Lower Hospital Readmission Rates Research Articles

Enhancing Healthcare Efficiency at Almasara Hospital: Distributed Data Analysis and Patient Risk Management

This study presents a distributed system using RAY, K-means clustering, and Weka software to analyze clinical data from Almasara Hospital Group in Tripoli, Libya. The goal is to reduce patient risk and healthcare costs by providing daily feedback to hospital staff. The system utilizes a dataset containing information on 560 patients, including details like patient ID, gender, doctor ID, test IDs, medication, and a binary target variable. By implementing K-means clustering in Weka, the system categorizes patients and identifies patterns to reduce risks and costs for healthcare analytics. The study first reviews existing patient care and feedback practices and then details the implementation of the daily feedback system, which involves advanced data analysis for managing patient feedback and medical data continuously. The use of K-means clustering helps segment patient data, pinpointing specific risk factors and areas for improvement. Weka software aids in the in-depth analysis of these segments, leading to actionable insights. Results show significant improvements in patient outcomes, reduced hospital-acquired infections, and medication errors, and enhanced patient satisfaction scores. Moreover, the study notes a substantial decrease in overall healthcare costs due to more efficient resource allocation and lower hospital readmission rates. This integration of daily feedback with advanced data analysis tools like K-means and Weka emerges as an effective strategy for improving patient safety and operational efficiency in healthcare settings, demonstrating the value of data-driven decision-making and providing a scalable model for other hospitals aiming to enhance patient care and cost management.

Improvement of left ventricular ejection fraction in patients with heart failure with reduced ejection fraction: Predictors and clinical impact

BackgroundA percentage of patients with heart failure with reduced ejection fraction (HFrEF) improve left ventricular ejection fraction (LVEF) in the evolution. This entity, defined for the first time in an international consensus as heart failure with improved ejection fraction (HFimpEF), could have a different clinical profile and prognosis than HFrEF. Our main aim was to analyze the differential clinical profile between the two entities, as well as the mid-term prognosis. Material-methodsProspective study of a cohort of patients with HFrEF who had echocardiographic data at baseline and follow-up. A comparative analysis of patients who improved LVEF with those who did not was made. Clinical, echocardiographic and therapeutic variables were analyzed, and the mid-term impact in terms of mortality and hospital readmissions for HF was assessed. ResultsNinety patients were analyzed. Mean age was 66.5(10.4) years, with a male predominance (72.2%). Forty five patients (50%) improved LVEF (Group-1,HFimpEF) and forty five patients (50%) sustained reduced LVEF (Group-2,HFsrEF). The mean time to LVEF improvement in Group-1 was 12.6(5.7) months. Group-1 had a more favorable clinical profile: lower prevalence of cardiovascular risk factors, higher prevalence of de novo HF (75.6% vs. 42.2%; p<0.05), lower prevalence of ischemic etiology (22.2% vs. 42.2%; p<0.05), with less basal dilatation of the left ventricle. At the end of follow-up (mean 19(1) months) Group-1 had a lower hospital readmission rate (3.1% vs. 26.7%; p<0.01), as well as lower mortality (0% vs. 24.4%; p<0.01). ConclusionPatients with HFimpEF seem to have a better mid-term prognosis in terms of reduced mortality and hospital admissions. This improvement could be conditioned by the clinical profile of patients HFimpEF.

Impact of an Area Agency on Aging pharmacist-led Community Care Transition Initiative

BackgroundRural older adults are at risk of readmissions and medication-related problems after hospital discharge. ObjectivesThis study aimed to compare 30-day hospital readmissions between participants and nonparticipants and describe medication therapy problems (MTPs) and barriers to care, self-management, and social needs among participants. Practice descriptionThe Michigan Region VII Area Agency on Aging (AAA) Community Care Transition Initiative (CCTI) for rural older adults after hospitalization. Practice innovationEligible AAA CCTI participants were identified by an AAA community health worker (CHW) trained as a pharmacy technician. Eligibility criteria were Medicare insurance; diagnoses at risk of readmission; length of stay, acuity of admission, comorbidities, and emergency department visits score more than 4; and discharge to home from January 2018 to December 2019. The AAA CCTI included a CHW home visit, telehealth pharmacist comprehensive medication review (CMR), and follow-up for up to 1 year. Evaluation methodsA retrospective cohort study examined the primary outcomes of 30-day hospital readmissions and MTPs, categorized by the Pharmacy Quality Alliance MTP Framework. Primary care provider (PCP) visit completion, barriers to self-management, health, and social needs were collected. Descriptive statistics, Mann-Whitney U, and chi-square analyses were used. ResultsOf 825 eligible discharges, 477 (57.8%) enrolled in the AAA CCTI; differences in 30-day readmissions between participants and nonparticipants were not statistically significant (11.5% vs. 16.1%, P = 0.07). More than one-third of participants (34.6%) completed their PCP visit within 7 days. MTPs were identified in 76.1% of the pharmacist visits (mean MTP 2.1 [SD 1.4]). Adherence (38.2%) and safety-related (32.0%) MTPs were common. Physical health and financial issues were barriers to self-management. ConclusionAAA CCTI participants did not have lower hospital readmission rates. The AAA CCTI identified and addressed barriers to self-management and MTPs in participants after the care transition home. Community-based, patient-centered strategies to improve medication use and meet rural adults’ health and social needs after care transitions are warranted.

Improvement of left ventricular ejection fraction in patients with heart failure with reduced ejection fraction: Predictors and clinical impact

BackgroundA percentage of patients with heart failure with reduced ejection fraction (HFrEF) improve left ventricular ejection fraction (LVEF) in the evolution. This entity, defined for the first time in an international consensus as heart failure with improved ejection fraction (HFimpEF), could have a different clinical profile and prognosis than HFrEF. Our main aim was to analyze the differential clinical profile between the two entities, as well as the mid-term prognosis. Material-methodsProspective study of a cohort of patients with HFrEF who had echocardiographic data at baseline and follow-up. A comparative analysis of patients who improved LVEF with those who did not was made. Clinical, echocardiographic and therapeutic variables were analyzed, and the mid-term impact in terms of mortality and hospital readmissions for HF was assessed. ResultsNinety patients were analyzed. Mean age was 66.5(10.4) years, with a male predominance (72.2%). Forty five patients (50%) improved LVEF (Group-1,HFimpEF) and forty five patients (50%) sustained reduced LVEF (Group-2,HFsrEF). The mean time to LVEF improvement in Group-1 was 12.6(5.7) months. Group-1 had a more favorable clinical profile: lower prevalence of cardiovascular risk factors, higher prevalence of de novo HF (75.6% vs. 42.2%; p<0.05), lower prevalence of ischemic etiology (22.2% vs. 42.2%; p<0.05), with less basal dilatation of the left ventricle. At the end of follow-up (mean 19(1) months) Group-1 had a lower hospital readmission rate (3.1% vs. 26.7%; p<0.01), as well as lower mortality (0% vs. 24.4%; p<0.01). ConclusionPatients with HFimpEF seem to have a better mid-term prognosis in terms of reduced mortality and hospital admissions. This improvement could be conditioned by the clinical profile of patients HFimpEF.

Association of patient characteristics with the receipt of regional anesthesia

BackgroundRegional anesthesia (RA) may improve patient-related outcomes, including decreased operative complications, shortened recovery times, and lower hospital readmission rates. More analyses are needed using a diverse set of databases to...

The regular use of calcium channel blockers before flexible URS appears to facilitate primary UAS insertion: a retrospective study in a single center.

