Hospital System Research Articles

“It’s Traumatic for All of Us”: A Qualitative Analysis of Providers Caring for Seriously Ill Veterans With Surgical Conditions

Objective: We aimed to characterize sources of moral distress among providers in the context of surgery. Background: Moral distress is defined as psychological unease generated when professionals identify an ethically correct action to take but are constrained in their ability to take that action. While moral distress has been reported among healthcare providers, the perspectives of providers working in surgery specifically are not often explored and reported. Our study was developed from an overarching effort to investigate end-of-life care for seriously ill patients with surgical conditions. Methods: Using convenience sampling, we conducted 48 semistructured interviews with providers who provide high-intensity care (eg, surgeons, anesthesiologists, intensivists, and midlevel providers) for seriously ill patients with surgical conditions across 14 Veterans Affairs hospitals. Interviews were analyzed iteratively using thematic content analysis. Results: Providers described clinical encounters that generated moral distress while caring for seriously ill patients with surgical conditions: (1) difficulties in conflict resolution with and among patients and families; (2) specific types of patients or situations; (3) systemic factors hindering appropriate end-of-life care; (4) surgical culture and expectations of the surgeon’s role. Conclusions: Providers caring for seriously ill patients with surgical conditions report emotions and reactions consistent with moral distress. Our study highlights important triggers for providers and hospital systems to identify and address throughout a surgical provider’s training and career.

Patients Monitoring and Data Management System for Hospitals

This work concerns creating a monitoring system for a smart hospital using Raspberry Pi to measure vital signs. The readings are continually sent to central monitoring units outside the room instead of being beside the patients, to ensure less contacting between the medical staff and patients, also the cloud is used for those who leave the hospital, as the design can track on their medical cases. Data presentation and analysis were accomplished by the LabVIEW program. A Graphical User Interface (GUI) has been created by the Virtual-Instrument (VI) of this program that offer real-time access to monitor patients' measurements. If unhealthy states are detected, the design triggers alerts and sends SMS message to the doctor. furthermore, the clinicians can scan a QR code (which is assigned to each patient individually) to access its real-time measurements. The system also utilizes Electrocardiography (ECG) to detect abnormalities and identify specific heart diseases based on its extracted parameters to encourage patients to seek timely medical attention, while aiding doctors in making well-informed decisions. To evaluate the system's performance, it is tested in the hospital on many patients of different ages and diseases as well. According to the results, the accuracy measurement of SpO2 was about 98.39%, 97.7% for (heart rate) and 98.7% for body temperature. This shows that the system can offer many patients receiving health services from various facilities, and it ensures efficient data management, access control, real-time monitoring, and secure patient information aligning with healthcare standards.

Strengthening Hurricane Preparedness in Hospital Systems.

This Viewpoint highlights 10 categories of recommendations for preparing for current and future hurricane seasons.

Clinical utility of administering the WISC-V as standard practice in paediatric attention-deficit/hyperactivity disorder (ADHD) assessments in a public hospital and health system: a rapid review to inform clinical practice

ABSTRACT Objective The purpose of this rapid review is to appraise the current evidence-base to inform the development of a new assessment and diagnostic pathway for ADHD presentations in a public health paediatric department in Brisbane. We posited that the standardised WISC-V administration in all ADHD presentations regardless of cognitive indication was low-value, inefficient and burdensome for clinicians, children and their families. We wanted to find out if the literature supports this position. Method This review used PRISMA systematic methods to search two relevant databases (PUBMED, and Elsevier (ClinicalKey)). Search terms were used: (attention deficit hyperactivity disorder OR ADHD) AND (children) AND (assessment OR diagnosis) AND (Australia) AND (cognitive proficiency) OR (WISC). Results Search returned 286 full text journal articles, published between 2018 and 2023. Two hundred and sixty-two were removed to irrelevance, adult population, duplications, or focus on other paediatric mental health disorders. Following the application of exclusion criteria, 10 were reviewed at full text and four were ultimately included for contribution to this rapid review. Conclusions Neuropsychological testing if no cognitive query is indicated may confound the findings. This review provided the opportunity to improve clinical efficiency without compromising diagnostic accuracy.

Governance of healthcare quality: exploring the relationships between hospital board performance and healthcare quality outcomes.

