Admission Lists Research Articles

352 Validation of inpatient ICD9 diagnosis codes as predictors of venous leg ulcers

Venous Leg Ulcers (VLU) comprise about 70% of lower leg wounds and cost more than 14 billion USD per year. There is a need to establish VLU epidemiologic trends in order to develop better diagnostic, preventive, and treatment strategies. Patients with VLU are often admitted to the hospital; however, epidemiological study of this important patient subset is challenged by lack of validated database search protocol. Initially, five International Classification of Diseases (ICD) 9 codes were identified for their relationship with VLUs. The codes were 454.0 (leg varicosity with ulcer), 454.2 (varicose leg ulcer/inflammation), 459.11 (postphlebitic syndrome with ulcer), 707.9 (chronic skin ulcer NOS), and 707.10 (ulcer of lower limb NOS). A list of inpatient admissions at the University of Miami Hospital where any of these five codes were entered was obtained. A total of 320 unique admissions were identified. A chart review of these patients was performed, focusing on the admission where the diagnosis code was inserted. The ICD9 code was considered to successfully predict a VLU if the wound was located in the gaiter area and had either relevant clinical findings, a positive venous study, and/or a diagnosis of VLU written in the physician note. Excluded were subjects with an ulcer with a clear wound etiology other than VLU. After analysis, 454.0 in addition to any other code was the most accurate predictor of VLU, with a sensitivity of 77% and a specificity of 79%. In this group, the positive and negative predictive values (PPV, NPV) were 37% and 96%, respectively. Also, patients with only the 454.0 code without any of the other above codes had the highest sensitivity 100% (8/8); however, the PPV was low at 8.6%. In conclusion, patients admitted with an ICD9 code of 454.0 have a high probability of VLU, however there is a high percentage of patients with this condition who will not receive this diagnosis code.

Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions?: a cross-sectional study in the East of England

ObjectivesTo use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS)...

Factors influencing the documentation of fertility-related discussions for adolescents and young adults with cancer.

A cancer diagnosis and treatment may have significant implications for a young patient's future fertility. Documentation of fertility-related discussions and actions is crucial to providing the best follow-up care, which may occur for many years post-treatment. This study examined the rate of medical record documentation of fertility-related discussions and fertility preservation (FP) procedures for adolescents and young adults (AYAs) with cancer in Australia. A retrospective review of medical records for 941 patients in all six Australian states. Patients were identified through population-based cancer registries (four states) and hospital admission lists (two states). Trained data collectors extracted information from medical records using a comprehensive data collection survey. Records were reviewed for AYA patients (aged 15-24 years at diagnosis), diagnosed with acute myeloid leukaemia, acute lymphoblastic leukaemia, central nervous system (CNS) tumours, soft tissue sarcomas (STS), primary bone cancer or Ewing's family tumours between 2007 and 2012. 47.2% of patients had a documented fertility discussion and 35.9% had a documented FP procedure. Fertility-related documentation was less likely for female patients, those with a CNS or STS diagnosis and those receiving high-risk treatments. In multivariable models, adult hospitals with an AYA focus were more likely to document fertility discussions (odds ratio[OR] = 1.60; 95%CI = 1.08-2.37) and FP procedures (OR = 1.74; 95%CI = 1.17-2.57) than adult hospitals with no AYA services. These data provide the first national, population-based estimates of fertility documentation for AYA cancer patients in Australia. Documentation of fertility-related discussions was poor, with higher rates observed in hospitals with greater experience of treating AYA patients.

Prevalence of Medication Errors in Admitted Patients at the Philippine General Hospital

Background. Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events. Objective. This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center. Methods. This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses’ notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified. Results. The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OBGynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors. Conclusion. Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED

ObjectiveAcute upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department (ED). We aimed to compare the performance of the AIMS65, Glasgow-Blatchford (Blatchford), preendoscopic Rockall (pre-Rockall), and preendoscopic Baylor bleeding (pre-Baylor) scores in predicting 30-day mortality in patients with acute UGIB in the ED setting. MethodsConsecutive patients with acute UGIB who were admitted to the ED ward during 2012–2016 were retrospectively recruited. Data were retrieved from the admission list of the ED using international classification of disease codes via computer registration. The predictive accuracy of these four scores was compared using the area under the receiver operating characteristic curve (AUC) method. ResultsAmong the 395 patients included during the study period, the total 30-day mortality rate was 10.4% (41/395). The AIMS65 and Glasgow-Blatchford scores performed better with an AUC of 0.907 (95% confidence interval (CI), 0.852–0.963; P<0.001) and 0.870 (95% confidence interval, 0.833–0.902; P<0.001) compared with other scoring systems (preendoscopic Rockall score: AUC, 0.709; 95% CI, 0.635–0.784; P<0.001; preendoscopic Baylor score: AUC, 0.523; 95% CI, 0.472–0.573; P>0.05). ConclusionIn patients with acute UGIB in the ED, the AIMS65 and Glasgow–Blatchford scores are clinically more useful for predicting 30-day mortality than the preendoscopic Rockall and preendoscopic Baylor scores. The AIMS65 score might be more ideal for risk stratification in the ED setting.

Predicting Risk for Evaluating Eligible Students using Multi-Dimensional Dataset

Data Mining extracts required information from large dataset. The Key Concept of Data mining is to classify the desired data according to posterior probability. It utilizes data classification and prediction technique generating students rank list for college admission is an important risk in all the institution eligible students for particular discipline is evaluated based on specified constraints here risk evaluation and prediction is performed which allows the user to generate the risk predicting and determine whether seats can be granted or not. This paper concentrates mainly the concept of multidimensional data classification and clustering for predicting the

Prevalence of Beers Criteria Medications Among Elderly Patients in a Military Hospital.

Objective: This study aims to examine potentially inappropriate medication (PIM) prevalence and factors that affect the use of PIMs in a military treatment facility. Method: Admission and discharge medication lists of 60 patients aged ≥65 years were retrospectively reviewed by a clinical pharmacist and a member of the study team for the presence of PIM using the 2012 Beers Criteria. Patients included were those discharged between December 2012 and September 2013 from the Womack Army Medical Center, Internal Medicine unit. Results: Among the 60 patients evaluated, 44 (73%) were on at least one PIM at admission, whereas the prevalence of PIM at discharge (30 patients) was 50% (p < .001). The top three classes of PIM at admission were antihistamines (11, 15.3%), nonsteroidal anti-inflammatory drugs (10, 13.9%), and benzodiazepines (6, 8.3%). Patients on >10 medications at admission (37, 62%) were 4 times more likely to have a PIM (p < .001). Conclusion: Data showed a high and a previously unknown PIM prevalence among older adults in a U.S. military treatment facility.

Pharmacy impact on medication reconciliation in the medical intensive care unit.

Objective:Pharmacy-driven medication history (MH) programs have been shown to reduce the number of serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs).Methods:MHs were repeated over a 6-week period. Demographics, number, and nature of MDs were documented. Discrepancy severity was graded using a previously published method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs.Findings:Sixty-three MHs were repeated. Pharmacy MHs were less likely to contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001).Conclusion:Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT MDs on admission and home medication lists were common in patients admitted to the medical ICU. Pharmacy-driven medication reconciliation (MR) reduced the number and frequency of these discrepancies. Further research is required to improve current MR procedures.

Medication discrepancies revealed by medication reconciliation and their potential short-term and long-term effects: a Norwegian multicentre study carried out on internal medicine wards

PurposeTo investigate the extent of medication discrepancies (MDs) revealed by medication reconciliation (MR) and to assess the potential clinical relevance of the MDs for the patients in a short-term and...

