated with participation.

Benchmarking en cirugía torácica. Tercera edición

IntroductionBenchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. ObjectiveTo analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. MethodsStudy data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. ResultsGeneral parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. ConclusionsAs in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed.

Applicability of hospital reports submitted for reimbursement purposes for epidemiological studies based on the example of ischemic cerebrovascular diseases

In single-payer health care financing systems data extracted from hospital report forms submitted for reimbursement purposes may be used for epidemiological investigations. Based on data submitted by 14 neurological wards in Central Hungary the authors examined the reliability of these reports. Analyses were performed for the 3-digit codes of the 10th version of the International Classification of Diseases for cerebral infarcts (ICD-10 I63+I64) reported for the National Health Insurance Fund. The number of cases in individual hospitals changed between a decrease by 35% and an increase by 73% from the first to the second half of the year 2012, reflecting changes in the size of the catchment area of the hospitals in July 2012. Of those with an ICD-10 I63 or I64 discharge diagnosis 54-84% had acute stroke. Neurological wards cared for 34-98% of all stroke patients. The diagnoses submitted for reimbursement purposes corresponded in over 99% to the diagnoses in the hospital discharge reports. Inaccuracies occurred in a larger proportion (about 20%) in coding the DRG financing categories. Databases created from hospital reports submitted for reimbursement purposes can be used reliably in Hungary for stroke epidemiological studies.

Evaluation of quality indicators in hospital discharge reports in diabetic patients from an Internal Medicine Service: are we doing a good clinical practice?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Tłumacz przysięgły a pułapki tekstów medycznych

Medical translation has been an area of an increased growth in the demand for translation services. It is considered to cover an extensive variety of genres, starting from hospital discharge reports, epicrises, specialist articles in medical journals, patient information leaflets (PILs) or instructions for use (IFU). It also has entered the area of activity of sworn translators due to e.g. migration or Poland’s membership in the EU and resultant EU-law implementation procedures (i.e., implementation of the Medical Devices Directive 93/42/EEC) and commercialisation of medical devices, thus generating the need to deal with an array of texts from the entire realm of various fields of medicine, and related disciplines (pharmacy, pharmacology, biology, etc.). Sworn translators are therefore facing difficulties and at the same time challenges, among which most important are the lack of medical knowledge, medical terminology (including acronyms and abbreviations) or medical phraseology in general. This entails the development of a new professional approach towards proceeding with such tasks, and requires constant improvement of skills and knowledge. The priority of the translator while translating medical texts is the complexity of the original, embracing both complex terminological content as well as form with certain features typical of technical (scientific) texts in general. In the article the utmost significance of the translator’s specialist knowledge and competence is underlined and typical problem areas are presented. The absence of those two factors is reflected in practical examples which were analysed in terms of their correctness and terminological accuracy.

Resultados tras la implementación de un programa de mejora de la calidad del contenido de los informes de alta hospitalaria en insuficiencia cardiaca

ObjectivesTo analyse the information collected in hospital discharge reports (HDR) that are given to patients with a diagnosis of heart failure (HF), and demonstrate the improvement in the content of these reports after the introduction of an intervention. Material and methodsHDR with HF as the main diagnosis issued by the Department of Internal Medicine were analysed, and the presence of the diagnosis, prognosis and therapeutic data in these HDR was compared in a sample before and after the intervention, which consisted of reporting the results of analysis of the initial sample to the physicians. ResultsA total of 651 HDR (371 pre-intervention and 280 post-intervention) were analysed. Most of the HDR (over 70%) did not include the functional class. Most of the HDR did not include information about echocardiogram performed before the hospitalization period analysed, and most of the HDR that collected this information did not determine if the HF was diastolic or systolic. In the post-intervention sample there was a lower percentage of HDR that prescribed angiotensin-converting enzyme inhibitors or angiotensin receptor blocker ii (26% vs 32%, P<.001). In 30% of the pre-intervention sample and 38% of the post-intervention sample there was indication of beta-blockers (P=.027). ConclusionsA short discussion with the physicians responsible for patients with HF improves the inclusion of important data on the diagnosis, prognosis and treatment in the HDR.

Surgical Treatment of Head and Neck Squamous Cell Carcinomas in Spain During the 2006–2011 Period

Introduction and objectivesSurgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyze the current state of the use of surgery in patients with HNSCC in Spain. MethodsRetrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006–2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. ResultsWe obtained information on 26629 hospital discharges, with a total of 27937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. ConclusionsSurgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour.

