Hospital Readmission Research Articles

Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery

Study Design: Retrospective cohort study of national database. Objective: This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery. Summary of Background Data: Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery. Methods: Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months. Results: In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group. Conclusions: Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications. Level of Evidence: III

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

Abstract Introduction Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

Risk factors for readmission following esophagectomy and gastrectomy for cancer.

Hospital readmission after surgery is a key quality indicator. This nationwide cohort study aimed to assess readmission rates following esophagectomy and gastrectomy for cancer and identify associated risk factors. Data were extracted from the Dutch Upper GI Cancer Audit (DUCA) for patients with esophagogastric cancer who underwent esophagectomy or gastrectomy with curative intent between January 2011 and June 2016. Logistic regression analysis identified risk factors for 30-day readmission. In total, 5566 patients were included. Readmission within 30days occurred in 483 of 3488 (13.8%) patients after esophagectomy and 243 of 2078 patients (11.7%) after gastrectomy. Both minor (Clavien Dindo 1-2) and major (Clavien Dindo ≥3) postoperative complications were independent predictors of readmission after esophagectomy (OR 2.99; 95%CI 2.23-4.02; p< 0.001 and OR 5.20; 95%CI 3.82-7.09; p< 0.001). Specific complications included pulmonary (OR 1.49; 95%CI 1.20-1.85; p< 0.001), gastrointestinal (OR 2.43; 95%CI 1.94-3.05; p< 0.001), and infectious (OR 2.27; 95%CI 1.60-3.22; p< 0.001). Prolonged length of stay (pLOS) was associated with higher readmission rates in patients without complications following esophagectomy (OR 1.91 95% CI 1.19-3.07; p= 0.008), but lower rates in those with complications (OR 0.65 95% CI 0.51-0.83; p< 0.001). For gastrectomy, postoperative complications were also linked to readmission (OR 3.18; 95%CI 2.30-4.40; p< 0.001), particularly gastrointestinal (OR 2.16; 95%CI 1.40-3.32; p< 0.001), and infectious (OR 3.80; 95%CI 2.53-5.71; p< 0.001). Readmission after esophagogastric resection is common, particularly among patients with both minor and major postoperative complications. Prolonged stay after esophagectomy impacts readmission risk differently based on the presence of complications.

Synergistic use of Unplanned Reoperation and Hospital Readmission rates for quality monitoring in pediatric surgical care.

Unplanned reoperation (URO) and unplanned hospital readmission (UHR) are key quality indicators used to assess healthcare quality improvement. The aim of this study was to describe, quantify, analyze and compare both indicators in a Pediatric Surgery Department. An observational study was conducted reviewing the medical records of pediatric patients who underwent unplanned reoperation and unplanned hospital readmission over a six-year period in a pediatric surgical unit. The incidence, indications, and causes of reoperations and readmissions were analyzed. A total of 6,376 surgeries were performed over a six-year period. During this time, there were 37 (0.58%) URO and 20 (0.31%) UHR. There were 23/2,437(0.94%) URO and 14/2,437(0.57%) UHR among emergency surgeries. In contrast, there were 14/3,939(0.35%) URO and 6/3,939(0.15%) UHR among elective surgeries (p < 0.05). Outpatient surgeries had 3/1,639 (0.18%) URO and 1/1,639 (0.06%) UHR compared to inpatient surgeries that had 11/2,300(0.47%) URO and 5/2,300 (0.21%) UHR respectively (p = ns). A total of 1,570 appendectomies were performed during the study period, with 8/1,570(0.5%) patients requiring either a URO or a UHR. The most frequent indication for both URO and UHR were intra-abdominal infections. The main cause of URO was a technical error during surgery (70%), while the main cause of UHR was an error in the medical treatment (35%). In our practice, URO are more frequent than UHR. Emergency surgeries have a higher risk of undergoing an URO or a UHR. Acute appendicitis is the most common diagnosis associated with the need for an URO or a UHR. The majority of unplanned reoperation cases are due to technical errors during surgery.

Impact of hospital readmissions following hospitalisation with delirium on 12-month mortality: a quaternary Australian hospital experience.

Inpatient delirium and unplanned hospital readmissions are associated with increased mortality. This study aimed to determine the effect of 28-day unplanned hospital readmissions on 12-month mortality post-discharge in patients with delirium during index hospitalisation. Retrospective longitudinal cohort study of adults aged 65 or above with delirium during hospitalisation at a Victorian quaternary hospital was performed. Delirium was identified by the inclusion of ICD-10 (International Classification of Diseases, 10th revision) codes in the hospital medical discharge summary. Descriptive statistics was obtained for baseline characteristics. Cox proportional hazards model was developed to identify independent predictors of 12-month post-discharge mortality. One thousand six hundred thirty-four patients with delirium during in-patient admission were included. The overall 12-month mortality rate was 35% (572 patients). Of the 1,425 patients who survived their index admission, 11.2% had an unplanned 28-day readmission. In Cox regression analysis, unplanned readmission (hazard ratio (HR) 2.3, 95% confidence internal (CI) 1.7-2.9), older age (HR 1.38, CI 1.11-1.72), Charlson Comorbidity Index (HR 1.21, CI 1.17-1.27), and discharge to nursing home (HR 1.58, CI 1.23-2.02) were independent predictors of 12-month mortality. Readmitted patients with 12-month mortality were older, with higher rates of dementia, polypharmacy, and nursing home residence compared to readmitted patients who did not reach this endpoint. Unplanned hospital readmission within 28days of discharge is an independent predictor of 12-month mortality post in-hospital delirium admission. Admissions complicated by delirium and readmission episodes should instigate discussions regarding prognostication and goals of care. Greater research is required to minimise hospital readmission rates following discharge in this cohort.

Predictors of mortality among older adults discharged to or readmitted from a skilled nursing facility.

Previous studies have shown that patients who are readmitted to the hospital from a skilled nursing facility (SNF) have a higher mortality rate. The objective of this study is to determine factors associated with high mortality rate for older adults who require hospital readmission while on presumed short stay in SNF to trigger a goals-of-care discussion. Retrospective study of 847 patients aged 65 and above who were discharged from 1 large urban academic medical center to multiple SNF in 2019. Charts of 847 patients admitted to SNF after an acute hospital stay were reviewed; their overall 1-year mortality rate was 28.3%. The 1-year mortality rate among individuals readmitted to the hospital within 30 days of discharge to SNF was 50%, whereas for those who did not require readmission, the rate was 22%. For the most common diagnostic categories of nervous system, and musculoskeletal, patients with readmission to hospital within 30 days of discharge to SNF had a roughly threefold higher 1-year mortality rate. Worse frailty score on hospital readmission, poor nutrition, and weight loss were the most impactful individual factors carrying a higher degree of mortality of up to 83%. Hospital discharge to SNF and readmission from SNF within 30 days, further decline in functional status, and malnutrition characterize high-risk groups that should trigger care preference and prognostic discussions with patients as these events may be markers of vulnerability and are associated with high 1-year mortality rates.

AI-Enhanced Predictive Analytics for Proactive Healthcare Management: Leveraging Machine Learning to Improve Patient Care and Operational Efficiency

As healthcare changes quickly, combining artificial intelligence (AI) and machine learning (ML) technologies has become a major force that can change things. This is because it improves predictive analytics for proactive healthcare management. This essay looks at how AI-powered predictive analytics might be able to help healthcare systems provide better care to patients and run more smoothly. Machine learning algorithms can find patterns and trends in huge amounts of patient data that traditional analysis methods might miss. This lets healthcare workers make smart decisions before big problems happen. The study looks into many uses of AI-enhanced prediction analytics, such as figuring out which patients are at the highest risk, finding diseases early, and making treatment plans work better. Using past patient data and real-time tracking, predictive models can figure out how likely it is that a person will develop a chronic condition. This lets doctors act quickly and make personalized care plans for each person. This cautious method not only improves the health of patients, but it also makes healthcare systems less busy by cutting down on hospital readmissions and trips to the emergency room. The paper also looks at how predictive analytics can help healthcare groups streamline their working processes. Healthcare facilities can better arrange staff and tools, making sure that resources are available where and when they are needed, by predicting how many patients will be admitted and how resources will be used. This speed makes patients happier, cuts down on wait times, and raises the standard of care generally. The study also looks at the problems that come with using AI and predictive analytics in healthcare, such as worries about data privacy, integrating new systems with old ones, and the need for strong algorithms that can handle a wide range of patients. It stresses how important it is for lawmakers, healthcare workers, and data scientists to work together to make ethical rules for the use of AI in healthcare situations.

Survival models and longitudinal medical events for hospital readmission forecasting.

The rate of 30-day all-cause hospital readmissions can affect the funding a hospital receives. An accurate and reliable readmission prediction model could save money and increase quality-of-care. Few projects have explored formulating this task as a survival prediction problem, where models can exploit a real-valued time-to-readmission target. This paper demonstrates the effectiveness of a survival-inspired readmission model, especially when paired with a longitudinal patient representation that is agnostic to disease-cohort and predictive task. We forecast readmissions for a population-level cohort of 421,088 patients discharged in 2015 and 2016 from hospitals in Alberta, Canada. Clinical features and sequences of historical medical codes (calculated from at least four full years prior to discharge) from linked administrative sources serve as model inputs. We trained binary 30-day readmission models (XGBoost and a Deep Neural Network) and time-to-event readmission models (CoxPH and N-MTLR) with and without machine-learned medical knowledge at initialization, then compared against the popular LACE-based model using the AUROC score at 30 days (AUROC@30). Survival models are additionally evaluated using concordance, Integrated Brier, and L1-loss scores. All models that utilize sequence features markedly out-perform even the best models trained on only clinical features. Further, a time-to-event target improves predictive performance at 30 days, given the same model inputs and architecture. N-MTLR, using solely sequence inputs and initialized with pre-learned medical knowledge, achieves an average AUROC@30 of 0.8460 over five folds with a standard deviation of 0.003. All trained models match or out-perform the LACE baseline of 0.6587±0.003. Sequences of administrative medical codes contain rich predictive information for forecasting readmissions, and embedding medical knowledge a priori using machine learning provides readmission models an advantageous foundation for training. When combined with a model that can leverage a time-to-event target, excellent performance is possible on the 30-day all-cause readmission task using only administrative data.

OGC SO12 - Extended Venous Thromboembolism Prophylaxis in Postoperative Oesophagogastric Cancer Patients: A Completed Audit

Abstract Background Venous thromboembolism (VTE) is a life-threatening complication for cancer patients undergoing oesophagogastric surgery. The NICE recommends extending pharmacological VTE prophylaxis to 28 days for patients undergoing major abdominal cancer surgery. While the effectiveness of in-hospital VTE prophylaxis is well-documented, the optimal duration for postoperative VTE prophylaxis remains a subject of debate. This study aims to evaluate the prescribing compliance, effectiveness, and safety of extending VTE prophylaxis to 28 days following hospital discharge (HD), a policy adopted trust-wide since 2014. Method This is an 11-year retrospective study from July 2012-2022, followed by a complete audit cycle conducted between January 2023-2024. The study included all patients who underwent cardio-esophagectomy or gastrectomy for oesophagogastric cancers. Exclusion criteria comprised patients who died during the index admission, those who underwent benign oesophagogastric surgery or local excision of gastrointestinal stromal tumours (GIST), and patients with peripherally inserted central catheter (PICC) line-associated VTE. The primary outcome measured was the prescribing compliance of 28-day VTE prophylaxis post-hospital discharge. Secondary endpoints included the incidence of VTE and bleeding complications necessitating hospital readmission within 28 days of discharge. Results Our study included 582 patients, showing that post-2014, 423 out of 490 patients (86.3%) were discharged with 28-day VTE prophylaxis, compared to 13 out of 92 patients (14.1%) pre-2014, indicating a significant improvement (p&amp;lt;0.05). Only one patient (0.17%) developed VTE more than 28 days post-discharge, and no readmissions due to bleeding complications. In the subsequent audit, 63 out of 68 patients (92.6%) received the prophylaxis, further increasing prescribing compliance. Comparing the two periods, compliance improved from 86.3% to 92.6%, though not statistically significant (p=0.145). Overall, VTE incidence was minimised from 0.17% to 0%, with no readmissions due to bleeding complications. Conclusion Routine extended VTE prophylaxis for 28 days post-hospital discharge should be recommended for cancer patients undergoing oesophagogastric surgery. This practice has significantly improved prescribing compliance rates, reduced post-hospital discharge VTE incidence, and demonstrated safety, with no hospital readmissions due to bleeding complications.

Abstract 4134340: Title: Comorbidities Associated with One Year Mortality and Hospital Readmission After Leadless Pacemaker Implantation

Introduction: Previous studies have noted racial and ethnic disparities in access to leadless pacemaker implantation (LPI), but none have evaluated the socioeconomic disadvantaged (SED). Additionally, few studies have evaluated outcomes of LPI beyond thirty days on a large scale. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after LPI, including SED via the Social Deprivation Index (SDI). Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2018 SDI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for LPI were used. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models. Results: 3,094 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 17.2%, 31.3%, 50.2% and 5.7%, 7.1%, 10.7%, respectively. The most common diagnoses for readmission were dyspnea/chest pain (9.4%), heart failure (4%), and sepsis (3.8%). Federal insurance, heart failure (CHF), pulmonary disease, diabetes without complications, and renal disease (CKD) were associated with increased risk for twelve-month readmissions. African American race, myocardial infarction, CHF, CKD, and higher SDI were associated with increased risk for twelve-month mortality. Conclusion: CHF and CKD put patients at high risk of readmission and mortality. Sepsis was among the most common causes of readmission at twelve months. Patients of higher SED are at increased risk of mortality within one year after LPI.

Abstract 4132217: Comorbidities Associated with One Year Mortality and Hospital Readmission After Ventricular Tachycardia Ablation

Introduction: Many studies have evaluated outcomes after ventricular tachycardia (VT) ablation though few studies have evaluated outcomes past thirty days. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after VT ablation, including socioeconomic disadvantage (SED) via the Area Deprivation Index (ADI). Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2020 ADI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for VT and VT ablation were used. Patients undergoing pacemaker placement or with other arrhythmias were excluded. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models. Results: 1,798 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 18.5%, 27.4%, 41.4% and 3.5%, 4.1%, 6.5%, respectively. Common diagnoses for readmission were VT (24.8%) and dyspnea/chest pain (10.7%). After adjustment, African American race, federal insurance, heart failure (CHF), vascular disease, renal disease (CKD), severe liver disease (SLD), and higher ADI were associated with increased risk for twelve-month readmissions. Federal insurance, CHF, cerebrovascular disease, dementia, peptic ulcer disease, CKD, and SLD were associated with increased risk for twelve-month mortality. Conclusion: CHF and CKD increased the risk of readmission and mortality. Recurrent VT was the most common cause of readmission. Patients of SED are at increased risk of readmissions within one year.

Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin antisepsis protocols in major cardiac surgery: a randomized clinical trial.

Whether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear. CLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary outcome was any resternotomy by day 90 or any reoperation at the peripheral surgical site by day 30. Of 3242 patients (1621 in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%) men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years; 1247 (76.9%) men], the percentage required reoperation within 90days was similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5% [121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25 [95% confidence interval (CI), -1.58-2.07], P = 0.79). The incidence of surgical site infections at the sternum or peripheral sites was similar (4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the povidone-iodine-alcohol group; risk difference, 0.74 [95% CI -0.55-2.03], P = 0.26). Length of hospital stay, intensive care unit or hospital readmission, mortality and surgical site adverse events were similar between the two groups. Among patients requiring sternotomy for major heart or aortic surgery, skin disinfection at the surgical site using chlorhexidine-alcohol was not superior to povidone-iodine-alcohol for reducing reoperation and surgical site infection rates.

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Preoperative Anemia and Iron Deficiency in Elective Gastrointestinal Cancer Surgery Patients.

Preoperative anemia can impact postoperative outcomes, but its importance in gastrointestinal cancer patients, and significance of anemia etiology remains unclear. We aimed to characterize the frequency and impact of preoperative anemia, and iron-deficiency anemia (IDA), on perioperative outcomes. We performed a retrospective cohort study of adult patients undergoing elective gastrointestinal cancer surgery. The primary outcome was the incidence of perioperative RBC transfusion. Secondary outcomes included 90-day postoperative major morbidity, ICU admission, and 90-day hospital readmission. Multivariable analyses were performed to assess the association between preoperative anemia and IDA and outcomes. Preoperative anemia was present in 55.5% of patients (n = 15 414), and 58.3% of anemic patients were iron deficient. Preoperative anemia was independently associated with increased risk of RBC transfusion (RR 2.88, 95% CI 2.60-3.20), and secondary outcomes. For every preoperative hemoglobin decrease of 1 g/dL, the adjusted risk of perioperative RBC transfusion increased by 40% (RR 1.39, 95% CI 1.37-1.42). Preoperative anemia is prevalent, and an independent risk factor for adverse postoperative outcomes. Decreases in preoperative hemoglobin levels elevate the risk of transfusion and adverse outcomes, supporting further study to optimize management of treatable causes of preoperative anemia including IDA.

The Role of Nursing in Managing Chronic Illness: A Review of Patient Outcomes and Quality of Life

The management of chronic illness is a growing priority in healthcare, with nursing playing a critical role in improving patient outcomes and quality of life. This review explores the various nursing interventions that support chronic illness management, including patient education, symptom monitoring, and emotional support. By providing personalized care and fostering self-management skills, nurses contribute to reduced hospital readmissions, improved medication adherence, and enhanced physical and mental health outcomes. Additionally, nursing care significantly influences patients' quality of life, offering emotional support that positively impacts their mental well-being and overall satisfaction. Despite the benefits, challenges such as limited resources, time constraints, and nursing burnout remain barriers to effective care. This review emphasizes the need for continued support for nursing roles in chronic illness management, policy adjustments to address resource limitations, and integration of technology to enhance care delivery. Overall, a strengthened nursing role in chronic illness management not only benefits patient outcomes but also enhances patients' quality of life, underscoring the importance of investment in nursing care to meet the demands of chronic illness in healthcare.

Digital Transformation in Healthcare : Leveraging Technology to Enhance Patient Care

This article examines the successful implementation of Pega's Healthcare Customer Service and Care Management solutions at a major healthcare provider, demonstrating how digital transformation can revolutionize patient care delivery while optimizing operational efficiency. The implementation, which focused on integrated care coordination, patient case management, and compliance frameworks, resulted in significant improvements, including a 20% reduction in hospital readmissions, a 30% reduction in administrative costs, and a 25-35% reduction in operational costs. The organization achieved enhanced patient outcomes, streamlined operations, and improved regulatory compliance through comprehensive data integration, automated workflows, and user-centric design. The article highlights how strategic digital transformation initiatives, aligned with industry best practices and supported by robust change management, can successfully address healthcare's complex challenges while positioning organizations for future innovation in care delivery.

An evaluative project of a ward-based pharmacist working within an MDT as part of a ‘Reablement &amp; Frailty’ speciality unit

Abstract Introduction Reablement care aims to prevent hospital re-admissions, costly institutional placements, and increase quality of life for frail patients, as well as preventing long-term decisions being made prematurely based on the patient’s current state of health1. Pharmacist involvement in multi-disciplinary teams (MDT) across other specialities has been demonstrated extensively worldwide as effective in reducing medication errors and providing significant improvements to patient care. However, little research has been conducted specifically within a reablement &amp; frailty setting, and the subsequent impact on the scale and quality of care provided to patients2. Aim To identify the responsibilities of a singular ward-based pharmacist working within a ‘reablement &amp; frailty’ MDT and evaluate the subsequent impact on patient care by categorising and quantifying the significance of pharmacist interventions and contributions. Methods A three-stage, quantitative service evaluation project: 1. Pharmacist development of two data collection tools to capture responsibilities: one for clinical interventions/recommendations and one for structured medication reviews; 2. Collection of daily interventions on 18-bed reablement unit over 13 days (3-day pilot + 10-day data collection period) by ward pharmacist using above data collection tools; 3. Scoring of each intervention based on two adapted, previously validated scales3: I. Severity score –potential severity of harm to the patient if contribution was missed (clinically insignificant, significant, serious, or life-threatening) II. Intervention score –likelihood of contribution preventing hospital re-admission - scale of 1-3 (1 - no likelihood, 2 - possible likelihood, and 3 - high likelihood) Ethical approval was obtained through the Robert Gordon University university ethics committee in addition to local approval via the Epsom &amp; St Helier hospital’s research &amp; development department. Results A total of 88 clinical contributions were made and collected over the 3-day pilot and 10-day data collection period, averaging just under seven contributions per day. Two ‘life-threatening’ interventions were made, both with a high likelihood of preventing a hospital re-admission. Based on potential severity of harm, most entries were scored as ‘significant’ (67%, n=59), followed by ‘serious’ (16%, n=14). Just over half of all clinical interventions (52%, n=46) scored as having either a possible OR high likelihood to prevent a hospital re-admission. The ward doctor actioned 94% (n = 73) of the pharmacist’s recommendations. Discussion / Conclusion With an average of just under 7 clinical contributions made daily, it is clear that pharmacist involvement in the ‘reablement &amp; frailty’ MDT can reduce medication error incidence through prompt identification and resolution, optimise medication regimens, and contribute to reducing patient risk of future re-admissions through effective interventions and medicines optimisation. Due to the different uses of the term ‘reablement’ globally, the findings from this study may not be applicable to all areas of reablement, such as home-based rehabilitation or bed-based respite. However, with this study forming foundation research into a novel reablement unit within secondary care, a promising argument has been made to promote pharmacist inclusion within MDTs across all specialities and the benefit that pharmacist contributions can bring to ensuring holistic care and effective patient reablement.

Postpartum Acute Care Utilization in a Health Care System in the Southeastern United States.

Introduction: Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. Methods: We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023. We excluded people with a hospital stay >6 days (n = 29). Results: In this cohort of 6,041 birthing people, 11.3% had ≥1 outpatient encounters(range 0-6) and 3.2% had ≥1 hospital readmissions (range 0-4) within 12 weeks of discharge from the birth hospitalization. Median time to first outpatient PACU was 10 days post-discharge and 6 days for first hospital readmission. Among encounters for the top five medical indications, time to first postpartum acute care encounter varied by medical indication (log-rank test of equality over strata Chi-square = 69.93, degrees of freedom = 4, p < 0.0001). Complications specified during the puerperium (n = 234) and hypertension and hypertensive-related conditions complicating the puerperium (n = 87) were the two most frequent indications. Conclusion: These findings can inform efforts to direct health resources to improve postpartum health care and health outcomes.

Effectiveness of Coronary Artery Disease Health Education among the patients of Coronary Artery Disease in Tertiary Cardiac Centre

Background and Aims: Secondary prevention of coronary artery disease is vital in preventing the future cardiac events. Inadequate knowledge of the disease is related to non-compliance with the treatment therapy which directly results in disease progression and its complication. The objective of this study is to assess the effectiveness of health education about coronary artery disease among the patients of coronary artery disease in a tertiary cardiac centre. Methods: A quantitative, prospective, interventional research design was designed to collect the data by non-probability convenience sampling method. Patients diagnosed with coronary artery disease and admitted in different wards of Shahid Gangalal National Heart Centre were included. Data was collected from July 2022 to December 2022 in three phases: prior to health education; within 24 hours of health education and after 3 months. A semi structured face to face interview was used to collect data from the patients, which was then filled in the web-based questionnaire and appropriate statistical methods were used for analysis. Results: A total of 167 patients were enrolled during the study period. Only 145 (86.8%) patients completed the 3rd phase of data collection. There was a significant improvement in patients’ overall knowledge (P value; &lt;.01) as well as knowledge regarding medical (P value; &lt;.01), coronary artery disease risk factors (P value; &lt;.01), exercise (P value; &lt;.01), nutrition (P value; &lt;.01) and psychological risk (P value; &lt;.05). There was a significant improvement (P value; &lt;.01) related to behavior related characteristics like smoking, tobacco consumption, alcohol consumption and physical activity. However, correlation between health behaviors and post intervention knowledge showed a non-significant weakly positive relation of knowledge with education (r=.081), whereas there was non-significant weakly negative relation with physical activity (r=-.0126). Conclusion: The educational intervention has significant improvement in level of knowledge and change in behavior pattern among the patients of coronary artery disease. This study demonstrates that targeted health education programs can lead to significant improvements in knowledge and behavior among coronary artery disease patients, potentially reducing hospital readmission rates and promoting better long-term disease management.

Association of physical function with hospital readmissions among older adults: A systematic review.

Hospital readmissions pose significant burdens on healthcare systems, particularly among older adults. While efforts to reduce readmissions have historically focused on medical management, emerging evidence suggests physical function may also play a role in successful care transitions. However, there is a limited understanding of the relationship between functional measures and readmission risk. This systematic review aims to assess the association between physical function impairments and hospital readmissions. This systematic review aims to assess the association between physical function impairments and hospital readmissions. A systematic review was conducted following PRISMA guidelines, with studies identified through databases including PubMed, CINAHL, Embase, and others published January 1, 2010-December 31, 2022. Inclusion criteria encompassed observational studies of adults aged 50 and older in the United States, reporting readmissions within 90 days of discharge and assessing physical function across domains of the International Classification of Function model. Data extraction and risk of bias assessment were independently conducted by two authors using theScottish Intercollegiate Guidelines Network (SIGN) tool. Seventeen studies, representing 80,008 participants, were included in this systematic review. Patient populations included a wide array of medical populations, including general medical inpatients and those undergoing cardiac surgery. Across various functional measures assessed before or during admission, impairments were consistently associated with increased risk for hospital readmissions up to 90 days after admission. Measures of participation, including life-space mobility, were also associated with increased readmission risk. Functional impairments are robust predictors of hospital readmissions in older adults. Routine assessment of physical function during hospitalization can improve risk stratification and may support successful care transitions, particularly in older adults.