To evaluate the effect of regular use of CCB before flexible URS for successful primary UAS insertion. We retrospectively analyzed 209 patients who underwent flexible ureteroscopy (URS) for upper urinary tract calculi between Jan 2021 and Dec 2021. Patients were divided into two groups based on whether calcium channel blockers (CCB) were used (n = 72) or not (n = 137). The following parameters were collected: age, sex, height and weight, BMI, stone location, stone burden, number of stones, operation time, hospital stay, hospital readmission, post-operative fever, post-operative SIRS rate, Clavien-Dindo grade, hospitalization costs, successful primary UAS insertion. We compared the two groups using Student's t test, Mann-Whitney U test and χ2 test for quantitative and categorical variables, respectively. A logistic regression model was used to identify predictive factors of UAS successful primary insertion. Compared with the non-CCB group, the CCB group had a higher successful primary UAS insertion rate (97.2% vs.85.4%, p = 0.008), and a lower hospital readmission rate (2.8% vs.12.4%, p = 0.021). In multivariate analyses, the regular use of CCB was the only predictive factor of successful primary UAS insertion rate (OR 6.32, 95% CI 1.41-28.29, p = 0.016). The regular use of calcium channel blockers (CCB) before flexible URS appears to facilitate ureteral access sheaths (UAS) primary insertion.

Cohort design to assess the association between post-hospital primary care physician follow-up visits and hospital readmissions.

While multifaceted post-hospitalization interventions can succeed in preventing hospital readmissions, many of these interventions are labor-intensive and costly. We hypothesized that a timely post-discharge primary care physician (PCP) visit alone might prevent hospital readmission. We conducted a retrospective cohort study to assess whether post-hospitalization PCP visits within 14 days of discharge were associated with lower rates of 30-day hospital readmission. In a secondary analysis we also assessed: whether visits with a PCP at 7-days post-discharge changed rates of hospital readmissions and whether post-hospitalization PCP visits were associated with decreased 90-day hospital readmissions. We included all adults with a PCP who were discharged from an inpatient medical service in a large, urban integrated academic health system from January 1, 2019 to September 9, 2019 in our analysis. We performed unadjusted bivariate analyses to measure the associations between having a PCP visit within 14 and 7 days of discharge and hospital readmission within 30 and 90 days. Then we constructed multivariate logistic regression models including patient medical and utilization characteristics to estimate the adjusted odds of a patient with a post-hospitalization PCP visit experiencing a 30-day hospital readmission (primary outcome) and 90-day readmission (secondary outcome). A total of 9236 patients were discharged; mean age was 57.9 years and 59.7% were female. Of the study population, 35.6% (n = 3284) and 24.1% (n = 2224) of patients had a post-hospitalization PCP visit within 14 days and or 7 days, respectively. Overall, 1259 (13.6%) and 2153 (23.3%) of discharged patients were readmitted at 30 and 90 days, respectively. In unadjusted analyses, having a post discharge PCP visit was not associated with decreased hospital readmission rates, but after adjusting for sociodemographic, medical and utilization characteristics, having a post-hospitalization PCP visit at 14 and 7 days was associated with lower hospital readmission rates at 30 days: 0.68 (95% CI 0.59-0.79) and 0.76 (95% CI 0.66-0.89), respectively; and 90 days: 0.76 (95% CI 0.68-0.85) and 0.80 (95% CI 0.70-0.91), respectively. In this large integrated urban academic health system, having a post-hospitalization PCP visit within 14- and 7-days of hospital discharge was associated with lower rates of readmission at 30 and 90 days. Further studies should examine whether improving access to PCP visits post hospitalization reduces readmissions rates.

Abstract 9496: Association Between Oral Anticoagulant Type and Hospital Readmission Rates Following Myocardial Infarction With Percutaneous Coronary Intervention in Patients With Nonvalvular Atrial Fibrillation

Introduction: Clinical trials have shown improved outcomes with direct-acting oral anticoagulant (DOAC)- vs. warfarin-based regimens in patients with atrial fibrillation (AF) with acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI). This study investigated the impact of anticoagulant type on hospital readmission rates following a myocardial infarction (MI) managed with PCI in patients with nonvalvular AF (NVAF) in the real world. Methods: This was a retrospective, observational study using data from two US claims databases, Optum ® Research and PharMetrics ® Plus. Patients with NVAF who were hospitalized for MI, underwent PCI between January 1, 2014 and December 31, 2020, and initiated treatment with warfarin or a DOAC (dabigatran, rivaroxaban, apixaban, or edoxaban) exclusively during the index hospitalization or ≤365 days after discharge were included. Once identified, patients were followed for up to 12 months post-discharge. Hospital readmission rates at 30, 90, 180, and 365 days were compared for DOACs vs warfarin using multivariate Cox proportional hazards modeling. Results: The Optum cohort included 2647 patients (1997 DOAC, 650 warfarin) and the PharMetrics cohort included 2056 (1468 DOAC, 588 warfarin). In both cohorts, unadjusted all-cause, stroke/systemic embolism (SE)-related, and bleed-related hospital readmission rates were lower for DOACs vs warfarin at all timepoints. Regression analysis showed a significantly lower risk of hospital readmission with DOACs vs warfarin ( Table ). Conclusions: Real-world data from two large claims databases demonstrated that post-hospitalization DOAC treatment was associated with lower hospital readmission rates than warfarin treatment in patients with NVAF who were hospitalized for MI and underwent PCI. These results thus demonstrate the value of DOAC treatment for these patients.