Implementación de un sistema de alarmas automático para la detección precoz de los pacientes con sepsis grave

ObjectiveThe objective of this study was to assess the usefulness of a software tool integrated into the medical electronic history at the time of emergency triage. The aim was the early detection of patients with severe sepsis, and the potential impact of this software tool on reducing the mortality rate in patients treated. MethodThe study consisted of two comparative samples. Patient selection was performed retrospectively into two groups using ICD-9 codes from the hospital and emergency department discharge reports. The codes were 038.9, 995.9 and 995.92 for sepsis, and 785.52 for severe sepsis and septic shock. The sample called «alarms» consisted of patients studied after implementing the sepsis alarm system in the Emergency Department computer system. There were two types of alarms, a serious one and an alert one depending on the on vital signs defined. The historical sample called «no alarms» consisted of patients seen in the Emergency Department during the year before the introduction of the alarm system. ResultsThe compliance rate of the sepsis treatment package was higher in the «alarms» sample, compared to the sample without alarms, with blood cultures, 96.3% versus 80.9% (P<.001), antibiotic treatment in less than one hour, 62.9% vs. 39.3% (P<.001), determination of lactic acid, 91.4% vs. 77.9% (P<.001), and applying appropriate volume, 57.7% vs 54.3% (P=.052), respectively. The hospital mortality was reduced in absolute terms from 25% in the sample without alarms to 13.6% in the sample with alarms. Survival at 30 days was higher in the sample with alarms (Log Rank=.004). ConclusionsThere were no studies that evaluated the effectiveness of an alarm system in our literature search. An electronic identification system for patients with sepsis allows acting earlier, better compliance with basic measures, and a reduction in hospital stay and mortality.

Impacto de una aplicación informática en la mejora de la conciliación de la medicación al alta hospitalaria

Background and objectiveTo assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Material and method DesignQuasi-experimental pre / post study with non-equivalent control group study.Study population: Medical patients at hospital discharge.Intervention: implementation of a software application.Variables: Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. ResultsA total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p<.001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. ConclusionsThe use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation.

Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011

Introduction and objectivesSurgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyse the current state of the use of surgery in patients with HNSCC in Spain. MethodsRetrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006-2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. ResultsWe obtained information on 26,629 hospital discharges, with a total of 27,937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. ConclusionsSurgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour.

Evaluation of the quality and appropriateness of medical prescriptions in the hospital discharge report

Objectives: The aim of this research has been to evaluate: (a) the frequency of the use of non-standard terms in medical prescriptions; (b) the proportion of “new drugs of irrelevant therapeutic value” or medication of low therapeutic utility (LTU); and (c) the use of Generic Pharmaceutical Specialties (GPS). Materials and methods: Descriptive transversal observational study with analytical components over the hospital discharge reports issued in a year. The main variables of the results were: a) the proportion of prescriptions with abbreviations, symbols or expressions of non-recommended doses in the discharge report, b) the frequency of prescriptions of pharmaceutical specialties without the relevant contribution (NRPS), c) the proportion of LTU medication in the hospital discharge reports, d) the frequency of GPS or, if they are not available, the Common International Denomination (CID) of the active ingredient in the discharge reports, and e) the mean cost per prescribed medication in the hospital discharge report. Results: A total of 854 discharge reports have been studied containing 4,055 medical prescriptions. A considerable number (38.8%) of the medical prescriptions in the discharge report have used abbreviations and non-recommended symbols for dose expression. The prescription of new drugs of irrelevant therapeutic value reached 2.8% while the prescription of pharmaceutical products of LTU was 2.1%. Only 13.8% of the prescriptions were carried out as an active ingredient. The mean cost per prescription was 17.3 euros (SD = 31.34). Conclusions: Appropriateness in the prescription of medication at hospital discharge is considered to be not satisfactory and our results are consistent with other previously published reports. However, there are frequent errors in the prescription of medication and given the demonstrated relationship between errors and possible adverse effects, it is necessary to introduce programs to raise awareness about the importance of the introduction of safe practices in the medical prescriptions of the hospital discharge report.

Emergency department of a university hospital

Our main aim was to describe the path of patients seen in our emergency department (ED) and either admitted or transferred and to compare the characteristics of patients hospitalized in our hospital with those of transferred patients. Our secondary aim was to compare the receipts linked to patient hospital stays. All patients seen in the ED of our hospital and ill enough to be either admitted or transferred were prospectively enrolled during 2 consecutive weeks. Information was obtained from the hospital discharge report and from local medical databases. The characteristics of the patients and receipts were compared according to their path. Among the 251 patients included in the study, 9% were transferred directly from the ED to another hospital. Among admitted patients, two-thirds were admitted to the short-stay unit (SSU). Schematically, patients transferred from the ED are more likely to be men around 50 years of age with few comorbidities, requiring surgery with relatively short hospital stays. Patients transferred from the SSU were more likely to be women around 67 years of age with severe comorbidities requiring medical care and longer stays. The mean receipt per day was two to three times greater for patients transferred from the ED as compared with patients hospitalized in our hospital. The mean receipt per day for patients transferred from the SSU also tended to be higher. Our results show that patients requiring shorter care are transferred, whereas more severe patients are hospitalized on site. Hospitals will need solutions to optimize their receipts while fulfilling their public missions such as continuity of care.