The effects of improving service efficiency in a specialist inpatient eating disorder treatment program

The Hollywood Clinic is a private adult eating disorder inpatient service in Western Australia with ten specialised beds. It was identified that this service had a long length of stay, which was shown to limit access to care and made the program less cost-effective. Not only are there sizable financial savings in reduced length of stay but indirect “costs” to patients may include missed school and work, impoverished relationships and decreased quality of life. Conversely, early discharge resulting from pressure on length of stay may negatively impact treatment outcomes and recovery trajectories. Our objective then, was to optimise patients' length of stay. We introduced a range of initiatives to improve program efficiency. These included earlier increases in oral intake prescription, higher energy content of menus, closer monitoring of weight restoration, stream-lining our protocol and utilising our day patient program on discharge. These initiatives resulted in a reduction in the average length of stay from 52 days to 35 days. Concomitantly, there has been no reduction in treatment gains during shorter admissions. Furthermore, there is currently no waiting list for admission to our inpatient eating disorder program, giving us increased capacity to treat more patients in need of the service.

The Necessity of Proper Case Presentation in Educational Sessions

Morning report sessions are for sure the best known case- based educational meetings in the history of medical education. This study is aimed to evaluate the proper case presentation in such sessions. Seventy three morning report sessions in different wards of five main hospitals of a type-1 university were evaluated regarding the number of the cases, duration of each presentation, availability of 24-hour admission lists and seven quality indices of proper case presentation. The Mean number of the cases was 3 and the mean duration of case presentation was 4 minutes. The Total score of quality indices was 82%, while the Total score of the availability of admission list of cases was 50%. In the present study, the different aspects of proper case presentation were revealed in the studied university.

Mei-Shin Shih: a surgeon, master, and mentor.

Dr. Mei-Shin Shih (Figure 1) was born on January 5, 1918 to a literary family in Fuzhou City, Fujian Province. In his early years China was being plagued by years of fighting among factional warlords, and people were living in misery. He studied very hard and was determined to get enrolled into the Shanghai Medical College, now an affiliate to Fudan University. His name appeared on the school’s admission list published by Shun Pao newspaper on August 18, 1936.

Improving quality in a national intestinal failure unit: greater efficiency, improved access and reduced mortality

ProblemIn 2010, there was a significant waiting list for admission to the intestinal failure unit (IFU) at the Salford Royal National Health Service (NHS) Foundation Trust. There had been a...

Multidisciplinary team puts the ‘home’ in hospital-to-home

Kim Thrasher, PharmD, BCPS, CPP, recently received a call from a care manager at Community Care of the Lower Cape Fear (CCLCF) about a medically fragile 2-year-old patient. The child had had numerous hospitalizations and was on multiple chronic medications. Most recently, the child had been discharged from the hospital after being on a ventilator and receiving narcotics for several weeks. She was discharged with a 36-hour supply of compounded methadone solution to combat withdrawal symptoms.

OC-039 Improving Quality In A National Intestinal Failure Unit: Greater Efficiency, Improved Access, Reduced Mortality

IntroductionIn 2010, there was a significant waiting list for admission to the Intestinal Failure Unit (IFU) at Salford, one of two current nationally-accredited centres. There had also been a steady...

G185 Reducing same-day cancellations for paediatric cardiac surgery

AimsOver time, demand for paediatric intensive care beds is rising inexorably.1 Most units, operating close to capacity, balance the needs of planned admissions with emergencies. Following cardiothoracic surgery, most children...

Reasons for discharge delays in teaching hospitals.

OBJECTIVETo analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards.METHODSWe reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed.RESULTSDelays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%).CONCLUSIONSBoth hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission.

Antibiotic therapy for inpatients with community‐acquired pneumonia in a developing country

The aim of this study was to identify antibiotic prescription patterns for community-acquired pneumonia (CAP) in Vietnam. Medical records for CAP adult patients admitted to 10 hospitals across the country were randomly selected from admission lists during the peak pneumonia season. CAP cases were identified from manual record reviews by clinical pharmacists. Data was collected using a standard data collection tool including patient clinical features on admission, comorbidities, microbiological culture results, and antibiotic regimens. Pneumonia severity was estimated using the CURB-65 score. A total of 649 medical records for adult patients (55.2% male and 52.3% urban residents, median age 68 years) met the selection criteria for CAP. Pneumonia severity was assessed as mild (64.1% of patients), moderate (23.0%), and severe (9.2%). Antibiotics were most frequently administered intravenously (93.4%) and as combination therapy (dual therapy 54.4%, monotherapy 42.5%, and triple therapy 3.1% of patients) regardless of CAP severity. Third-generation cephalosporins were used most frequently (29.3% as monotherapy and 40.4% as combination therapy). Third-generation cephalosporins were most commonly combined with penicillins and/or quinolones. This first nationwide study provides a baseline profile of antibiotic use in the treatment of CAP. Third-generation cephalosporins were widely used for initial empirical management of CAP, often in combination with quinolones, regardless of CAP severity. The study will assist in providing an evidence base to inform new national antibiotic guidelines for CAP management and will contribute locally relevant data for the national master plan addressing antibiotic resistance and the development of educational interventions to improve CAP management.

Comparison of 3 scoring systems to predict mortality from unstable upper gastrointestinal bleeding in cirrhotic patients

ObjectiveWe aimed to compare the performance of Glasgow-Blatchford, preendoscopic Rockall, and model for end-stage liver disease (MELD) scores in cirrhotic patients with unstable upper gastrointestinal bleeding (UGIB) in the emergency department (ED). MethodsThis was a retrospective cohort study conducted at a university-affiliated teaching hospital. Adult cirrhotic patients who presented with acute UGIB and unstable vital signs (heart rate >100 beats/min or systolic blood pressure <100 mm Hg) between January 2009 and February 2011 were included. Patients who were transferred from another hospital, received no emergency endoscopy study, or had incomplete medical records were excluded. Data were retrieved from the admission list of the ED critical zone using international classification of disease code via computer registration. ResultsAmong enrolled visits, the initial median hemoglobin level was 8.6 (interquartile range, 7.2-10.1) mg/dL in the ED. The median heart rate and systolic blood pressure were 111.0 beats/min and 94.0 mm Hg, respectively. The endoscopic diagnosis of variceal bleeding accounted for 86.6% of the events. The mortality rate was 16.0% (19/119). Model for end-stage liver disease score performed better with an area under the curve (AUC) of 0.736 (95% confidence interval [CI], 0.629-0.842; P = .001) compared with other scoring systems (Glasgow-Blatchford score: AUC, 0.527; 95% CI, 0.393-0.661; P = .709; preendoscopic Rockall score: AUC, 0.591; 95% CI, 0.465-0.717; P = .208). ConclusionModel for end-stage liver disease score performed better in terms of predicting mortality of unstable UGIB in cirrhotic patients compared with Glasgow-Blatchford and preendoscopic Rockall scores in the ED.

Pattern and outcome of admissions in the medical wards of a tertiary health center in a rural community of Ekiti State, Nigeria.

To determine the pattern and outcome of medical admissions as well as the basic demographic characteristics in medical wards of a tertiary health center located in a rural area. Materials and Methods : A retrospective analysis of medical wards admissions of the Federal Medical Centre, Ido-Ekiti, Ekiti State, southwest Nigeria, between January 2009 and December 2011. Data obtained was analyzed using SPSS Version 16 software. The total number of patients admitted during the period was 1519, age ranged from 16 to 120 years, with a mean of 56.1 + 18.8 years. There were 823 (54.3%) males and 696 (45.7%) females in a ratio of 1.2:1.0; the highest number of age group admitted was the elderly. Disorders of the cardiovascular system topped the admission list (32.1%) in general, and noncommunicable diseases were also predominant (68.4%) on the admission list compared with communicable diseases (31.6%). The most common cause of death was cardiovascular diseases (33.0%). Male gender and elderly aged groups were predominant on admission. Noncommunicable diseases were of higher proportion on admission than communicable diseases. The most common cause of death was cardiovascular diseases of which stroke topped the list.