This paper aims to contribute to the existing literature in the field of hospital governance by exploring the relationship between the attributes and performance of hospital boards and hospital performance in terms of quality of healthcare. A survey of board performance in public hospitals in Morocco was carried out, in which we surveyed all board members of the 13 hospitals in the Casablanca-Settat region. A total of 82 members responded (82% response rate) to the previously adapted and validated self-evaluation questionnaire on board self-assessment questionnaire (BSAQ) board member performance. On average, the hospital boards studied had eight members. In terms of clinical expertise, half the members were physicians and 17% were nurses. In addition, positive correlations were found between certain board characteristics, notably age, seniority, members' perceptions of their impact on the quality of healthcare and several dimensions of board performance. In parallel, the results showed strong and significant associations between turnover rate and BSAQ score. Negative correlations were also found between average length of stay and BSAQ score. With regard to mortality parameters, it should be noted that we were unable to establish a strong empirical correlation between hospital boards' self-assessed performance and other hospital mortality indicators. The present study offers a rigorous rationale for the use of the French-translated BSAQ in the hospital context, and we hope that others will use this tool in future work within the framework of evidence-based research. In addition, the BSAQ tool's focus on board competencies (and not just structure, composition or processes) provides valuable insights into what boards need to learn in order to function effectively. However, despite the insistence of the authors of this study on the need for a comprehensive census of public hospital board members in the region, several obstacles were encountered. Firstly, there were difficulties related to vacancies within the hospitals, which had the effect of restricting the representativeness of the sample. Secondly, access to hospital board members proved complex due to their busy schedules and the confidential nature of their meetings. Finally, it is important to note that national performance indicators in Morocco may not be as reliable as in other countries, which could complicate the identification of high-performing hospital systems and, consequently, make inference difficult. This study provides large-scale empirical evidence of processes related to the governance of quality of healthcare and elucidates the existence of an association between hospital board performance and clinical performance. The use of validated tools such as the BSAQ should therefore help improve the performance of boards and governance in public hospitals.

Multisource representation learning for pediatric knowledge extraction from electronic health records.

Electronic Health Record (EHR) systems are particularly valuable in pediatrics due to high barriers in clinical studies, but pediatric EHR data often suffer from low content density. Existing EHR code embeddings tailored for the general patient population fail to address the unique needs of pediatric patients. To bridge this gap, we introduce a transfer learning approach, MUltisource Graph Synthesis (MUGS), aimed at accurate knowledge extraction and relation detection in pediatric contexts. MUGS integrates graphical data from both pediatric and general EHR systems, along with hierarchical medical ontologies, to create embeddings that adaptively capture both the homogeneity and heterogeneity between hospital systems. These embeddings enable refined EHR feature engineering and nuanced patient profiling, proving particularly effective in identifying pediatric patients similar to specific profiles, with a focus on pulmonary hypertension (PH). MUGS embeddings, resistant to negative transfer, outperform other benchmark methods in multiple applications, advancing evidence-based pediatric research.

HPB SO26 - Evaluation of Theatre Database Accuracy in a Tertiary HPB Center According to NCIP Standards in the UK

Abstract Background The goal of creating the NCIP (National Clinical Improvement Programme) theatre data set discovery information system is to allow NHS Improvement to evaluate how theatre data can improve the attribution of surgical activities, as documented in Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, to individual consultants. The success of NCIP is at risk due to the inaccurate attribution of existing activity data to consultants. Method The NCIP theatre database for the Hepato-Pancreato-Biliary (HPB) surgery department was compiled over a 12-month period (from April 2022 to April 2023) and analyzed based on the operating consultant recorded in the operative notes, clinical letters, and the Carfelow system (admitting office records). Results In Nottingham University Hospitals (NUH), 143 major liver and pancreatic resections were performed, including 38 Whipple’s procedures (both classic and Pylorus-preserving Pancreatico-Duodenectomy), 19 Distal Pancreatectomies, and 86 Liver resections. Of these, only 58 patients (40.6%) had correct entries in the NCIP database regarding the operating surgeon. The NCIP data inaccuracies for the operating consultant were 65.8% (25/38) for Whipple’s procedures, 57.9% (11/19) for Distal Pancreatectomies, and 56.97% (49/86) for Liver resections. Conversely, the NCIP data was 100% accurate concerning the assigned consultant on Careflow, which matches the clinical letters from the outpatient clinic. Conclusion The gap between the NCIP database and the admitting office database leads to inaccurate attributions of surgical activity. This hinders learning and improvement efforts essential for achieving program benefits and prevents providers from complying with license conditions and delivering efficient healthcare services. To ensure accurate HES data, admitting officers should request proper communication and accurate consultant codes from consultant secretaries to ensure accurate data across the different hospital systems

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice

ABSTRACT Background The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. Objective To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. Method A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment e-mails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. Results The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. Conclusion This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.

Community Palliative Care: What are the Best Models?

Palliative care seeks to address the physical, psychosocial and spiritual concerns of patients with a life limiting illness and their caregivers. Early referral to palliative care improves symptoms and is the standard of care. This paper evaluates the evidence for different models of community palliative care and looks at the effects of homecare, hospice programs and residential aged care facility (RACF) interventions on symptom management, home death rate and acute health service utilization. It also examines the impact of COVID-19, telehealth, integration and staffing models on the efficacy of community palliative care. Evidence suggests that community palliative care increases the rate of death at home and may improve satisfaction with care, but effect on symptoms and acute health care utilization are less certain. Enrolment in a hospice program may decrease hospitalizations and improve satisfaction. RACF staff training interventions to improve the quality of palliative care provided to residents show mixed results across all indicators. COVID-19 saw a relative increase in the demand for community palliative care, as people opted out of the hospital system. Models of community palliative care that facilitate integration, support primary health providers, and promote technological innovation are worthy of further research.

Value in acute care surgery, part 4: The economic value of an acute care surgery service to a hospital system

ABSTRACT The Healthcare Economics Committee of the American Association for the Surgery of Trauma has published a series of three articles on the topic of value in acute care surgery (ACS). In this series, the key elements of value, cost and outcomes, and the impact of stakeholder perspective on what constitutes high-value care are discussed. The fourth article in this series continues the discussion by focusing on the unique economic value that an ACS service brings to a hospital system and its patients. Characterized by the immediate 24-hour availability of surgeons trained in trauma management, emergency general surgery, and surgical critical care, acute care surgeons extend the benefits of surgical rescue and critical care to all hospitalized patients. As such, an ACS service acts as a vital part of a hospital's infrastructure to successfully care for complex and seriously ill patients, in addition to enabling the establishment of other, high revenue-generating services such as vascular, transplant, and complex oncologic surgery programs. The trauma service acts as intake for patients that lead to downstream revenue creation by other disciplines such as orthopedic and neurological surgery, while trauma center designation itself results in dedicated state funding to ensure trauma readiness in many states in the United States. The traditional “value equation” in health care of outcomes achieved per dollar spent is ill-suited to capture many of these unique aspects and benefits of ACS. This article provides the background to understand the economic value of an ACS service and future directions toward improving overall value of care. LEVEL OF EVIDENCE Economic & Value-based Evaluations: Level IV.

Abstract Su603: Out-of-hospital cardiac arrest presenting with ST-segment elevation myocardial infarction: Real world assessment and treatment

Background: Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described. Objectives: This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice. Methods: We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis. Results: A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy. Conclusion: This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.

Effective Communication of System-Level Events for Hospital System Health and Nurse Well-Being: A Qualitative Study

Many injuries and deaths occur yearly in the United States due to preventable errors; however, documented harm is lower in hospitals with Magnet® designation from the American Nurses Credentialing Center (Silver Spring, MD, USA). This manuscript illustrates insights from Magnet® and non-Magnet® nurses and nursing leaders regarding what impacts hospital system health, how those factors are communicated, and how hospital system health impacts patient safety. A qualitative descriptive approach was used with semi-structured interview questions. Within-methods data triangulation was applied to transcribed interviews using thematic analysis, application of the Goodwin statistic, and natural language processing (NLP). Thematic analysis revealed the four main themes of Healthy Systems, Unhealthy Systems, Patient Safety, and Nurse Well-Being. NLP revealed non-Magnet® leaders and nurses scored highest for anxiety, anger, and sadness, in contrast to Magnet® participants who had the highest levels of positive emotion. Key findings from the Magnet® participants revealed that poaching employees and placing people in the wrong positions harm hospital system health and patient safety. The use of within-methods data triangulation illuminated the contextual depth of the participants’ speech, revealing the alarming emotional state that non-Magnet® nurses and leaders are facing. Healthcare staff’s wellness must be prioritized to cultivate environments that provide safe care.