Enrollment in Early Intervention Programs Among Infants Born Late Preterm, Early Term, and Term

To compare the prevalence of and characteristics associated with early intervention (EI) program enrollment among infants born late preterm (34–36 weeks’ gestation), early term (37–38 weeks’ gestation), and term (39–41 weeks’ gestation). A Massachusetts cohort of 554 974 singleton infants born during 1998 through 2005 and survived the neonatal period was followed until the third birthday of each infant. Data came from the Pregnancy to Early Life Longitudinal Data System that linked birth certificates, birth hospital discharge reports, death certificates, and EI program enrollment records. We calculated prevalence and adjusted risk ratios to compare differences and understand associations. The prevalence of EI program enrollment increased with each decreasing week of gestation before 41 weeks (late preterm [23.5%],early term [14.9%], and term [11.9%]. In adjusted analyses, the strongest predictors of EI enrollment (adjusted risk ratio ≥1.20) for all gestational age groups were male gender, having a congenital anomaly, and having mothers who were ≥40 years old, non high school graduates, and recipients of public insurance. Infants born late preterm and early term have higher prevalence of EI program services enrollment than infants born at term,and may benefit from more frequent monitoring for developmental delays or disabilities.

CLINICO-EPIDEMIOLOGICAL STUDY OF ACUTE CORONARY SYNDROME/ACUTE MYOCARDIAL INFARCTION: DATA FROM THE TASHKENT CITY DISTRICT REGISTER

Aim. To assess epidemiological characteristics of acute coronary syndrome/acute myocardial infarction (ACS/AMI), using the data from the Tashkent City district register.Material and methods. The data on ACS/AMI among permanent residents of one of the Tashkent City districts were obtained from the following sources: ambulance service database, hospital case histories and discharge reports, ambulatory cards from polyclinics, autopsy records, medico-legal expertise protocols, and death certificates from the civil registration office.Results. Over one year, 683 ACS/AMI patients were included in the register: 464 (67,9%) men and 219 (32,1%) women. The prevalence of ACS/AMI was 2,1 times higher in men than in women: 67,9% vs. 32,1%, respectively (р&lt;0,01). One-third of the patients had heart failure in their medical history, and more than one-third had AMI earlier (31,2% of men and 26,9% of women). Only in 7,2% of ACS/AMI cases, the volume and quality of prehospital medical care met the required standards. Arterial hypertension (AH) was present in 81,7% of the patients (78,0% of men and 89,5% of women). Stage 2 AH was diagnosed in 15,7%, and Stage 3 AH in 5,4%.Conclusion. The prevalence of ACS/AMI was 2,1 times higher in men than in women. Women developed ACS/AMI, on average, 10 years later than men. Among ACS/AMI patients, particularly in younger age groups, the prevalence of risk factors was high, while the risk factor awareness was low.

Variación temporal y distribución geográfica de las cardiopatías congénitas en la Comunitat Valenciana

ObjectivesThe objective of this study is to estimate the prevalence of congenital heart defects (CHD) in the Comunitat Valenciana (CV) in children less than one year old and identify whether there are temporal and geographic variations within this prevalence. MethodsThe minimum basic data set from hospital discharge reports was used to select patients, who were born between 1999-2008, were less than one year old, and who lived in the CV with at least one hospital admission in which the primary diagnosis and/or any of the events were coded as CHD (codes 745-747 of the International Classification of Diseases 9th Revision Clinical Modification). The first hospital discharge report with CHD was selected, using the health card number to detect duplication. The prevalence and 95% confidence intervals were calculated, and the prevalence ratio (PR) and smoothed PR was obtained for each municipality to identify geographic patterns. ResultsIn the period 1999-2008 there were 6.377 patients younger than one year with some CHD, representing the 43.2% of cases of congenital anomalies. The prevalence was 134.3 per 10.000 live births (95% CI: 131.1-137.6). There was a significant increase in the prevalence, from 115.8 in the 1999-2003 period to 149.5 in the 2004-2008 period. A higher risk was identified in the north of the CV, and in some municipalities of the province of Alicante, in the south. ConclusionsThe observed increase in CHD agrees with the findings in other countries and it can be explained, at least in part, by improved diagnostic techniques. The geographic pattern identified requires a more detailed analysis that could explain the geographic variations found.