The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a 2-year time period.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality, and utilization of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study, we aim to evaluate the safety and efficacy of a specialized nurse-led DCCV service. This was a retrospective cohort study analysing the outcome of patients presenting with AF or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019. Analysis included a total of 341 patients (mean age = 68.37; standard deviation = 10.96) who presented with either AF (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were females (N = 101) and 70% were males (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). Thirty-eight patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3-month period (7.04%). Importantly, no patients were admitted as a direct complication of the DCCV procedure. Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF-related issues after successful DCCV.

Qualitative and Quantitative Analysis of Pediatric Post Neurosurgical Care in a Lower Middle-Income Country: The Zambian Experience

Pediatric postoperative neurosurgical care is an essential component of a child's treatment pathway. It is important to better understand how neurosurgeons in lower middle-income countries (LMICs) have been able to address socioeconomic and systemic factors to improve their patients' access to quality pediatric postoperative neurosurgical care. We aim to characterize the pediatric neurosurgical postoperative system in place in Zambia and to discuss how these efforts have been implemented to improve outcomes and address socioeconomic barriers to accessing health care. We acquired a patient list of 90 tenants of House of Hope (HOH)-an out-of-hospital center caring for children awaiting surgery, as well as those recovering from surgery. Of the patient list, 44 patients qualified for our study. Survey responses and occurrence of demographic and clinical characteristics were calculated. Non-normally distributed variables (age) were reported by median and interquartile range (IQR). Dichotomous variables were presented as percentages. Fisher's Exact test was applied to compare categorical data and hospital re-admission. A P-value of <0.05 was considered significant. Our study demonstrates two key findings: (1) low 30-day hospital re-admission rate of 9% and (2) favorable postoperative experience by patient families. Of the 44 patients, a majority were 1-year-old children (n= 31, 70%) and female (n= 24, 55%) (IQR 1-2 years). Presenting conditions included: hydrocephalus only (n= 35, 80%), hydrocephalus and myelomeningocele (n= 5, 11%), myelomeningocele only (n= 2, 5%), cerebral palsy (n= 1, 2%), and encephalocele (n= 1, 2%). Half (n= 22, 50%) of the patients lived in east Zambia, 8 (18%) lived in central, 8 (18%) in north, 5 (11%) in south, and 1 (2%) in west Zambia. We report the first qualitative and quantitative analysis of postoperative care for LMIC pediatric neurosurgical patients in the academic literature. Quality, patient-centered postoperative pediatric neurosurgical care that is rooted in addressing socioeconomic determinants of health produces good outcomes in LMICs.

Impact of TheraNow Telehealth Physical Therapy Program on Hospital Readmission Rate Post Major Joint Replacement Surgery

Background: Hip and knee replacement are two of the most commonly performed major joint replacement surgeries in orthopedic surgery. Both procedures successfully eliminate pain, correct the deformity, and improve patient mobility to regain quality of life and perform daily life activities. Rehabilitation and recovery are crucial during the 12 weeks following any major joint replacement surgery. Most people are discharged from the hospital 2–3 days after surgery to continue rehabilitation. Specific exercises aim to improve the joint’s mobility, improve strength and restore patient function.&#x0D; The primary cause of hospital readmissions after major joint replacement is infection and can hinder the patient’s functional recovery. Therefore, a comprehensive program is essential to reduce infections and promote recovery. The virtual rehabilitation program is an evolving approach to optimize care and compliance. One such program is the TheraNow telehealth physical therapy program. TheraNow integrates artificial intelligence-powered tools and highly trained physical therapists in a care-navigation platform specially designed for rehabilitation after major joint replacement surgery. The objective of this study was to evaluate the impact of the TheraNow Telehealth Physical Therapy program on patient rehabilitation and hospital readmission rate following major joint replacement surgery.&#x0D; Materials and Methods: Forty patients participated in this particular post-joint replacement virtual rehabilitation program on TheraNow application for an online and in-home physical therapy program. The program incorporated three phases of rehabilitation: pre-rehabilitation, post-surgical rehabilitation, and functional rehabilitation. A licensed physical therapist evaluated the patient via a synchronous video conferencing visit, at which time the Physical Therapist developed a customized program for each patient. Every patient booked appointment according to their own choices of time slots, and the same licensed physical therapists administered the entire program from start to finish for each patient. Physical Therapists provided customized therapy to every patient with a duration of 45-60 minutes of the personalized session. In addition, this study tracked and identified all hospital readmissions within 30 days of discharge from the patients’ medical records.&#x0D; Results: The overall mean age of the study population was 65.20+8.41. Out of the 40 enrolled patients, 3 (7.50%) are 41-50 years old, while the majority (42.5%) belonged to 61-70 years of age followed by 71-80 years (27.5%) and 51-60 years (22.5%). 23 (57.5%) were female, while 17 (42.5%) were males. Only one re-admission happened due to surgical site infection in the first 30 days after the surgery under the program brought the readmission rate to 2.5%.&#x0D; Conclusion: The study reported lower hospital readmission rate after major joint replacement surgeries. The TheraNow Telehealth Physical Therapy program reported a 2.5% readmission rate in the first 30 days of the physical therapy program for major joint replacement surgeries as compared to the previous literature where they have reported hospital readmission rate of 3.3%- 5.6% in 30 days post-surgical follow-up.

The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period

Abstract Funding Acknowledgements Type of funding sources: None. Background &amp; Purpose Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service. Methods This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019. Results Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure. Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α&amp;lt;0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α&amp;lt;0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α&amp;lt;0.05) or hypertension (χ2 = 2.075; p = 0.150; α&amp;lt;0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α&amp;lt;0.05) or LA size (χ2 = 1.310; p = 0.727; α&amp;lt;0.05) upon cardioversion success rates. We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α&amp;lt;0.05). Conclusion Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.

Discharge destination influences risks of readmission and complications after lumbar spine surgery in severely disabled patients

ObjectiveFor individuals with severe disability requiring spine surgery, appropriate discharge destination is a challenging and complex decision. Past studies have found associations between discharge destination and postoperative outcomes but were limited by biases in sampling characteristics. The purpose of this study was to explore whether there is an association between discharge destination and odds of worse postoperative outcomes in high-risk individuals with severe/crippling/bedbound disability who received lumbar spine surgery. MethodsThis was an observational study using the Quality Outcomes Database Spine Registry. Subjects were limited to age ≥18 years, primary lumbar spine surgery, and severe disability at baseline (Oswestry Disability Index [ODI] ≥50%). Discharge destination was dichotomized to home or healthcare institution. ResultsOf the 13,050 patients, 11,859 patients (90.9%) were discharged home and 1191 (9.1%) patients were discharged to a healthcare institution. Individuals who were discharged to a healthcare institution were older (68.6 vs 56.9 p < 0.001) and had worse baseline characteristics (higher American Society of Anesthesiology [ASA] score, presence of back pain, and prevalence of comorbidities, all p < 0.001) compared to those who were discharged home. In covariate-controlled multivariate analysis, the home discharge cohort had lower rates of hospital readmission (OR = 0.68, 95% CI 0.55, 0.84) and revision surgery (OR = 0.56, 95% CI 0.37, 0.85) within three months and return to operating room (OR = 0.46, 95% CI 0.34–0.63) and complications (all OR < 0.50 except hematoma, p < 0.01) within 30 days than the institution discharge cohort. ConclusionSeverity of disability measured by ODI may influence but does not dictate discharge destination and the associated postoperative outcomes.

Leveraging the Coronavirus Disease 2019 Pandemic: Is It Time to Consider Incorporating Mobile Applications Into Standard Clinical Management of the Liver Transplantation Patient?

Over the past decade, major advancements in the development of mobile applications and telehealth monitoring systems have assisted healthcare professionals in the diagnosis and management of chronic disease. When effectively used, mobile applications can lead to higher quality care and better patient-reported outcomes.(1) Mobile applications can also improve patient self-management of chronic metabolic disease.(2) Despite these known benefits in other chronic diseases, telehealth and mobile applications have been slow to be adopted in standard clinical management of the liver transplant patient, in-part due to the complexity of chronic liver disease where there is often a need for physical examination, physical frailty assessment, support network determination and building rapport.(3).

Integrated Nurse Practitioner and Pharmacist Post-discharge Heart Failure Clinic: Impact on Patient Outcomes

IntroductionThe American Heart Association recommends implementation of integrated transition of care programs to manage patients following hospitalization for acute decompensated heart failure (ADHF). At our site, a Nurse Practitioner (NP) has been historically responsible for seeing patients post discharge in the Heart Failure Access Clinic (HFAC). Whether the addition of a clinical pharmacy specialist (CPS) to co-manage patients at the HFAC clinic leads to improved outcomes is not known. Therefore, we conducted a pilot study to assess the feasibility and potential benefits of this integrated approach.ObjectiveWe evaluated 30-day heart failure readmission, emergency department (ED) visits, and all-cause mortality in post-discharge patients who were seen in our integrated CPS and NP pilot HFAC clinic. The clinic process and CPS interventions were also assessed.MethodsPatients who were discharged from the hospital for ADHF were eligible for the pilot study if they had at least mild LV systolic dysfunction (LVEF ≤50%). In the integrated HFAC clinic, the NP determined patients’ volume and perfusion status, implemented a flexible diuretic plan, and set parameters for patients contacting the HF team. Responsibility for medication reconciliation, neurohormonal medication education, and dose optimization was shifted to the CPS. Descriptive statistics were used as appropriate.ResultsBetween 11/18/2019 and 3/10/2020, 24 visits were conducted in the integrated clinic. Our patients were predominantly Caucasian (88%), male (96%), and elderly (mean age: 70 ± 12 years). Most patients (75%) had LVEF ≤40%. The 30-day post-discharge readmission rate was 2/24 (8%), while both ED visits and all-cause mortality rates were 0%. Historically, veterans at our NP led HFAC clinic have had a 30-day readmission rate of 15.8% (data from 2019). The average time to appointment was 12 ± 8 days post-discharge with 25% patients seen within 7 days. The mean duration of the CPS visit was 36 minutes; the NP visit was 41 minutes (n=12). The CPS noted medication discrepancies in 14/24 (58%), alerted other providers for medication issue follow-up in 10/24 (42%), and identified HF inappropriate medications in 3/24 (13%). HF medications were titrated by the CPS in 13/24 (54%), and 16/24 (67%) patients were scheduled with CPS for ongoing medication dose titration. One patient (4%) was referred for tobacco treatment.ConclusionsEarly analysis indicates that the integrated HFAC leads to high-quality patient care as evidenced by a very low 30-day hospital readmission rate without ED visits or fatality. These outcomes compare favorably to our institution's 30-day readmission rate observed prior to implementation of this pilot project. Potential benefits of adding a CPS as a provider to our HFAC include medication reconciliation and education, identification of harmful drugs, and timely medication titration. Further analysis is warranted to compare the impact of the integrated HFAC versus standard of care over a longer time frame.

Impact of da Vinci Xi robot in pulmonary resection.

BackgroundThis study sought to evaluate the impact of a da Vinci Xi surgical robot on perioperative outcomes after pulmonary resections.MethodsA retrospective analysis of prospectively collected STS data was performed at a single institution for patients who underwent elective lung resections from 2012 to 2019. Patient outcomes were compared at three different time periods: before the adoption of the robot technology (predominately VATS), during the initial robot experience (the first 18 months), and after the mature robot experience (the second 18 months). Univariate and multivariate logistic regression modeling was performed to determine the factors associated with perioperative complications.ResultsFive hundred and four patients underwent pulmonary resection between the three time periods: 220 patients (43.7%) had surgery prior to the first use of the robot (predominately VATS), 126 patients (25%) had surgery during the initial experience with robot, and 158 patients (31.1%) had surgery during the mature robot experience. There were significantly less post-operative complications (15.2% vs. 34.9% vs. 39.1%, P<0.001), shorter median length of stay (2 vs. 3 vs. 4 days, P<0.001), and lower hospital readmission rates (1.9% vs. 4% vs. 11.8%, P<0.001) in the mature robot period compared to the initial robot period and the predominately VATS period, respectively. Multivariate analysis showed that the robot was associated with a decrease in post-operative complications (OR 0.36; 95% CI, 0.23–0.57, P<0.001).ConclusionsThe adoption of a da Vinci Xi robot in our institution was associated with improved outcomes in patients having pulmonary resections.

Is family history of coronary artery disease important in the emergency department triage?

ObjectiveTo explore the role of family history (FH) as a risk factor for ST elevation myocardial infarction (STEMI) in the emergency department (ED) setting during nurse triage and to analyze the clinical outcomes and time lags of patients with and without FH of coronary artery disease (CAD). MethodsA retrospective archive study was conducted in 2017 in a public tertiary ED at an academic teaching hospital. Data were collected from the electronic medical record for the period of January 2015 to December 2016 on STEMI patients.Of the 335 patients identified with STEMI we included 140 (41.8%) who were eligible to the study inclusion criteria and treated at the ED. Patients transferred directly to the catheterization lab were excluded. We collected and compared information from nurse and physician records on known risk factors for STEMI in adherence to American Heart Association guidelines and hospital outcomes between patients with and without FH of CAD. Logistic regressions were performed to identify the contribution of each risk factor on hospital outcomes. ResultsA negligible number of triage nurses documented if the patient had a FH compared to physicians (5.7% vs. 98.8%). Patients with and without FH of CAD were similarly evaluated at ED triage. However, patients with FH transferred earlier to the catheterization lab and had lower hospital readmission rates. Logistic regression analysis showed that FH is a protective factor for ED revisit for general and cardiac reasons. ConclusionThere is a need to retrieve information on FH of CAD for all patients presenting with symptoms suggestive of STEMI at ED triage.

Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study

ObjectiveTo evaluate the association of the discharge medicines review (DMR) community pharmacy service with hospital readmissions through linking National Health Service data sets.DesignRetrospective cohort study.SettingAll hospitals and 703 community pharmacies...

Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcomes in Patients With Metastatic Cancer.

Patients with cancer often require acute hospitalizations, many of which are unplanned. These hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals-of-care (GOC) discussions be initiated early for metastatic cancers. We hypothesized that discussing GOC during hospitalization could help reduce readmissions. Our aim was to examine the association between the timing of GOC discussion, length of hospital stay, and the time to readmission. We conducted a retrospective review of medical records of patients with stage IV cancers hospitalized between August 2017 and July 2018. We recorded timing of GOC discussion, use of palliative care services, and hospital readmissions within 90 days. χ2 tests were used to identify independent associations with GOC discussion, and logistic regression was used to examine association with readmission within 90 days. Of all study patients (N = 241), 40.6% were female, 46% (n = 112) had a GOC discussion, and 34% (n = 82) had a palliative care consultation. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units (P < .05). Thirty-eight percent (n = 92) had unplanned hospital readmission within 90 days. Having a GOC discussion was independently associated with a reduction in the odds of an unplanned hospital readmission within 90 days by 79% (odds ratio = 0.21, 95% confidence interval: 0.12-0.37). Among hospitalized patients with stage IV cancer, performing an early GOC discussion has an important association with lower hospital readmission rates and increased rates of goal-congruent patient care.

High Self-Care and Mobility Admission Scores are Associated with Lower Rates of Hospital Readmission

High Self-Care and Mobility Admission Scores are Associated with Lower Rates of Hospital Readmission