Number Of Daily Admissions Research Articles

The impact of air pollution on hospitalization for COPD patients in China.

With the rapid development of the global economy and the acceleration of urbanization, air pollution has become a major environmental problem threatening human health. There is limited evidence on the acute effects of air pollution on chronic obstructive pulmonary disease (COPD). From 2014 to 2019, we collected data on daily admissions for COPD patients from a city in China. We used the generalized additive model together with distributed lag models to fit the associations of air pollutants with hospital admissions. We observed significant increments in the number of daily admissions (0.086-0.109%) for COPD for a unit range increase in air quality index, PM2.5 and PM10 over four lag days. The impact of air pollution on the number of daily admissions was mainly reflected in the COPD patients who were hospitalized through outpatient departments and tertiary hospitals. Short-term exposure to outdoor air pollution may induce the occurrence or exacerbation of COPD patients; therefore, government departments should strengthen the management of air pollution, improve supervision and control mechanisms, pay attention to the quality of medical services, and reduce the adverse effects of air pollution on patients' health.

Association of ambient temperature and acute heart failure with preserved and reduced ejection fraction.

Evidence on the association between ambient temperature and the onset of acute heart failure (AHF) is scarce and mixed. We sought to investigate the incidence of AHF admissions based on ambient temperature change, with particular interest in detecting the difference between AHF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). Individualized AHF admission data from January 2015 to December 2016 were obtained from a multicentre registry (Tokyo CCU Network Database). The primary event was the daily number of admissions. A linear regression model, using the lowest ambient temperature as the explanatory variable, was selected for the best-estimate model. We also applied the cubic spline model using five knots according to the percentiles of the distribution of the lowest ambient temperature. We divided the entire population into HFpEF+HFmrEF and HFrEF for comparison. In addition, the in-hospital treatment and mortality rates were obtained according to the interquartile ranges (IQRs) of the lowest ambient temperature (IQR1 <5.5°C; IQR25.5-13.3°C; IQR3 13.3-19.7°C; and IQR4 >19.7°C). The number of admissions for HFpEF, HFmrEF and HFrEF were 2736 (36%), 1539 (20%), and 3354 (44%), respectively. The lowest ambient temperature on the admission day was inversely correlated with the admission frequency for both HFpEF+HFmrEF and HFrEF patients, with a stronger correlation in patients with HFpEF+HFmrEF (R2 =0.25 vs. 0.05, P<0.001). In the sensitivity analysis, the decrease in the ambient temperature was associated with the greatest incremental increases in HFpEF, followed by HFmrEF and HFrEF patients (3.5% vs. 2.8% vs. 1.5% per -1°C, P<0.001), with marked increase in admissions of hypertensive patients (systolic blood pressure >140mmHg vs. 140-100mmHg vs. <100mmHg, 3.0% vs. 2.0% vs. 0.8% per -1°C, P for interaction <0.001). A mediator analysis indicated the presence of the mediator effect of systolic blood pressure. The in-hospital mortality rate (7.5%) did not significantly change according to ambient temperature (P=0.62). Lower ambient temperature was associated with higher frequency of AHF admissions, and the effect was more pronounced in HFpEF and HFmrEF patients than in those with HFrEF.

Concentrations of nitrogen compounds are related to severe rhinovirus infection in infants. A time-series analysis from the reference area of a pediatric university hospital in Barcelona.

