Inpatient Hospital Research Articles

Perspectives of older adults with chronic illness on person-centered practice at an inpatient hospital department: a descriptive study

BackgroundThe growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person’s perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department.MethodsA quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA).ResultsThe results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was working with the person’s beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain.ConclusionsThese results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults.

Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study.

To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people. Qualitative interview study. Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study. Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options. Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care. Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care. The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery. Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

Does a weekly ward‐based interpersonal therapy group reduce psychological distress for women in an acute psychiatric inpatient hospital? A service evaluation

Does a weekly ward‐based interpersonal therapy group reduce psychological distress for women in an acute psychiatric inpatient hospital? A service evaluation

Managing the patient portfolio using mathematical programming: decision support guidelines using a real-world use case at a university hospital

AbstractMany hospitals in Germany are facing escalating economic pressures. After several years of stagnation, the number of inpatient hospital treatments dropped by $$\:13\%$$ in 2020 compared to the previous year. This negative tendency can also be seen in operating theaters (OTs). Strategic management of the case mix in hospital OTs now necessitates a solid data foundation. The case mix and the case mix index have become central economic indicators in contemporary hospital operations. In this work, we develop a mathematical model for case mix optimization at Augsburg University Hospital in Germany, which is based on an extensive data analysis with descriptive methods. The optimization model is subject to rigorous testing and evaluation through an extensive series of scenario analyses. The primary objective is to calculate a revenue-maximizing patient mix while respecting the available scarce personnel resources in the OT and intensive care unit. This research marks a pioneering effort in delineating the practical integration of case mix planning into a hospital’s routine operations using mathematical optimization. The analyses reveal a strong correlation between an upsurge in revenue and an increased number of cases. Furthermore, the results demonstrate that strategic planning of the patient mix has the potential to enhance revenue with existing resources. Even though the optimal patient mix may not be directly implementable in practice, the findings yield valuable insights for managerial decision-making. A critical examination of these results also fosters a nuanced discourse on the utilization of optimization models as decision support tools within hospital management.

Team-based care in specialist practice: a path to improved physician experience in British Columbia

BackgroundSpecialist physicians in the province of British Columbia commonly work on teams in acute care settings such as operating rooms or inpatient hospital units. However, while the implementation of team-based care (TBC) has been supported in primary care clinics, no formal mechanisms have supported specialist physicians in adopting TBC in their private outpatient offices. Adopting TBC models is associated with improving physician experience, efficiency, and patient experience.MethodsThe Institute for Healthcare Improvement Breakthrough Series guided a program to support 11 specialist physicians, representing nine different specialties, to develop and implement TBC in outpatient offices. Participants were supported through resources including funding, mentorship, and learning opportunities. To determine whether the program improved physician experience, quantitative data were collected using the validated Mini Z survey and qualitative data were collected through monthly reports, semi-structured interviews, and focus groups. Patient experience data were collected through surveys and follow-up calls.ResultsThe fifteen-month program was successful, with 10 of the 11 specialists implementing TBC in their offices. The Mini Z results demonstrated that physician experience improved over the course of the program, with scores on job satisfaction, work pace, and time spent on the electronic medical record improving the most. Interviews with specialists and focus groups with specialists’ team members support these findings, with participants stating that TBC modulates workloads, begins to affect burnout, improves work-life balance, and increases the efficiency of care. Patients reported positive experiences while receiving TBC. Patients were less likely to visit the emergency department after consultations with specialist teams, and providers agreed that their patients would be less likely to seek acute care because of the new practice models.ConclusionTBC is a viable model for specialist physicians and their health care teams practicing in British Columbia to foster well-being, job satisfaction, and efficiency, and to improve patient experience. These findings may be of interest to specialists, health care providers, policymakers, and administrators looking to better support and retain specialist practices that are integral to patient care.

End-of-Life Healthcare Utilization in Lewy Body Dementia.

Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. This study examined healthcare utilization and care continuity in the last year of life in LBD. Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79). This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.

Dermatovenereology in the Russian Federation: results of 2023

The article presents information on dynamics of dermatovenerological service resources, indicators of the population of the Russian Federation provision with dermatovenerologists and dermatovenerological beds, main performance rates and results of dermatovenereological medical care providing in outpatient, inpatient and day hospital conditions for the period 2019–2023. The dynamics of sexually transmitted infections (syphilis, gonococcal infection, trichomoniasis, chlamydial infection, anogenital herpetic viral infection and anogenital venereal warts) incidence in the Russian Federation, as well as contribution of foreign citizens to the syphilis incidence rates are analyzed. The dynamics of prevalence and incidence rates of diseases of the skin and subcutaneous tissue in the Russian Federation in 2019–2023, as well as dynamics of prevalence and incidence of atopic dermatitis, psoriasis, contact dermatitis, localized scleroderma, discoid lupus erythematosus among children aged 0–17 years and adults 18 years and older are presented.

Impact of Government-Funded Health Insurance on Out-of-Pocket Expenditure and Quality of Hospital-Based Care in Indian States of Madhya Pradesh and Maharashtra.

With its clear focus on financial protection, government-funded health insurance (GFHI) stands out among the strategies for universal health coverage (UHC) implemented by low-to-middle income countries globally. Since 2018, India has implemented a GFHI programme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which covers 500 million individuals. The current study aims to evaluate the performance of GFHI in meeting its key objectives of improving access, quality and financial protection for hospital-based care in two large central Indian states: Madhya Pradesh and Maharashtra. The study measures access in terms of utilisation of inpatient care. Financial protection was measured in terms of catastrophic health expenditure which was defined as the incidence of out-of-pocket expenditure (OOPE) above thresholds of 10% and 25% of annual household expenditure. Patient-satisfaction with care was taken as an indicator of quality. A household survey was conducted in 2023, covering a multi-stage sample of 11,569 and 12,384 individuals in Madhya Pradesh and Maharashtra, respectively. Multi-variate analyses were conducted to find the effect of GFHI-enrolment on the desired outcomes. The instrumental variable method was applied to address potential endogeneity in insurance enrolment. Additionally, propensity score matching was done to ensure robustness. Around 71% and 63% of surveyed individuals were enrolled under GFHI in Madhya Pradesh and Maharashtra, respectively. The hospitalisation rate did not differ much between the GFHI-enrolled and non-enrolled population. The average OOPE on hospitalisation was similar for the GFHI-enrolled and non-enrolled patients. The OOPE and catastrophic health expenditure in private hospitals remained very high, irrespective of GFHI enrolment. The pattern was similar in both states. Multi-variate adjusted models showed that GFHI had no significant effect on utilisation, quality, OOPE and catastrophic health expenditure. The above results were confirmed by propensity score matching. Coverage by GFHI enrolment was ineffective in improving access, quality or financial protection for inpatient hospital care despite 5 years of implementation of the programme. Long-standing supply-side gaps and poor regulation of private providers continue to hamper the effectiveness of GFHI in India.

Acceptability and Feasibility of an Ecological Momentary Intervention for Managing Emotional Distress Among Psychiatric Inpatients at Risk for Suicide