Abstract Su303: Afferent Rapid Response Limb Failure Prior to Non-ICU In-Hospital Cardiac Arrest and Associated In-Hospital Mortality

Introduction/Background: Rapid Response Teams (RRT) have been widely implemented to recognize and manage clinical deterioration outside of the intensive care unit (ICU). Hospital systems frequently rely on individual healthcare provider’s skill and attention to identify early deterioration and activate the appropriate clinical resources. This is referred to as the afferent limb, or triggering mechanism, of the Rapid Response system. Hypothesis: Afferent limb failure leads to delayed clinical intervention and potentially worse outcomes for patients that progress to in-hospital cardiac arrest (IHCA). Goals/Aims: The aim of this retrospective study was to identify if afferent limb failure, defined as failure to recognize two or more standardized early warning criteria in the 24 hours prior to non-ICU IHCA, is associated with increased in-hospital mortality when compared to patients with zero to one standardized early warning criteria. Methods: Non-ICU IHCAs over a 6-year period (January 1 st , 2018, to December 31 st , 2023) at a large academic medical center were reviewed using standardized criteria to determine 1) if any RRT activation criteria had been met in the 24 hours prior to non-ICU IHCA, 2) how many RRT criteria were met, 3) whether an RRT activation occurred, and 4) in-hospital mortality. Statistical analysis included a Chi-Square analysis and Pearson Correlation Coefficient. Results: We identified 386 adult non-ICU IHCAs, with 214 (55.4%) meeting at least two RRT criteria in the 24 hours preceding their non-ICU IHCA. In patients without a preceding RRT activation (N=313), there was significantly higher in-hospital mortality in patients who met two or more RRT criteria prior to their non-ICU IHCA than patients who met one or zero criteria (91/151, 60.2% vs 114/162, 70.3%, p < 0.05). We also found a weak but statistically significant correlation between the total number of RRT criteria met prior to IHCA and in-hospital mortality (r=0.1331, p < 0.05). Conclusion: Afferent limb failure is associated with higher in-hospital mortality in patients with multiple markers of clinical deterioration prior to non-ICU IHCA. There is also an association between in-hospital mortality and the total number of clinical deterioration criteria met prior to non-ICU IHCA.

QLTI-15. MEDICAL MALPRACTICE AND GLIOMA

Abstract BACKGROUND Medical malpractice affects the practice of medicine in every field and specialty. It is a particular concern in high risk specialties including neurological surgery, which has the greatest risk of malpractice litigation. Treatment of glioma patients is complex and requires diagnosis based on presentation and imaging, followed by the decision of resection versus biopsy to confirm diagnosis and potentially improve prognosis. The possibility of a complication accompanies every procedure and patients generally also go on to receive chemotherapy and radiation. Interdisciplinary care is a hallmark. We explored medical malpractice litigation pertaining to gliomas with a focus on outcomes and the role of the defendants as well as the liabilities prompting litigation. METHODS WestLaw Precision, an established legal database, was queried for all cases relevant to “glioma” occurring since 2000. Cases and settlements, in particular, were considered. Keywords included “glioma” and “medical malpractice” with the date range including all cases after January 1, 2000. Cases were identified and analyzed for variables of interest. RESULTS Fourteen relevant cases were identified and reviewed. There were three plaintiff verdicts, one settlement and ten defense verdicts in favor of the defense. Two cases involved minors, while all others concerned adults. Both cases pertaining to the care of minors with gliomas resulted in findings for the defense. The majority of cases centered on failure to diagnose occurring before surgery or treatment. Defendants included neurosurgeons, pathologists, radiologists, nurses and hospital systems. Although the number of cases considered here is small, jury verdicts in favor of plaintiffs resulted in far higher payouts compared with settlements. CONCLUSIONS Medical malpractice allegations relating to glioma treatment are shown to be rare and infrequent. The majority of cases alleged a failure to appropriately diagnose, before surgery or treatment took place. The great majority of cases reported within WestLaw Precision resulted in jury verdicts for the defense.

Public Hospital Workers' Views on the Process of Switching from the Hospital Information Management System to the e-Health Information System in a Province

The purpose of this study is to investigate the views, reasons for satisfaction, and difficulties encountered by medical staff members regarding the Hospital Information Management System (HIMS) in state hospitals located in Amasya and its surrounding areas. It also assesses the knowledge and experiences of healthcare professionals with e-Health apps in public hospitals, emphasizing their opinions and recommendations for assistance, training, adaptation, and involvement throughout the integration of these applications into healthcare services. The goal of the study is to better understand how healthcare professionals feel about digital technologies and to provide suggestions for raising the caliber of healthcare services. The Amasya Provincial Health Directorate oversees four facilities where the research was carried out. Following permission by the ethics committee, data gathering was underway on April 22, 2024, with a pilot research carried out in April of the same year. There are 913 healthcare workers in the population, and a minimum sample size of 405 at a 95% confidence interval was found to be appropriate. Using the'stratified, simple random' approach, the sample was selected and split into three strata based on occupational groupings. With a median age of 37, 38.8% of the 405 participants were female. 34.2% of physicians, 33.7% of midwives, nurses, and health officers, and 40.4% of medical secretaries and data entry staff expressed satisfaction when HIMS satisfaction was analyzed. The system's capacity to decrease errors and enhance workflow was one of the primary factors contributing to user satisfaction. Furthermore, 42.7% of individuals worked nights. Compared to other professional groups, physicians utilized e-health applications like e-prescription and e-report more frequently. Physicians were more likely to employ telemedicine than other healthcare professionals, who were less knowledgeable in this field. The study recommends developing training methodologies specific to various professional groups and expanding the use of e-Health applications. The study highlights the need for regular in-service training, a more robust technical infrastructure, and user-friendly interfaces to boost healthcare personnel' satisfaction with e-Health. In summary, this study offers important information for strengthening e-Health and HIMS applications and presents important suggestions for raising the caliber of healthcare services through digital transformation.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

A Multifaceted Assessment of the Consultation Liaison Psychiatry Service Within a Regional Australian Hospital

Background: Medical and mental health conditions have a reciprocal relationship, with each impacting the other. Consultation–liaison psychiatry (CLP) is a sub-speciality that addresses psychiatric comorbidities in the general hospital system and positively impacts hospital resources through its service aspects of ‘consultation’ and ‘liaison’. This multi-faceted evaluation aims to describe and evaluate the characteristics of a regional CLP service. Methods: Retrospective evaluation of all referrals accepted by CLP between May 2021 and 2022 were reviewed through the hospital’s electronic records. An evaluation tool was designed to assess multiple aspects of care, including the source of referrals, the reasons for referral, patient demographics, how quickly the patient was seen, information on their mental health, and the details and timeframe of CLP involvement. Findings: There were 147 patients included in this study. Doctors were the primary referrers (92%). A total of 94% of patients were reviewed within 24 h of the referral being received. Referral reasons were balanced across diagnostic clarification/review, medication review, and risk review. A large proportion of referrals were aged > 60 years. There was a large proportion of patients who lived rurally, requiring hospital transfer. CLP involvement was primarily required to provide a diagnosis (91% of patients) and provide pharmacological management advice (88%). Conclusions: The CLP service currently operates with limited resources, and without additional support, the sustainability of the service will become increasingly challenged due to population ageing. It is essential that we address this issue to ensure that the community’s needs are met effectively.

The Cross-sectional Relationship Between Use of Automatic Insulin Delivery Systems and Eating Styles Among Older Adults With Type 1 Diabetes: An Exploratory Analysis.

The number of older adults with type 1 diabetes (T1D) is increasing. Use of automated insulin delivery (AID) may influence nutrition and eating behaviors. We explored how three eating styles (restrained, external, emotional) differ between older adults with T1D who use and do not use AID. We administered a one-time electronic survey from September to November 2023 to adults ≥65 years with T1D receiving care through a university-affiliated hospital system. Clinical and demographic information was collected from medical records. Eating styles were characterized with the Dutch Eating Behavior Questionnaire. Our sample (n = 77, 95% non-Hispanic white) had mean (SD) age: 71.8 (4.1) years, diabetes duration: 33 (18) years, hemoglobin A1c (HbA1c): 6.83 (1.12%), and body mass index (BMI): 27.3 (4.7) kg/m2. Respondents reported variable eating styles, with the highest median scores for external and restrained eating and lower scores for emotional eating. Older adults using AID systems had higher median scores for emotional and external eating, and more varied restrained eating scores compared to those not using AID systems. Weak correlations were found between eating styles and HbA1c (restrained: r = -0.14; external: r = 0.08; emotional: r = 0.15), as well as between restrained (r = 0.09) and external (r = 0.04) eating with BMI, with a small correlation between emotional eating and BMI (r = 0.27). Eating styles may vary between older adult AID users and non-users. To our knowledge, this is the first study to characterize eating styles in this population, though generalizability is limited by a non-diverse and small sample with high technology use overall (eg, continuous glucose monitoring, insulin pumps).

Effect of Mental Health Care Visits on HIV Care Outcomes.

To improve the quality of life for people living with HIV (PLWH), it is vital their treatment plans closely follow the HIV care continuum. However, many barriers, such as mental health disorders (MHD), can complicate treatment. Patients being treated for HIV with comorbid MHD are more likely to not be retained in care and maintain an unsuppressed viral load. As PLWH and people vulnerable to acquiring HIV are more commonly diagnosed with MHD in comparison to the general population, it is important that steps to mitigate the possible effects of MHD are addressed during treatment. This study examines how minimal mental health care in a safety-net hospital system in the U.S. South can show benefits in retaining patients throughout their treatment of HIV. The results showed that older individuals retained a higher level of viral suppression when they followed up regularly with a mental health care provider during treatment. In addition, regardless of age, the higher the number of mental health care visits a patient attended during treatment, the higher the likelihood of viral suppression. By incorporating mental health care into the HIV treatment plan, the patients who met at least one of these criteria had better treatment outcomes and progressed further along the HIV care continuum.

Cross-Sectional Survey to Assess Hospital System Readiness for Hemorrhage During and After Cesarean Delivery in Africa.

Mothers in Africa are 50 times more likely to die after cesarean delivery (CD) than in high-income countries, largely due to hemorrhage. It is unclear whether countries across Africa are adequately equipped to prevent and treat postpartum hemorrhage (PPH) during and after CD. This was a cross-sectional survey of anesthesiologists and obstetricians across the African Perioperative Research Group (APORG). The primary objective was to determine readiness of the hospital system to implement the World Health Organization (WHO) recommendations for prevention and treatment of PPH during and after CD. The secondary objectives were to evaluate the availability of blood products, skilled human resources and establish available postoperative care after CD. Survey question format was close-ended or Likert scale, with options "always," "sometimes," or "never." Responses were analyzed from 1 respondent from each of 140 hospitals from 29 low- and middle-income countries across Africa. Most respondents completed every data field on the case report form. Regarding WHO recommendations on prevention of PPH, oxytocin and misoprostol were available in 130/139 (93.5%) and 101/138 (73.2%) hospitals, respectively. There was limited access to heat-stable carbetocin (12/138 [8.7%]) and ergometrine (35/135, [25.9%]). Controlled cord traction for removal of placenta was always performed in 133/135 (98.5%) hospitals. Delayed cord clamping when neonatal resuscitation was not indicated, was not performed universally (86/134 [64.2%]). Regarding the treatment of PPH, crystalloids were always available in 133/139 (95.7%) hospitals, and the preferred initial resuscitation fluid (125/138 [90.6%]). Uterine massage was always performed in 117/139 (84.2%) hospitals. Tranexamic acid was always available in 97/139 (69.8%) hospitals. The availability of intrauterine balloon tamponade devices was limited. Most had immediate access to theater (126/139 [90.6%]). Responses concerning organizational recommendations showed that 113/136 (83.1%) hospitals had written protocols for the treatment of PPH. Protocols for patient referral and simulation training were limited. Most hospitals had access to emergency blood (102/139 [73.4%]). There was limited access to blood component therapy, with platelets available at 32/138 (23.2%), cryoprecipitate at 21/138 (15.2%) and fibrinogen at 11/139 (7.9%) hospitals. In-person specialist cover was reduced after-hours. Important WHO-recommended measures to reduce hemorrhage during and after CD, are not currently available in many hospitals across Africa. It is likely that the lack of a combination of factors leads to failure to rescue mothers in Africa from postoperative complications. These findings should facilitate codesign of quality improvement initiatives to reduce hemorrhage related to CD.