BackgroundThere is scarce information focused on the effect of weather conditions and air pollution on specific acute viral respiratory infections, such as rhinovirus (RV), with a wide clinical spectrum of severity.ObjectiveThe aim of this study was to analyze the association between episodes of severe respiratory tract infection by RV and air pollutant concentrations (NO x and SO2) in the reference area of a pediatric university hospital.MethodsAn analysis of temporal series of daily values of NO x and SO2, weather variables, circulating pollen and mold spores, and daily number of admissions in the pediatric intensive care unit (PICU) with severe respiratory RV infection (RVi) in children between 6 months and 18 years was performed. Lagged variables for 0–5 days were considered. The study spanned from 2010 to 2018. Patients with comorbidities were excluded.ResultsOne hundred and fifty patients were admitted to the PICU. Median age was 19 months old (interquartile range [IQR]: 11–47). No relationship between RV‐PICU admissions and temperature, relative humidity, cumulative rainfall, or wind speed was found. Several logistic regression models with one pollutant and two pollutants were constructed but the best model was that which included average daily NO x concentrations. Average daily NO x concentrations were related with the presence of PICU admissions 3 days later (odds ratio per IQR‐unit increase: 1.64, 95% confidence interval: 1.20–2.25)).ConclusionsThis study has shown a positive correlation between NO x concentrations at Lag 3 and children's PICU admissions with severe RV respiratory infection. Air pollutant data should be taken into consideration when we try to understand the severity of RVis.

Impact of weather changes on hospital admissions for hypertension

Blood pressure (BP) shows a seasonal variation with higher levels at lower temperatures. Many hypertensives, however, report on BP disturbances rather in association with acutely changing weather conditions than with absolute temperatures. To date, the impact of changing meteorological parameters on hypertensive episodes remains elusive. We performed a retrospective time series regression analysis on 203,703 patients in three hospitals in Germany between 2010 and 2018, of whom 7362 patients were admitted for hypertensive disease. Numbers of daily admissions for hypertension were associated with metereological data obtained from three nearby weather stations. Data comprised temperature (mean, maximal, minimal and range within 24 h), athmospheric pressure, and precipitation. Changes of these parameters were calculated over a two and three day period. There was an inverse correlation between maximal daily temperature and the number of admissions for hypertensive disease, which remained significant both after adjustment for seasonality and week day in a spline model and in a constrained distributed lag model. A decrease of maximal temperature by 5 °C was associated with a 3% increase of risk for admission for hypertension and vice versa. There were no significant effects of precipitation and athmospheric pressure on the number of admissions. With regard to all observed metereological parameters, neither the change within two, nor within three days was consistently associated with the number of daily admissions. High temperatures are associated with lower numbers of hypertensive episodes requiring hospital admission. In contrast to the subjective perception of many hypertensive patients, however, acutely changing weather conditions are not associated with a higher risk of hypertensive emergency.

Psychiatric Emergency Admissions and Inpatient Length of Stay Before and During the COVID-19 Pandemic in Germany

The impact of the COVID-19 year on the number of daily psychiatric emergency admissions and length of stay was compared with previous years. In a retrospective study, the four quarters of 2020 of several psychiatric hospitals in Germany were statistically compared with the respective quarters of 2018 and 2019. A total of 73,412 cases was analyzed. In the 2nd quarter of 2020, the number of daily admissions was significantly lower as compared to the control period (59.1 vs. 70.7; incidence rate ratio [95 % confidence interval] 0.81 [0.69; 0.96]; p = 0.012). Length of stay was numerically but not significantly different as compared to the control periods. The COVID-19 pandemic had a strong impact on inpatient psychiatric care. In the future, multimodal care structures must ensure the care of severely mentally ill people in crisis situations.

A learning health system approach to the COVID-19 pandemic: System-wide changes in clinical practice and 30-day mortality among hospitalized patients.

IntroductionRapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID‐19) pandemic created a new threat to this common “slow to learn and adapt” model in healthcare. We describe how the University of Pittsburgh Medical Center (UPMC) committed to a rapid learning health system (LHS) model to respond to the COVID‐19 pandemic.MethodsA treatment cohort study was conducted among 11 429 hospitalized patients (pediatric/adult) from 22 hospitals (PA, NY) with a primary diagnosis of COVID‐19 infection (March 19, 2020 ‐ June 6, 2021). Sociodemographic and clinical data were captured from UPMC electronic medical record (EMR) systems. Patients were grouped into four time‐defined patient “waves” based on nadir of daily hospital admissions, with wave 3 (September 20, 2020 ‐ March 10, 2021) split at its zenith due to high volume with steep acceleration and deceleration. Outcomes included changes in clinical practice (eg, use of corticosteroids, antivirals, and other therapies) in relation to timing of internal system analyses, scientific publications, and regulatory approvals, along with 30‐day rate of mortality over time.ResultsThe mean (SD) daily number of admissions across hospitals was 26 (29) with a maximum 7‐day moving average of 107 patients. System‐wide implementation of the use of dexamethasone, remdesivir, and tocilizumab occurred within days of release of corresponding seminal publications and regulatory actions. After adjustment for differences in patient clinical profiles over time, each month of hospital admission was associated with an estimated 5% lower odds of 30‐day mortality (adjusted odds ratio [OR] = 0.95, 95% confidence interval: 0.93‐0.97, P < .001).ConclusionsIn our large LHS, near real‐time changes in clinical management of COVID‐19 patients happened promptly as scientific publications and regulatory approvals occurred throughout the pandemic. Alongside these changes, patients with COVID‐19 experienced lower adjusted 30‐day mortality following hospital admission over time.

Reduction in Hospitalizations for Respiratory Diseases during the First COVID-19 Wave in Greece

Introduction: During the first COVID-19 wave, a considerable decline in hospital admissions was observed worldwide. Aim: This retrospective cohort study aimed to assess if there were any changes in the number of patients hospitalized for respiratory diseases in Greece during the first CO­VID-19 wave. Methods: In the present study, we evaluated respiratory disease hospitalization rates across 9 tertiary hospitals in Greece during the study period (March–April 2020) and the corresponding period of the 2 previous years (2018–2019) that served as the control periods. Demographic data and discharge diagnosis were documented for every patient. Results: Of the 1,307 patients who were hospitalized during the study period, 444 (35.5%) were males with a mean (±SD) age of 66.1 ± 16.6 years. There was a 47 and 46% reduction in all-cause respiratory morbidity compared to the corresponding periods of 2018 and 2019, respectively. The mean incidence rate for respiratory diseases during the study period was 21.4 admissions per day, and this rate was significantly lower than the rate during the same period in 2018 (40.8 admissions per day; incidence rate ratio [IRR], 0.525; 95% confidence interval [CI], 0.491–0.562; p < 0.001) or the rate during 2019 (39.9 admissions per day; IRR, 0.537; 95% CI, 0.502–0.574; p < 0.001). The greatest reductions (%) in the number of daily admissions in 2020 were observed for sleep apnoea (87% vs. 2018 and 84% vs. 2019) followed by admissions for asthma (76% vs. 2018 and 79% vs. 2019) and chronic obstructive pulmonary disease (60% vs. 2018 and 51% vs. 2019), while the lowest reductions were detected in hospitalizations for pulmonary embolism (6% vs. 2018 and 23% vs. 2019) followed by tuberculosis (25% vs. both 2018 and 2019). Discussion/Conclusion: The significant reduction in respiratory admissions in 2020 raises the reasonable question of whether some patients may have avoided seeking medical attention during the COVID-19 pandemic and suggests an urgent need for transformation of healthcare systems during the pandemic to offer appropriate management of respiratory diseases other than COVID-19.

Changed pattern of hospital admission in stroke during COVID-19 pandemic period in Iran: a retrospective study

BackgroundSome previous reports have shown a reduced number of admission in stroke cases during the coronavirus disease 2019 (COVID-19) pandemic period. The present study aimed to investigate this changing pattern and the potential causes behind it at an academic neurology and neurosurgery center in Iran.MethodsPatients admitted to our center with the diagnosis of ischemic and hemorrhagic stroke, between March 1, 2019, Jun 1, 2019, and the similar 3-month period in 2020 (COVID-19 pandemic period), were compared in terms of clinical characteristics and outcome. Poisson regression was also conducted to assess the correlation between daily admissions and the COVID-19 pandemic period.ResultsA total of 210 patients with stroke (ischemic and hemorrhagic) in 2019 were compared with 106 patients in 2020. COVID-19 pandemic period was significantly associated with the decline in the number of daily admissions in ischemic stroke (IRR, 0.51 [95% CI, 0.4–0.64]). A significant reduction (P = 0.003) in time from onset to arrival at hospital from median 12 h [IQR, 5–32] in 2019 to median 6 h [IQR, 4–16] in 2020 was found in ischemic stroke cases. National Institute of Health Stroke Scale (NIHSS) was significantly increased (P < 0.001) from median 4 [IQR, 2–7] in 2019 to median 9 [IQR, 4–14] in 2020. Glasgow coma scale (GCS) was significantly decreased from 13.9 (SD, 2) in 2019 to 12.8 (SD, 2.9) in 2020 (P < 0.001).ConclusionsThe present study provided new pieces of evidence regarding the changed pattern of hospital admission in stroke especially the possible reasons for its decline.

Bed Utilization and Overcrowding in a High-Volume Tertiary Level Pediatric Emergency Department

To measure bed utilization rate and overcrowding in a high-volume tertiary level pediatric emergency department (ED) and correlate with outcome. All children beyond neonatal age attending the 22-bedded emergency were prospectively enrolled from February to December, 2019. Number of daily admissions, boarders, discharges, ward transfers, length of stay (LOS) and unfavorable outcomes (care discontinuation and deaths) were recorded. Daily bed occupancy rate (BOR) was calculated and correlated with unfavorable outcome. A total of 17,463 children visited the ED during the study period. The median (IQR) daily attendance and admission rate was 58 (51,65) and 22 (17,26) patients, respectively. The median (IQR) number of boarders and BOR was 48 (40-58) and 218% (181-263%), respectively. The median (IQR) LOS was 42.7 (23-71.4) hours. Unfavorable outcome correlated positively with number of boarders and BOR (P<0.001). Overcrowding of the ED was associated with increased frequency of care discontinuation and mortality. This data calls for systemic changes to tackle overcrowding.

The impact of COVID-19 pandemic on urological emergencies: a single-center experience.

PurposeCOVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies.Methodswe retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models.ResultsThe final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096–6.757, p = 0.0297) was a significant predictor of admission.ConclusionsUrgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.Electronic supplementary materialThe online version of this article (10.1007/s00345-020-03264-2) contains supplementary material, which is available to authorized users.

T125. AN ASSOCIATION BETWEEN OZONE, BUT NOT OTHER AIR POLLUTANTS, AND DAILY NUMBER OF VISITS TO PSYCHIATRIC EMERGENCY SERVICES

BackgroundAir pollution is a major environmental risk to health. Exposure to xenobiotic heavy metals such as lead and cadmium—constituents of air pollution such as particulate matter and nitrogen and sulfur oxides, organic solvents, and other environmental pollutants—could be component causes for schizophrenia and other psychotic disorders. Long-term exposure to ambient air pollution could be an independent risk factor for mental health disorders. Recent studies analysing the association between daily levels of air pollutants and hospital admissions for mental disorders showed significant results for different pollutants considered both for admissions for generic mental disorders and for specific diagnoses such as schizophrenia, depression and substance abuse. Aim of the present study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy)MethodsWe collected data about daily admissions to psychiatric emergency services of two general hospitals, daily levels of respirable particular matter (PM10 and PM2.5), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and meteorological data (daily average temperature, pressure, humidity, and maximum and average wind speed) for the time period 1 January 2015 until 31 December 2016 (731 days). We used air monitoring data for the different types of air pollutants which were averaged across up to 16 monitor stations dispersed in the region. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework.ResultsA total of 1860 cases of emergency department admissions for mental disorders were recorded over the study period.We observe a statistically significant impact of O3 levels on daily admissions. The estimated coefficient of O3 is statistically significant at the 1 percent level. According to our results, an increase of one µg/ m3 of O3 concentration (relative to the average concentration of the last 20 days) results in 0.013 more admissions to the hospitals.All other pollutants are not significantly associated with the number of daily admissions.DiscussionWe observed a statistically significant association of daily ozone levels and daily number of admissions to psychiatric emergency services. Ozone is a component of photochemical smog and a powerful oxidant, and is considered as one of the most important air pollutants. Ozone may have a relevant interference with CNS physiology, and its exposure may be linked to brain disease and contribute to inflammation and oxidative stress.Ozone exposure may be considered a potential environmental risk factor for impaired mental health. Epidemiological studies found evidence that ozone exposure may affect autism spectrum disorders, lead to motor disorders and cognitive impairment, and have an influence on the incidence of depression and suicide. In recent studies ozone air levels showed an association with increased risk of an emergency department visit for depression. This is one of the first studies worldwide investigating the association between daily concentration of air pollutants and the daily number of visits to a psychiatric emergency unit.Our results add to previous literature on existing evidence for air pollution to have a role in the cause or worsening of mental distress and psychiatric disorders. Contrary to our hypothesis, we did not find a positive association between most of the air pollutants considered in our study. This is in contrast with previous literature on this subject.This could be explained by the methodological limitations of our study.

748 The Calm After the Storm? Burn Injury Incidence Following Hurricanes and Tropical Storms

Abstract Introduction In recent years, we have noted a pattern of a surges in burn admissions occurring in the wake of some of the larger storm events occurring in our region. Many injuries incurred in the activities related to the storms’ aftermath— accelerate related burns from burning debris, generator explosions, and electrical repair burns. It is suspected that conditions created by larger storms may increase the population-wide risk for burn injuries for some time after the storm itself. If trues, this would suggest a need for more concerted burn prevention efforts in the wake of major natural disasters. The purpose of this study was to identify whether there is indeed a predictable surge in burn injuries relationships between seasonal variation and burn injuries in one catchment area of a regional center. We hypothesize that there is an underlying association between significant storms and an increased number of burn-related injuries before and after storms. Methods Using a retrospective approach, we examined burn center admission data from 2007–2018 (N=4,637) to include burns in the week prior to and three weeks after hurricane or tropical storm events (a storm window) in our state. This dataset only examined burns in which patients were admitted greater than 20 hours to exclude any confounding follow-up visits. Results Using Poisson regression to evaluate the effect of the storm window has on the number of daily admissions, there was found to be no significant association in respect to daily case totals (p=.165) when comparing across all years in respect to storm windows. When examining data from 2017 and 2018; years in which severe storms (category 4+) hit the state of Florida, there was found to be a significant increase in the number of daily burn admissions during the storm window by about 39% (p=0.039) as compared to 2015 when no storms hit the state. Conclusions It is hypothesized that a significant association of injuries were found in later years due to the ever-increasing intensity of storms hitting the state. Public awareness should be directed to the dangers of burns and related injuries in the wake of major weather events, i.e. before and after storms. In addition, further studies should examine the relationships between injuries and weather-related events. Applicability of Research to Practice Awareness of a tendency for burn injuries and admissions to surge after major storms could be used to improve the timing and content of burn prevention response to these incidents.

Air pollutants and daily number of admissions to psychiatric emergency services: evidence for detrimental mental health effects of ozone.

Aim of the current study is to investigate the associations between daily levels of air pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide) and daily admissions for mental disorders to the emergency department of two general hospitals in Umbria region (Italy). We collected data about daily admissions to psychiatric emergency services of two general hospitals, air pollutants' levels and meteorological data for the time period 1 January 2015 until 31 December 2016. We assessed the impact of an increase in air pollutants on the number of daily admissions using a time-series econometric framework. A total of 1860 emergency department admissions for mental disorders were identified. We observed a statistically significant impact of ozone levels on daily admissions. The estimated coefficient of O3 is statistically significant at the 1% level. All other pollutants were not significantly associated with the number of daily admissions. Short-term exposure to ozone may be associated with increased psychiatric emergency services admissions. Findings add to previous literature on existing evidence for air pollution to have an impact on mental health. Ozone may be considered a potential environmental risk factor for impaired mental health.

Seasonality in trauma admissions - Are daylight and weather variables better predictors than general cyclic effects?

BackgroundTrauma is a leading global cause of death, and predicting the burden of trauma admissions is vital for good planning of trauma care. Seasonality in trauma admissions has been found in several studies. Seasonal fluctuations in daylight hours, temperature and weather affect social and cultural practices but also individual neuroendocrine rhythms that may ultimately modify behaviour and potentially predispose to trauma. The aim of the present study was to explore to what extent the observed seasonality in daily trauma admissions could be explained by changes in daylight and weather variables throughout the year.MethodsRetrospective registry study on trauma admissions in the 10-year period 2001–2010 at Oslo University Hospital, Ullevål, Norway, where the amount of daylight varies from less than 6 hours to almost 19 hours per day throughout the year. Daily number of admissions was analysed by fitting non-linear Poisson time series regression models, simultaneously adjusting for several layers of temporal patterns, including a non-linear long-term trend and both seasonal and weekly cyclic effects. Five daylight and weather variables were explored, including hours of daylight and amount of precipitation. Models were compared using Akaike’s Information Criterion (AIC).ResultsA regression model including daylight and weather variables significantly outperformed a traditional seasonality model in terms of AIC. A cyclic week effect was significant in all models.ConclusionDaylight and weather variables are better predictors of seasonality in daily trauma admissions than mere information on day-of-year.

The Concomitant Use of Diuretics, Non-Steroidal Anti-Inflammatory Drugs, and Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers (Triple Whammy), Extreme Heat, and In-Hospital Acute Kidney Injury in Older Medical Patients.

We investigated whether the concomitant use of diuretics, non-steroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (triple whammy, TW) predicts in-hospital acute kidney injury (AKI) and whether admission during recorded periods of extreme heat influences this association. We retrospectively collected data on patient characteristics and use of TW/non-TW drugs on admission, AKI (increase in serum creatinine≥27µmol/l either within the first 48h of admission or throughout hospitalization, primary outcome), length of stay (LOS), and mortality (secondary outcomes) in medical patients ≥65years admitted (1) during five consecutive heat waves (HWs) between 2007 and 2009 (n=382) or (2) either before or after each HW, matched for HW period, age, and admission day of the week (non-HW, controls, n=1339). Number of TW and non-TW drugs, co-morbidities, number of daily admissions, incidence of in-hospital AKI, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, logistic regression showed that TW use did not predict AKI within 48h of admission either during non-HW periods (OR 0.79, 95% CI 0.34-1.83, P=0.58) or during HWs (OR 1.02, 95% CI 0.21-2.97, P=0.97). Similar results were observed when AKI was captured throughout hospitalization. TW use did not predict LOS or mortality irrespective of environmental temperature on admission. TW use on admission did not predict in-hospital AKI, LOS, or mortality in older medical patients admitted either during periods of normal environmental temperature or during HWs.

Psychotropics, Environmental Temperature, and Hospital Outcomes in Older Medical Patients.

The authors investigated whether the use of psychotropics and environmental temperature on admission influence hospital length of stay (LOS) and mortality in older medical patients. Clinical and demographic characteristics, Charlson Comorbidity Index, use of psychotropic and nonpsychotropic drugs, hospital LOS, and mortality were retrospectively collected in medical patients 65 years and older (n = 382) admitted to a metropolitan teaching hospital during 5 consecutive heat waves (HWs) between 2007 and 2009. Patients admitted either before or after each HW, matched for HW period, age, and admission day of the week, served as controls (non-HW, n = 1339). Total number of psychotropic and nonpsychotropic drugs, Charlson Comorbidity Index, comorbidities, number of daily admissions, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, competing risks regression showed that psychotropic use, particularly antipsychotics, predicted increased LOS during non-HW (subdistribution hazard ratio: 95% CI, 0.82, 0.72-0.94; P = 0.003) but not HW (subdistribution hazard ratio: 95% CI, 0.89, 0.69-1.14; P = 0.36) periods. The effect of psychotropics on LOS during normal weather conditions was particularly evident in the old-old subgroup (difference [SE] in coefficients between non-HW and HW periods: -0.52 [0.25], P = 0.036 in patients >80 years; 0.11 [0.19], P = 0.54, in patients 65-80 years). By contrast, psychotropics did not predict hospital mortality during non-HW or HW periods. Psychotropic use on admission, particularly antipsychotics, predicted hospital LOS, but not mortality, in older medical patients, particularly those older than 80 years, during normal environmental temperature. However, there was no effect of psychotropics on LOS during extreme heat.

Agravamento da saúde e vulnerabilidades climáticas e socioeconómicas: indivíduos com AVC, dispneia e asma e dor torácica (Porto, 2005-2008)

Este trabalho de investigação tem como objetivo averiguar as relações existentes entre a saúde (ocorrências na urgência com AVC, Dispneia &amp; Asma e Dor Torácica) e o contexto socioambiental dos doentes, a partir da análise de múltiplas variáveis, de modo a contribuir para a identificação de fatores que possam ajudar a explicar a distribuição e magnitude do número de ocorrências diárias de urgências e, assim, fornecer informações úteis para a definição de medidas que permitam antecipar e mitigar o problema, minimizando a exposição ao risco de desenvolvimento ouagravamento das doenças mencionadas.

Heat Waves, Drugs with Anticholinergic Effects, and Outcomes in Older Hospitalized Adults.

To determine whether heat waves (HWs) affect exposure to drugs with anticholinergic effects (DACEs) on admission and the effect of such on length of stay (LOS) and in-hospital mortality in older adults. Retrospective. Metropolitan teaching hospital. Individuals aged 65 and older with at least one chronic condition (n=307) admitted to a medical ward during five consecutive HWs (≥5 consecutive days of a maximum temperature of ≥35°C or ≥3 consecutive days of a maximum temperature of ≥40°C) recorded between 2007 and 2009. Individuals admitted before or after each HW, matched for HW period, age, and day of the week admitted, served as controls (n=1,114). Data on clinical and demographic characteristics, Charlson Comorbidity Index (CCI), total medication and DACE exposure on admission (any DACE, number of DACEs, or Anticholinergic Risk Scale (ARS) score), LOS, and in-hospital mortality were collected using electronic medical data. No significant differences in total medications, DACE exposure, CCI, number of daily admissions, LOS, or in-hospital mortality were observed between the HW and control groups. DACE exposure (ARS) predicted longer LOS during non-HW (β=0.70, standard error (SE)=0.27, P=.01) but not HW (β=0.02, SE=0.46, P=.96) periods. ARS did not predict mortality during non-HW (odds ratio (OR)=1.02, SE=0.12, P=.87) or HW (OR=1.21, SE=0.23, P=.31) periods. The effect of DACE exposure on LOS, but not mortality, is different between HW and non-HW periods in older hospitalized adults. This should be considered when assessing the effect of DACEs in pharmacoepidemiological studies.

Associations between attending physician workload, teaching effectiveness, and patient safety.

Prior studies suggest that high workload among attending physicians may be associated with reduced teaching effectiveness and poor patient outcomes, but these relationships have not been investigated using objective measures of workload and safety. To examine associations between attending workload, teaching effectiveness, and patient safety, hypothesizing that higher workload would be associated with lower teaching effectiveness and negative patient outcomes. We conducted a retrospective study of 69,386 teaching evaluation items submitted by 543 internal medicine residents for 107 attending physicians who supervised inpatient teaching services from July 2, 2005 to July 1, 2011. Attending workload measures included hospital service census, patient length of stay, daily admissions, daily discharges, and concurrent outpatient duties. Teaching effectiveness was measured using residents' evaluations of attendings. Patient outcomes considered were applicable patient safety indicators (PSIs), intensive care unit transfers, cardiopulmonary resuscitation/rapid response team calls, and patient deaths. Mixed linear models and generalized linear regression models were used for statistical analysis. Workload measures of midnight census and daily discharges were associated with lower teaching evaluation scores (both β = -0.026, P < 0.0001). The number of daily admissions was associated with higher teaching scores (β = 0.021, P = 0.001) and increased PSIs (odds ratio = 1.81, P = 0.0001). Several measures of attending physician workload were associated with slightly lower teaching effectiveness, and patient safety may be compromised when teams are managing new admissions. Ongoing efforts by residency programs to optimize the learning environment should include strategies to manage the workload of supervising attendings.

Shaping Up: Unit‐to‐Unit Handoffs with a Lean Six Sigma Work Out

Purpose for the Program It is well documented that ineffective communication through handoffs can lead to gaps in patient safety. Sharp Mary Birch Hospital for Women & Newborns has approximately 8,500 annual deliveries. As a result of the rapid turnover of patients, number of daily admissions, and daily bed capacity limitations, unit‐to‐unit handoffs are frequent, fast‐paced, and problem prone. The Employee Opinion Survey and Culture of Safety data indicated that there was room for improvement in unit‐to‐unit handoffs and teamwork across departments. Proposed Change Conducting a Lean Six Sigma Work Out that focused on unit‐to‐unit handoffs. A Work Out is a process designed to bring together the right stakeholders to develop solutions and actions. The Work Out group reviewed current practices, determined information that should be included in reports between units, and developed a standardized report checklist. The Work Out group also planned the next steps for implementing face‐to‐face report. Implementation, Outcomes, and Evaluation After a trial of the standardized report checklist, input from staff was used to revise the checklist, which is now to be used for all unit‐to‐unit handoffs. When comparing the 2012 with the 2011 Culture of Safety Survey for the hospital, there were significant improvements in patient safety perception and teamwork within units. There was no change in the overall score for teamwork across units, though this score was already at the 75th percentile and there were notable improvements in individual departments. The hospital plans to implement face‐to‐face report in all hospital units starting with labor and delivery and maternal infant services. To minimize training costs to implement the new process and to improve retention of information, creative tools, such as animated video of good and bad handoffs, will be used. Implications for Nursing Practice Lean Six Sigma tools provide an effective methodology for process improvement in hospitals. The Lean Six Sigma Work Out process can be used to standardize report between units and as a result lead to improvements in patient safety. It is well documented that ineffective communication through handoffs can lead to gaps in patient safety. Sharp Mary Birch Hospital for Women & Newborns has approximately 8,500 annual deliveries. As a result of the rapid turnover of patients, number of daily admissions, and daily bed capacity limitations, unit‐to‐unit handoffs are frequent, fast‐paced, and problem prone. The Employee Opinion Survey and Culture of Safety data indicated that there was room for improvement in unit‐to‐unit handoffs and teamwork across departments. Conducting a Lean Six Sigma Work Out that focused on unit‐to‐unit handoffs. A Work Out is a process designed to bring together the right stakeholders to develop solutions and actions. The Work Out group reviewed current practices, determined information that should be included in reports between units, and developed a standardized report checklist. The Work Out group also planned the next steps for implementing face‐to‐face report. After a trial of the standardized report checklist, input from staff was used to revise the checklist, which is now to be used for all unit‐to‐unit handoffs. When comparing the 2012 with the 2011 Culture of Safety Survey for the hospital, there were significant improvements in patient safety perception and teamwork within units. There was no change in the overall score for teamwork across units, though this score was already at the 75th percentile and there were notable improvements in individual departments. The hospital plans to implement face‐to‐face report in all hospital units starting with labor and delivery and maternal infant services. To minimize training costs to implement the new process and to improve retention of information, creative tools, such as animated video of good and bad handoffs, will be used. Lean Six Sigma tools provide an effective methodology for process improvement in hospitals. The Lean Six Sigma Work Out process can be used to standardize report between units and as a result lead to improvements in patient safety.