The weeks following an inpatient psychiatric hospitalization are known to be the highest-risk time for suicide. Interventions are needed that are well-matched to the dynamic nature of suicidal thoughts and easily implementable during this high-risk time. We sought to determine the feasibility and acceptability of a novel registered clinical trial that combined three brief in-person sessions to teach core cognitive-behavioral therapy (CBT) skills during hospitalization followed by smartphone-based ecological momentary intervention (EMI) to facilitate real-time practice of the emotion management skills during the 28 days after hospital discharge. Results from this pilot study (N = 26) supported some aspects of feasibility and acceptability. Regarding feasibility, 14.7% of all screened inpatients met study eligibility criteria. Half (50.3%) of those who were ineligible were ineligible because they were not part of the population for whom this treatment was designed (e.g., symptoms such as psychosis rendered them ineligible for the current study). Those who were otherwise eligible based on symptoms were primarily ineligible due to inpatient stays that were too short. Nearly half (48%) of study participants did not receive all three in-person sessions during their hospitalization. Among enrolled participants, rates of engagement with the smartphone-based assessment and EMI prompts were 51.47%. Regarding acceptability, quantitative and qualitative data supported the perceived acceptability of the intervention, and provided recommendations for future iterations. Well-powered effectiveness (and effectiveness-implementation) studies are needed to determine the effects of this promising and highly scalable intervention approach.

Prescription patterns of home rescue benzodiazepines for febrile seizures

ObjectiveTo describe the prescription patterns of home, non-intravenous rescue benzodiazepines (non-IV-rBZDs) for febrile seizures and the factors associated with their prescription. MethodsRetrospective descriptive study using the MarketScan Commercial Database, a large database of employer-sponsored privately insured patients in the United States. We used data from January 1st 2006 to December 31st 2022. We studied patients with febrile seizures as the main code for the healthcare encounter (identified with International Classification of Diseases codes) with age from 6 months to 5 years of age and with at least 1 month of follow-up. ResultsThere were a total of 82,835 patients [median (p25-p75) age 1.0 (1.0–2.0) years, 56.7 % males] with at least one febrile seizure, of whom 9,737 (11.8 %) filled at least one non-IV-rBZD prescription. Among the 9,737 patients who filled at least one prescription, the median (p25-p75) time from first febrile seizure to non-IV-rBZD prescription was 27 (2–186) days. Among the factors known at the time of the first febrile seizure, complex febrile seizure (OR: 3.51, 95 % CI: 3.24–3.79), and an initial inpatient hospitalization for febrile seizure (OR: 3.53, 95 % CI: 3.29–3.79) were the factors most strongly associated with filling a non-IV-rBZD prescription. In contrast, sex, rural patient's residence, and salary employment (versus other employment class) were not independently associated with filling a non-IV-rBZD prescription. Among the factors known at the end of follow-up, complex febrile seizures, type of initial encounter, and an eventual diagnosis of epilepsy were major independent factors associated with filling a non-IV-rBZD prescription. ConclusionOnly approximately 12 % of children with a febrile seizure filled a prescription for a home non-IV-rBZD. The major factors independently associated with prescription were complex febrile seizure, hospital admission, recurrent febrile seizures, and an eventual diagnosis of epilepsy.

The impact of the COVID-19 pandemic on burnout levels among healthcare workers: A comparative analysis of the pandemic period and post-pandemic period

Emotional burnout among physicians is a serious problem that can affect their health and the quality of medical care. This condition occurs when physicians experience excessive stress and pressure at work, often due to high demands and expectations imposed on them by patients. This study aims to assess the experience and factors associated with emotional burnout among health workers who deal with COVID-19-positive patients. The study population includes employees at the infectious diseases hospital and the inpatient clinical hospital examined using the Maslach Burnout Inventory. The prevalence of high emotional exhaustion among infectious diseases specialists and inpatient physicians was 51.2 ± 3.4 % and 43.3 ± 8.1 %, respectively. The prevalence of high depersonalization was 39.4 ± 7.9 % and 40.5 ± 8.1 %, respectively. Finally, the prevalence of reduced professional efficacy was 26.3 ± 7.1 % and 41.3 ± 8.3 %, respectively. The main burnout contributors were a heavy workload, a high risk of infection, the lack of protective equipment, insufficient social support, constant interaction with suffering patients, and work-life imbalance. To prevent burnout among health workers who deal with COVID-19-positive patients, it is best to create a working environment that is conducive to good physical and mental health, implement stress management courses, and provide employees with enough time for rest and recovery. These preventive measures will help to improve the quality of health care. The findings of the study can be utilized for the development of support programs for healthcare professionals, improvement of working conditions, and reduction of the risk of emotional burnout.

