Hospital Resource Utilization Research Articles

The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.

The death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS. Trauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A t test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (P < .05). 1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, P < .001], cirrhosis [OR = 8.55, P < .001], disseminated cancer [OR = 8.53, P < .001], congestive heart failure (CHF) [OR = 6.62, P < .001], chronic renal failure (CRF) [OR = 6.16, P < .001], chemotherapy for cancer [OR = 5.64, P < .001], peripheral arterial disease (PAD) [OR = 5.32, P < .001], myocardial infarction (MI) [OR = 4.96, P < .001], dementia [OR = 4.62, P < .001], and functionally dependent health [OR = 4.57, P < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD. Nontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.

Abstract 4136509: Children in Foster Care with Heart Disease Have Greater Resource Utilization and Mortality

Background: While children and youth in foster care (CYFC) have greater healthcare needs generally, data are lacking in heart disease. We characterize CYFC with heart disease, assess the impacts of being in foster care on outcomes, and examine validity of ICD-10 code Z62.21 for identification of CYFC in administrative data. Methods: In this single-center, retrospective cohort study of all cardiac surgical patients (&lt;18yo) admitted 2017-2022, CYFC were identified using institutional Electronic Medical Records via natural language processing or ICD codes, with confirmation by chart review. Demographics, medical characteristics and outcomes of CYFC were compared to children not in foster care. Generalized linear models assessed associations with primary outcomes of mortality at current follow-up (logit link) and total hospital days (log link), controlling for clinical factors and length of follow-up. We separately added Child Opportunity Index (COI) and payer to models. This cohort was then studied in the administrative pediatric health information system (PHIS) dataset to calculate ICD code sensitivity and specificity. Results: Of 4,431 cardiac surgical patients, 67 (1.5%) were in foster care. CYFC did not have significantly higher mortality (9% vs 5.8%), 30-day readmission or cardiac reoperation, number of complex chronic conditions (CCC), RACHS-2, or distance from center compared to non-CYFC. CYFC had lower COI (median 61 vs 72, p=0.016) and more Medicaid coverage (87% vs 40%, p&lt;0.001). Length of stay after index surgery was similar; however, cumulative hospital days during the study were significantly higher for CYFC (median 22 [IQR 10,45] vs 12 [6,27], p&lt;0.001). Adjusting for RACHS-2, CCC, age, readmission, reoperation, and follow-up duration, CYFC had higher odds of mortality (2.7 [95%CI 1.0,6.9] p=0.046) and more total hospital days (p=0.008). With COI or payer in the model, CYFC was not associated with mortality but remained an independent risk factor for more total hospital days. Only 16/67 (23.9%) of CYFC were coded with the Z62.21 in PHIS, yielding sensitivity of 21.9% (95%CI 13.1,33.1), and specificity of 100% (99.9,100). Conclusion: CYFC with heart disease have a relative social disadvantage, greater hospital resource utilization, and long-term mortality despite similar illness severity. Improved capture of foster care status in administrative data is needed to guide future studies and reduce health disparities for the vulnerable population of CYFC.

October 7th 2023 mass casualty incident in southern Israel: lessons for emergency preparedness and management.

Mass Casualty Incidents (MCIs) pose significant challenges for healthcare systems. While policies are typically crafted based on past experiences, the lessons learned from each incident play a crucial role in enhancing emergency preparedness. On October 7th, 2023, Israel came under the largest terror attack in its history. During an ongoing terror attack, more than 1300 Israelis were killed, and more than 200 were abducted to Gaza. During the first day of the attack, 1457 casualties were evacuated to a hospital, approximately half of them to Soroka University Medical Center (SUMC). This MCI surpassed conventional MCI challenges, necessitating a need to face the unexpected under fire. Through a description of this extreme MCI, we delve into the challenges faced, the strategic interventions deployed to address them, and the invaluable lessons learned. Injury characteristics, severity and outcomes of casualties are presented based on the medical records of all casualties arriving to SUMC between October 7th 6:30 a.m. andOctober 8th 7:00 a.m. Data regarding patient influx, capacity and hospital resource utilization, were collected from the Patient Registration System and other hospital information systems. During the incident, a total of 673 injured arrived at SUMC within a mere 24-h period, at a peak rate of 83 injured per hour. The mean casualty age was 29.6, with male predominance. Gunshot wounds and shrapnel injuries were the dominant types of injuries. Out of the casualties arrived, about half were hospitalized or transferred to receive definitive care at other hospitals after initial care at SUMC. Mortality rate was low, at 2.9% of those admitted alive. In this article, we describe the injury characteristics and outcomes of casualties seen at SUMC on October 7th 2023, during one of the largest MCIs in history. We present a detailed overview of the challenges encountered, strategies implemented to address them and lessons learned. These insights hold global relevance, offering actionable guidance for the refinement of future emergency protocols and policies on a global scale.

Preoperative anemia is associated with increased length of stay in adult spinal deformity surgery: evaluation of a large single-center patient cohort and future suggestions for patient optimization.

This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preoperative optimization protocols. The authors reviewed consecutive patients who underwent elective thoracolumbosacral posterior spinal fusion (PSF) involving six or more vertebrae for ASD from January 1, 2013, to December 13, 2021, with a minimum follow-up period of two years. This study primarily investigated the association of preoperative hemoglobin levels with hospital and ICU LOS. To analyze the data, both unadjusted and adjusted generalized linear models (GLM), incorporating cubic splines for non-linear variables, were applied. A total of 598 patients were included. GLMs for hospital and ICU LOS demonstrated nonlinear relationships with preoperative hemoglobin levels. Specifically, hospital LOS decreased with increasing preoperative hemoglobin until a significance threshold of 13.5g/dl. Similarly, ICU LOS significantly decreased with increasing preoperative hemoglobin until 13.0g/dl. Lower preoperative hemoglobin was associated with more perioperative transfusions, less likely discharge to home, and greater risk of reoperation. Preoperative anemia is an independent non-linear risk factor that significantly affects LOS, disposition, and outcomes after surgery for ASD. These findings advocate for a systemic preoperative approach and highlight the need for future research to improve postoperative outcomes and reduce hospital resource utilization. IV.

Analysis of Environmental Footprints of Health Centers in Kangra District, Himachal Pradesh, India

The experiment was conducted during December, 2020 to June, 2021 at Kangra district of Himachal Pradesh, India to evaluate the ecological footprint of 15 hospitals that were chosen at random. The purpose of this study was to assess the ecological impact of these medical facilities-which included both government and private hospitals—across five blocks of district. The ecological footprint framework was utilized to analyze factors such as food waste, solid waste, water consumption and energy consumption and material use, determining their impact on biocapacity. The average ecological footprints of the hospitals ranged from 116.5 to 271.4 global hectares (g ha). The ecological footprints varied across different blocks as follows Jawalamukhi (349.7 g ha), Dharamshala (535.6 g ha), Nurpur (698.3 g ha), Palampur (722.3 g ha), and Kangra (814.0 g ha). Notably, the hospitals in the Jawalamukhi block were the most sustainable, exhibiting the lowest ecological footprint. These results underscore the significant environmental impact of hospitals and the urgent need for initiatives to reduce their ecological footprint, particularly in the Kangra block. The results emphasize the importance of sustainable resource utilization in healthcare institutions to minimize their ecological footprint and promote environmental sustainability. To achieve a balance between providing healthcare services and protecting the environment, the research recommends extensive actions to enhance the effectiveness of resource utilization, waste management, and energy consumption in hospitals.

Short-term Outpatient Parenteral Antimicrobial Therapy Administration in the Pediatric Emergency Department: Feasibility, Safety, and Outcome.

The practice of administration of intravenous (IV) antimicrobial therapy in outpatient settings (OPAT) is a low-cost alternative to in-patient admission and treatment. There is, however, limited evidence supporting OPAT management protocols for children. The primary objective of this study was to describe the use of pediatric emergency-based OPAT, as well as the safety of this practice. The study was a prospective, observational study conducted in pediatric emergency department of a tertiary care hospital. Children younger than 14 years who required pediatric emergency department-based OPAT were included in the study. Three hundred and ninety-two children were included in the study. The mean duration of OPAT was 3.5 days. Ceftriaxone was the most frequently used antimicrobial. Chest infection was the commonest indication, followed by sickle cell disease with fever and soft tissue infections. There were no major intravenous line-related complications over course of treatment. Most of the patients (89.5%) completed the OPAT course successfully. Only 10.4% patients required subsequent hospital admission, with failure to improve on the OPAT protocol being the main reason patients for admission. None of the admitted patients required intensive care settings or faced unexpected morbidity. Our results affirm that pediatric emergency-based OPAT is a safe yet effective practice in children with good clinical outcome. We believe that a reduction in admissions translates to better hospital resource utilization.

Outcomes and Healthcare Resource Utilization in Patients with COVID-19 Treated with Nirmatrelvir-Ritonavir: Real-World Data Analysis.

Background: Nirmatrelvir-ritonavir was granted emergency use authorization in Israel in January 2022 to treat high-risk patients with mild-to-moderate COVID-19. The aim of the study was to assess the association between nirmatrelvir-ritonavir treatment and COVID-19-related hospitalization and healthcare resource utilization (HCRU) in a country with a high level of vaccinations compared to patients who were offered treatment and declined. Methods: The Maccabi Healthcare Services dataset was used to identify high-risk SARS-CoV-2-positive adults from January to February 2022 who received nirmatrelvir-ritonavir within 5 days of symptom onset (treatment group) or who were offered nirmatrelvir-ritonavir treatment and declined it (reference group). COVID-19-related hospitalizations and all-cause mortality and HCRU within 30 days were compared between treatment and reference groups using inverse probability of treatment weighting. Results: Treatment and reference groups included 3460 (median age, 68.4 years) and 1654 (70.2 years) patients, respectively. Patients with ≥1 dose of COVID-19 vaccine accounted for 89.5% (treatment group) and 72.1% (reference group) of the total. Treatment was associated with a lower risk of COVID-19-related hospitalization (adjusted OR, 0.59 [95% CI, 0.41,0.83]). Results were similar by age group (18-64/≥65 years) and among patients with/without vaccination in the prior 180 days. There were 11 (0.3%) versus 11 (0.7%) deaths in the treatment and reference groups, respectively. Treated patients had lower inpatient HCRU and greater less intensive outpatient HCRU (e.g., telemedicine and emergency room visits). Conclusions: Nirmatrelvir-ritonavir treatment was associated with a reduced risk of COVID-19-related hospitalization and a shift to less intensive outpatient HCRU. Comparison with a reference group of nirmatrelvir-ritonavir-eligible patients who declined treatment enabled an unbiased outcome assessment. Real-world data gathered during the Omicron BA.1 variant wave of COVID-19 in Israel support the continued use of nirmatrelvir-ritonavir for high-risk adults of all ages, regardless of previous vaccinations.

Reverse Shoulder Arthroplasty for Proximal Humerus Fractures and Reverse Shoulder Arthroplasty for Elective Indications Should Have Separate Current Procedural Terminology (CPT) Codes

BackgroundReverse shoulder arthroplasty (RSA) for fracture currently shares a single current procedural terminology (CPT) code with RSA for arthropathy despite potential differences in patient factors, procedural demands, postoperative care and needs, and overall hospital systems’ resource utilization. We hypothesize that patients indicated for RSA for fracture will have greater medical complexity, require longer operative duration, have higher complication rates, demonstrate inferior functional outcomes, and require greater healthcare cost expenditures compared to a cohort undergoing RSA for rotator cuff arthropathy. Methods383 RSAs were retrospectively reviewed from January 2011 to December 2020. Demographics, comorbidities, operative time, financial charge and cost data, length of stay (LOS), discharge disposition, and all-cause revisions were assessed. Visual analog scale (VAS) pain score and active range of motion (AROM) were evaluated at 2, 6, and 12 months postoperatively. Results197 total RSA were included with 28 for fracture and 169 for arthropathy indications after exclusions. RSA operative time was longer for fractures with an average of 143.2±33.7 minutes compared to 108.2±33.9 minutes for arthropathy (p=0.001). Average cost per patient for RSA for proximal humerus fracture was $2,489 greater than cost for RSA for elective indications; however, no statistically significant difference was noted between average costs (p=0.126). LOS was longer for RSA for fracture compared to arthropathy with a mean of 4.0 ± 3.6 days versus 1.8 ± 2.3 days (p=0.004). The fracture group was 3.6 times more likely to be discharged to a skilled nursing facility or inpatient rehab (32% versus 9%, p=0.002). Early and late all-cause revisions were similar between groups. Differences in postoperative AROM for fracture versus arthropathy were significant for active forward flexion (aFF) at 2 months (95.5±36.7°, 117.0±32.3°) and 6 months (110.9±35.2°, 129.2±28.3°) (p=0.020) as well as active adducted external rotation (aER) at 6 months (20.0±20.9°, 33.1±12.3°) (p=0.007) and at 12 months (23.3±18.1°, 34.5±13.8°) (p=0.012). No difference in VAS pain scores were noted between fracture and arthropathy groups at any time point. DiscussionRSA for fractures versus arthropathy have substantial differences in patient characteristics, surgical complexity, and hospital resource utilization. This is of importance given the currently available CPT code does not differentiate indications for RSA, especially if intending to accurately document surgical care delivered.

TCT-708 Interim Real-World Multicenter Hospital Resource Utilization Results of a Novel Non-Aspiration-Based Mechanical Thrombectomy for the Treatment of Native Infrainguinal Acute to Chronic Arterial Thrombi and Emboli: The PROWL Registry

TCT-708 Interim Real-World Multicenter Hospital Resource Utilization Results of a Novel Non-Aspiration-Based Mechanical Thrombectomy for the Treatment of Native Infrainguinal Acute to Chronic Arterial Thrombi and Emboli: The PROWL Registry

Comorbidity profiles and pulmonary embolism risk assessment: Leveraging the Charlson Comorbidity Index for improved prognostication in a national data set.

Current risk assessment of pulmonary embolism (PE) stratifies patients based on hemodynamic stability, clinical parameters of severity, right ventricular dysfunction and cardiac injury but fails to integrate a wide variety of comorbid conditions. The Charlson Comorbidity Index (CCI) predicts mortality based on patients' diseases and provides a system to quantify disease burden. The National Inpatient Sample (NIS) database (2016-2018) was used to identify patients with PE and calculate CCI score groups of 0, 1-2, 3-5, and ≥6 and stratify them by outcome. Of 561,625 patients with PE, 176,460 (31.4%) had CCI score of 0, 223,870 (39.8%) had CCI of 1-2, 102,305 (18.2%) had CCI of 3-5, and 58,990 (10.5%) had CCI ≥ 6. Higher CCI scores were associated with increased mortality: CCI 1-2 (adjusted odds ratio [aOR] 2.09), CCI 3-5 (aOR 3.12), CCI ≥ 6 (aOR 5.44) compared to CCI 0, along with stepwise increases in shock and mechanical ventilation with each increase in CCI score group. CCI scores ≥3 had increased length of stay (1.4-1.72 days) and increased total hospital costs ($3651-$4265) compared to CCI0. Patients with CCI ≥ 3 were less likely to receive systemic thrombolysis, catheter directed thrombolysis and mechanical thrombectomy. Acute PE in patients with elevated comorbidity scores is associated with higher morbidity and mortality, increased hospital resource utilization, and decreased usage of advanced therapies in a large cohort reflective of patients across the United States. Integration of comorbidities in risk assessment profiles identifies patients with higher short-term mortality which may guide management strategy.

Prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention: a retrospective observational cohort study using routinely-collected health data.

To identify the prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention among six public hospitals in one Australian State. A retrospective observational research design was used. A total of 4387 cases were obtained from the State Cardiac Outcomes Registry and National Hospital Cost Data Collection. The two datasets were linked using identifiable data items. Patients were those who had elective percutaneous coronary intervention between December 2012 and December 2019 either discharged the same day of the procedure or the next day. Data were analysed using descriptive and inferential statistics. The overall same-day discharge prevalence was 6.5%, with a trend increasing from 0.2% in 2013 to 9.0% in 2019. The prevalence varied at the individual hospital level. Two hospitals did not perform same-day discharge during the study period. The remaining hospitals demonstrated variability in same-day discharge prevalence, with the highest from one hospital being 28.2% in 2019. Almost all same-day discharge patients experienced no complications during or following percutaneous coronary intervention within 24 hours. Compared to next-day discharge, same-day discharge reduced the length of stay by 18 hours and conferred an average of $3695 cost-savings per patient. There was limited implementation of same-day discharge in the six public hospitals contributing data to this study. Improvement in the same-day discharge rate could result in better hospital resource utilisation and reduce low-value care. Hence, strategies to implement and promote same-day discharge are warranted.

Epidemiology and Regional Variation in Additional Surgical Interventions for Children with Congenital Diaphragmatic Hernia: A Multi-institutional Analysis.

To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. Neonates who underwent CDH repair between 2012-2022 in the United States Pediatric Health Information System database were identified. Multivariable regression identified predictive factors for additional surgical morbidity after CDH repair, defined by an additional surgical intervention during index hospitalization or within one year after discharge. To narrow the spectrum of severity of disease, only patients with an intensive care unit admission on index hospitalization were included. Secondary analysis compared frequency of operations and hospital resource utilization by region. 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. Most performed surgeries were gastrostomy tube (28%), fundoplication (13%), and tracheostomy (5%). Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. Patients who required additional surgical procedures had longer initial inpatient length of stays (71 versus 31d) and higher associated costs ($357,000 versus $161,000). Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis.

Objectives: The objective of this paper was to assess hospitalizations and health resource utilization associated with diabetic foot infection (DFI)-related visits within emergency departments (EDs) in the U.S. Methods: This nationally representative, cross-sectional historical cohort utilized the Centers for Disease Control and Prevention's (CDC's) National Hospital Ambulatory Medical Care Survey across a ten-year period from 2012 to 2021. Inclusion criteria were as follows: adults ≥18 years of age; a diagnosis of Type 1 or Type 2 diabetes mellitus; presence of a DFI. Comparisons were drawn relative to a cohort of patients with diabetes without foot complications. Study outcomes included 72-hour (72 h) ED revisit, hospitalization, and length of stay (LOS). Top diagnoses and medications were also reported. Multivariable, generalized, linear regression analyses were employed, controlling for key demographics, health system factors, clinical characteristics, and year. Results: An estimated 150.6 million ED visits included a diabetes diagnosis, with 2.4 million involving a DFI (1.6%). Approximately half of DFI cases were hospitalized (43.7%). Anti-infective medications were prescribed in 83.1% of DFI cases, including vancomycin in 28.1%. Multivariable analyses observed that DFIs were associated with a 3.002 times higher odds of hospital admissions (CI: 2.145-4.203, p < 0.001) and a 55.0% longer LOS (IR = 1.550, CI: 1.241-1.936, p < 0.001). DFIs were not significantly associated with a 72 h ED revisit. Conclusions: This nationally representative study of 2.4 million DFI-related ED visits in the U.S. observed higher odds of hospital admissions and a longer LOS for DFIs versus diabetes without foot complications. Continued research should seek to assess prevention and coordinated treatment interventions prior to the emergence of DFIs requiring ED care.

A Three-Day Prehabilitation Program is Cost-Effective for Preventing Pulmonary Complications after Heart Valve Surgery: A Health Economic Analysis of a Randomized Trial.

While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients. A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022. There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs. While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery. This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

BackgroundAs with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.MethodsThis is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED.ResultsThere were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care.ConclusionOur findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

Hospital charge and resource use analysis of extended-spectrum penicillin antibiotic therapy after pancreatoduodenectomy in intermediate- and high-risk patients

BackgroundWe previously reported that an extended antibiotic mitigation pathway following pancreatoduodenectomy in patients with intermediate-/high-risk glands is associated with 83 % lower odds of clinically relevant postoperative pancreatic fistula (CR-POPF). We now describe associations between the pathway, resource utilization, and hospital charges. MethodsWe performed a retrospective cohort study of patients who underwent elective pancreatoduodenectomy with soft gland texture and fistula risk score (FRS) ≥3 who received standard or extended antibiotics. Hospital charges and resource utilization within 90 days of surgery were compared by CR-POPF status and antibiotic pathway. ResultsA total of 34 patients received extended antibiotics and 53 received standard antibiotics. In patients with CR-POPF, patients who received extended antibiotics had lower likelihood of surgical or percutaneous reintervention (75.0 % vs. 100.0 %, p = 0.022). Ninety-day postoperative charges associated with CR-POPF were higher than no CR-POPF ($60,527 vs. $25,631, p = 0.028). Our risk-based model predicted a $15,825 decrease in hospital charges per patient receiving extended antibiotics. ConclusionsCR-POPF is associated with higher 90-day hospital charges. Extended antibiotic therapy following pancreatoduodenectomy in patients with soft gland texture and FRS ≥3 is associated with fewer reinterventions in patients who develop CR-POPF. These outcomes will be formally tested in a randomized controlled trial (NCT05753735).

Modeling hospital resources based on global epidemiology after earthquake-related disasters

Injured people require hospital emergency services and timely medical treatment after extreme earthquakes. Earthquake-related patients often have trauma injuries and stress-linked (ischemic) ailments that require multiple healthcare procedures, such as minor orthopedic treatment, surgical treatment of fractures, and thrombolysis or thrombectomy. Hospital operation models have been proposed to examine these healthcare procedures; however, they exhibit two fundamental gaps that hinder their ability to assess critical service areas after earthquakes. First, these models rest heavily on emergency procedures based on injury severity rather than type. Second, healthcare demands are often modeled from injury profiles after moderate earthquakes in the United States without including epidemiology data after large earthquakes globally. This approach has led to oversimplified hospital emergency services and resource utilization representation. This research presents a new hospital operations model based on patient injury type and worldwide earthquake epidemiology to fill these gaps. We build the model using discrete-event simulations to capture dynamic metrics on hospital operational outcomes after the earthquake, such as patient time-to-treatment and unassisted patient ratio. We then studied how these metrics vary with different levels of functional capacity in the specific hospital resources. Our results showed that waiting times for emergency department (ED)-level patients vary non-linearly with changes in the number of functional service areas. Also, significant reduction in the waiting time for hospital-level procedures was found for relatively small decrease in the bed occupancy rate, for example, if reverse triage procedures are activated (i.e. a discharge of non-critical patients admitted before the earthquake). Our findings provide a valuable tool for decision-making in hospital preparedness as they explicitly measure the impacts of functional capacity on key healthcare metrics for specific earthquake-related patients.

Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery.

To determine the frequency of children with chronic respiratory failure (CRF) and home ventilator dependence undergoing surgery at a tertiary children's hospital, and to describe periprocedural characteristics and outcomes. We conducted a retrospective cohort study of patients with CRF and home ventilator dependence who underwent noncardiac surgery from January 1, 2013, to December 31, 2019. Descriptive statistics were used to report patient and procedural characteristics. Univariable and multivariable analyses were used to assess for factors associated with 30-day readmission. We identified 416 patients who underwent 1623 procedures. Fifty-one percent of patients used transtracheal mechanical ventilation (trach/vent) support at the time of surgery; this cohort was younger (median age 5.5 vs 10.8 years) and more complex according to American Society of Anesthesiologists status compared with bilevel positive airway pressure-dependent patients. Postoperatively, compared with bilevel positive airway pressure-dependent patients, trach/vent patients were more likely to be admitted to the ICU with longer ICU length of stay (median 5 vs 2 days). Overall 30-day readmission rate was 12% (n = 193). Presence of chronic lung disease (adjusted odds ratio 1.65, 95% confidence interval 1.01-1.69) and trach/vent dependence (adjusted odds ratio 1.65, 95% confidence interval 1.02-2.67) were independently associated with increased odds for readmission. Children with CRF use anesthetic and surgical services frequently and repeatedly. Those with trach/vent dependence have higher hospital and ICU resource utilization. Although overall mortality for these patients is quite low, underlying diagnoses, nuances of technology dependence, and other factors for frequent readmission require further study to optimize resource utilization and outcomes.

COVID-19 and Acute Myocardial Infarction: Exploring Clinical Factors and Treatment Expenditures

Background: The concurrence of acute myocardial infarction (AMI) with COVID-19 can complicate the clinical conditions of patients and affect the patterns of hospital resource utilization. This study aimed to investigate and analyze the direct treatment costs of AMI patients with concurrent COVID-19. Methods: This cross-sectional study collected and analyzed clinical data, including symptoms, readmission, and interventions, and treatment cost data for all patients at Tehran Heart Center using SPSS26 software. The mean medical costs of patients from January through May 2022 were also calculated. Results: The COVID-19 group was composed of 72.9% male and 27.1% female patients, whereas the non-COVID-19 group consisted of 67.3% male and 32.7% female patients. Most of the patients in the COVID-19 group (60%) were in the elderly age group (&gt;65 y). The length of stay was 8.70±5.84 days for the COVID-19 group and 6.31±4.42 days for the non-COVID-19 group. The mortality rate in the COVID-19 group was 24%, higher than the 5% rate in the other group. Additionally, the average total treatment costs were $6384.54±$6760.13 in the COVID-19 group and $6362.49±$4343.07 in the non-COVID-19 group (P&gt;0.78 and P&gt;0.050). Conclusion: The study found that the COVID-19 group had a significantly higher in-hospital mortality rate than the non-COVID-19 group. During the follow-up period, the incidence of complications (chest pain and heart failure) was higher in the non-COVID-19 group. It also showed that longer hospital stays resulted in higher treatment costs.

Economic burden of respiratory syncytial virus in adults in Germany – a health claims analysis between 2015 and 2018

Aims Respiratory syncytial virus (RSV) causes severe lower respiratory tract infections (LRTI) in infants and adults. While the clinical burden was recently estimated in adults in Germany, little is known about the economic burden. To fill this gap, this study aimed to assess hospital and outpatient healthcare resource utilization (HRU) and costs of RSV infections in adults in Germany. Methods In this retrospective, observational study on nationwide, representative, anonymized claims data (2015–2018), we identified patients ≥18 years with ICD-10-GM-codes specific to RSV (“RSV-specific”). To increase sensitivity, patients with unspecified LRTIs (including unspecified bronchitis, bronchiolitis, bronchopneumonia, and pneumonia) during RSV seasons were also included as cases potentially caused by RSV (“RSV-possible”). RSV-related HRU (hospital days, ICU and ventilation treatment, drug dispensation) and direct costs were estimated per episode. Excess costs per episode and for follow-up periods were compared to a matched control cohort. All outcomes were reported per healthcare sector and stratified by age and risk groups as well as disease severity (ICU admission/ventilation). Results Direct inpatient and outpatient mean episode costs were 3,473€ and 82€, respectively, with substantially higher costs for severe cases requiring intensive care and/or ventilation (10,801€). Direct costs for RSV-specific cases were higher than for RSV-possible cases (inpatients: 6,247€ vs. 3,450€; outpatients: 127€ vs. 82€). Moreover, costs were significantly higher for RSV patients than for controls and increased over time (inpatients: 5,140€ per episode vs 10,093€ per year; outpatients: 46€ per quarter vs 114€ per year). Limitations While the number of RSV-specific cases was low, inclusion of seasonal LRTI cases likely increased the sensitivity to detect RSV cases and allowed a better estimation of the total costs of RSV. Conclusions The economic burden of RSV-LRTI in adults in Germany is substantial, persists long-term, and is particularly high in the elderly. This highlights the need for cost-effective prevention measures.