Through the eyes of Spanish-speaking patients, caregivers, and community leaders: a qualitative study on the in-patient hospital experience

BackgroundSpanish-speakers with non-English language preference and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Communication challenges during prolonged hospitalizations for complex illnesses negatively influence how this group engages in their care and decision-making while hospitalized. Limited literature capturing the perspectives of Spanish-speaking patients in this context exists. Given the impact of language barriers on care and medical decision-making, this study documents the experiences of Spanish-speaking patients with NELP and hospitalized with complex care needs as well as caregivers and community leaders.MethodsUsing community-engaged recruitment strategies and semi-structured interviews and a focus group, we gathered insights from Spanish-speaking patients hospitalized for prolonged periods, caregivers, and community leaders from three geographic regions. Data were deidentified, transcribed, translated, coded in duplicate, and analyzed guided by grounded theory using NVivo.ResultsWe interviewed 40 participants: 27 patients, 10 caregivers and 3 community leaders. We identified four major themes: (1) Disconnected experiences impeding interactions, communication, and decision-making (2) Inadequate interpreter services (3) Benefits and consequences of family at the bedside (4) Community -informed recommendations.ConclusionThe study showed that in-person interpreters were preferred to virtual interpreters; yet interpreter access was suboptimal. This resulted in ad hoc family interpretation. Participants noted language negatively impacted patient’s hospital experience, including decreasing confidence in medical decision-making. Recommendations from patients, caregivers, and community leaders included expanding interpreter access, bolstering interpreter quality and accuracy, and increasing resources for patient education.

Cannabis use patterns and association with hyperemesis: A comprehensive review.

Cannabis use in the general population is prevalent and is rising because of increased acceptance of its use, legalization in most US states, and perceived health benefits. Cannabis product potency has dramatically increased with higher delta-9-tetrahydrocannabinol content. Cannabis has documented antiemetic properties and cannabinoid pharmaceuticals are used in disorders like chemotherapy-induced nausea and vomiting. Forty to eighty percent of cyclic vomiting syndrome (CVS) patients use cannabis products, which reportedly reduce stress as well as nausea and vomiting. Cannabinoid hyperemesis syndrome (CHS) has a presentation similar to CVS, but is associated with longstanding, high dose cannabis use, and is thought to be relieved by sustained cannabis abstinence. Most CHS patients have used cannabis on a daily or near-daily basis for more than 2 years. Compulsive hot-water bathing behaviors are reported by most CHS patients, but are not specific for this disorder as they are also noted by about half of CVS patients. Episodic vomiting associated with cannabis use contributes to extensive health resource use, including emergency department visits and inpatient hospitalizations, and impacts patients and their families negatively. Treatment for CHS overlaps with CVS although cannabis abstinence remains the cornerstone of its management. Challenges associated with cannabis use cessation in CHS include patient skepticism of the role of cannabis as a cause of symptoms, perceived benefits of cannabis, and a lack of other effective therapies. In this review, we highlight cannabis use patterns in the US and discuss diagnosis and management of CHS and gaps in knowledge about this disorder.

Quantifying the risk of medical evacuation in spaceflight

IntroductionTraditionally, NASA mission planners have used a heuristic and qualitative approach to design medical systems based on prior experience; however, this approach may result in implicit bias in design. The risk of needing to return to definitive care (RTDC) or medevac, has been particularly difficult to quantify due to the complexity of exploration spaceflight. The Informing Mission Planning through Analysis of Complex Tradespaces (IMPACT) tool is a probabilistic risk assessment approach designed by NASA to model medical risk in long duration spaceflight. This paper discusses how this tool can inform RTDC risk and improve the health and safety of astronaut crews. MethodsIMPACT was developed by subject matter experts using an evidence-based approach and can be used to quantify the risk of exceeding the onboard medical capabilities. Within the model, RTDC occurs when a condition meets a specific threshold that exceeds the on-board capabilities and requires a higher level of care. A notional lunar surface design reference mission (DRM) was modeled using IMPACT, and the RTDC rate was analyzed. ResultsOf the 119 medical conditions evaluated, thirty-four were preassigned to have zero probability of RTDC based on lack of acuity. Thirty-one conditions used the need for inpatient hospitalization or admission to intensive care as the RTDC surrogate. Twenty-six conditions used the probability of needing surgery, and ten conditions used treatment failure rates as the RTDC surrogate. The remaining 18 conditions had unique surrogates that did not fall into the above categories or were assigned a 100 % probability of RTDC due to their definition. In the sample DRM, the overall risk for RTDC was 0.32 events per mission. DiscussionQuantifying medical risk for human spaceflight is challenging but important in designing medical systems that support the health and performance of our astronaut crews. IMPACT can use the best available evidence to quantify the risk of an RTDC event based on mission parameters and help mission planners make informed design decisions. More work is underway to further refine the model and evidence that drives the RTDC calculation to improve model fidelity and utility for missions to the Moon, Mars, and beyond.

Readmission rate and early complications in patients undergoing total knee arthroplasty: A retrospective study

BACKGROUND Total knee arthroplasty (TKA) can improve pain, quality of life, and functional outcomes. Although uncommon, postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery. Identification of the risk factors for complications and readmissions after TKA, taking into account common causes, temporal trends, and risk variables that can be changed or left unmodified, will benefit this process. AIM To assess readmission rates, early complications and their causes after TKA at 30 days and 90 days post-surgery. METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1, 2017, and February 28, 2022. Of the 633 patients, 28 were not contactable, leaving 609 who met the inclusion criteria. Both inpatient and outpatient hospital records were retrieved, and observations were noted in the data collection forms. RESULTS Following TKA, the 30-day and 90-day readmission rates were determined to be 1.1% (n = 7) and 1.8% (n = 11), respectively. The unplanned visit rate at 30 days following TKA was 2.6% (n = 16) and at 90 days was 4.6% (n = 28). At 90 days, the unplanned readmission rate was 1.4% (n = 9). Reasons for readmissions included medical (27.2%, n = 3) and surgical (72.7%, n = 8). Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group (P = 0.922), body mass index (BMI) (P = 0.633), unilateral vs bilateral TKA (P = 0.696), or patient comorbidity status (30-day P = 0.171 and 90-day P = 0.813). Reoperation rates after TKA were 0.66% (n = 4) at 30 days and 1.15% (n = 8) at 90 days. The average length of stay was 6.53 days. CONCLUSION In this study, there was a low readmission rate following TKA. There was no significant correlation between readmission rate and patient factors such as age, BMI, and co-morbidity status.

Implementation of the Acute InpatientMedicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) in rural Veterans Health Administration hospitals: A mixed methods evaluation protocol.

Few rural hospital medicine programs include workforce development training that provides social and professional support for interdisciplinary teams. Even fewer include training that creates supportive learning environments that result in higher staff satisfaction, lower burnout, and reduced turnover. The Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) aims to create supportive learning environments in Veterans Health Administration (VA) rural hospital medicine teams. AIM-HI is a type II hybrid implementation study utilizing a convergent mixed methods approach to evaluate the Relational Playbook, a workforce development intervention, and three implementation strategies: behavioral nudges, learning and leadership collaboratives, and leadership coaching. AIM-HI implementation will occur in waves, enrolling additional hospitals every 12 months. In the first wave, AIM-HI will be implemented at three tertiary VA hospitals that treat at least 1000 rural Veterans annually and have an active inpatient hospital medicine program. The primary outcomes in year 1 will be the acceptability, appropriateness, and feasibility of AIM-HI assessed through participant surveys and interviews. In subsequent years, trends in the learning environment, job satisfaction, burnout, and turnover scores will be assessed using a linear mixed-effect model. The anticipated impact of AIM-HI is to evaluate the utility of the implementation strategies and assess trends in Playbook intervention outcomes. The Playbook has strong face validity; however, before large-scale adoption across the VA enterprise, it is essential to establish the acceptability, appropriateness, and feasibility of the Playbook and implementation strategies, as well as to gather data on AIM-HI effectiveness.

Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation.

Background: Cognitive impairment is a relevant problem in psychiatry and can be well assessed with a cross-diagnostic test such as the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of our pilot study is to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression using the German version of the SCIP (SCIP-G). We also investigate whether cognitive dysfunction improves over the course of the inpatient treatment, where patients are offered a combination of pharmacological treatment and cognitive remediation. Methods: A total of 143 adult inpatients were included in the study. Cognitive testing was performed using two different forms of the SCIP-G. All patients received state-of-the-art pharmacotherapy and cognitive remediation using the COGPACK® software package version 6.06. Results: Based on the ICD-10 Criteria for Research, 54 patients were given an F2 diagnosis (schizophrenia and schizotypal and delusional disorders). Thirty-nine patients met the criteria for bipolar disorder (F30 and F31) and fifty for depression (F32 and F33). At baseline, a significant difference was observed between the SCIP total scores of the F2 and F32/33 patients (p < 0.001) and between the F2 and F30/31 groups (p = 0.022). At the second measurement time point, the SCIP total score showed significant improvement in all three groups (p < 0.001), and there was no statistically significant interaction between SCIP total score and diagnostic groups (p = 0.860). Conclusions: Cognitive dysfunction is present in psychiatric disorders and can be easily assessed during an inpatient hospital stay. In our sample, patients with a psychotic disorder were more cognitively impaired at baseline than patients with an affective disorder. Inpatient treatment, consisting of pharmacotherapy and cognitive remediation, improved cognitive deficits. Patients with psychotic disorders, bipolar disorder and depression showed similar improvements in cognitive performance.

Analysis of Interpersonal Communication, Motivation and Attitudes towards the Implementation of Patient Safety in Hospital Inpatients

The background to this research is that effective integration of interpersonal communication, motivation and attitudes can strengthen the implementation of patient safety in the health service environment, especially in inpatient settings. The aim of this research is to analyze whether there is an influence of Interpersonal Communication, Motivation and Attitude on the implementation of Patient Safety. The stages of achievement in this research include several stages of observation, sample determination, using a cross sectional approach using a questionnaire and data processing using a data analysis method using multiple linear regression tests. This research method is collecting primary data by giving questionnaires to all nurses who are directly involved in efforts to provide services to all patients at Jati Husada Karanganyar General Hospital with a cross sectional design, the sample size is 69 nurses. The research data was then tested for linear regression at a significance level of 0.005. The results of this research are that the level of understanding and implementation of patient safety in the Jati Husada Karanganyar Hospital inpatient is good, which is 89.7% for the level of understanding (interpersonal communication, motivation and attitude), on the variables of Interpersonal Communication, Motivation and Attitude simultaneously. has a significant effect on the implementation of patient safety in the Jati Husada Karanganyar Hospital, which means that the higher the value of interpersonal communication, motivation and attitude, the more disciplined the nurses are in carrying out patient safety procedures, the variables Interpersonal Communication, motivation and attitude have a significant effect on the implementation of patient safety in Inpatient care at Jati Husada Karanganyar Hospital, where the influence is positive, which means that the better the nurse's attitude in implementing patient safety procedures, the higher the level of patient safety implementation.

Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis.

Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures. To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018. None. We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases , 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions. In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.

Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study.

Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. "Caring contacts" validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital's Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital's electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies.