Number Of Home Medications Research Articles

The impact of clinical pharmacists’ medication reconciliation upon patients’ admission to reduce medication discrepancies in the emergency department: a prospective quasi-interventional study

BackgroundThe role of the clinical pharmacist in medication reconciliation is well established. Upon patients’ admission, the reconciliation service mainly focuses on achieving an accurate and full drug history. This will achieve the best treatment plan and reduce medication discrepancies.Upon the recent implementation of clinical pharmacy services in the emergency department at Alexandria Main University Hospital, medication reconciliation was one of the most important duties that needed to be focused on.We hypothesized that clinical pharmacists are able to achieve patients’ drug history lists with higher accuracy than emergency physicians.ResultsA total number of 161 patients were included. Age was 58.59 ± (13.78) years, number of comorbidities was 2.39 ± (1.22) and number of home medications was 4.51 ± (2.72). Clinical pharmacists’ fulfillment of patients’ drug history was significantly more accurate than the emergency physicians (75.16% and 50.3% of the total number of revised patients’ profiles respectively). The clinical pharmacists could put a written copy of the accurate patients’ drug history list in only 50.93% of the revised patients’ profiles. Five hundred eighty-five medication discrepancies were detected which represent an average of 3.63 discrepancies/medication sheet. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for medication reconciliation and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index were used to categorize discrepancies. Categories A, B, and C represented (66.5%), while categories D, E, and F represented (33.5%) of the total discrepancies. There was a significant direct relationship between the total number of discrepancies and both the number of comorbidities and the number of drugs administered before hospital admission.ConclusionThe clinical pharmacists are the main members of the emergency health care team. One of their fundamental services is medication reconciliation. The establishment of a complete drug history list and physicians’ discussion about the current treatment plan can obviously detect and reduce medication errors.Trial registrationNCT04395443. Registered 16 May 2020.

Value of pharmacy services upon admission to an orthopedic surgery unit

BackgroundIn Lebanon, the role of the pharmacist remains underestimated in the medication reconciliation process, especially in surgical departments. This study aims to assess the impact of pharmacist-conducted medication reconciliation performed within 48 h of hospital admission to the orthopedic surgical department.MethodsThis was a prospective single-arm study conducted in a tertiary-care teaching hospital in Lebanon between October 2019 and April 2020. Participants were adult inpatients hospitalized for orthopedic surgeries with ≥ 1 outpatient medications. Properly trained pharmacy resident obtained the Best Possible Medication History (BPMH) and led the reconciliation process. The primary endpoint was the number of reconciliation errors (REs) identified. Descriptive statistics were used to report participants’ responses and relevant findings. Linear regression was performed with the number of REs as a continuous dependent variable using backward method. Results were assumed to be significant when p was < 0.05.ResultsThe study included 100 patients with a mean age of 73.8 years, admitted for elective (54%) or emergency (46%) surgeries. Half of the study population had ≥ 5 home medications. The mean time for taking BPMH was around 8 min. A total of 110 REs were identified in 74 patient cases. The most common discrepancies consisted of medication omission (89.1%) and the most common medications involved were antihyperlipidemic agents. Twenty-four REs were judged as clinically significant, and four as serious. The most common interventions included the addition of a medication (71.9%). Most of the relayed interventions (84.5%) were accepted. The number of home medications was the only variable significantly associated with the number of REs (β 0.492; p < 0.001).ConclusionPharmacy-led medication reconciliation upon admission to orthopedic surgery department can reduce reconciliation errors and improve medication safety.Trial registrationRetrospectively registered in the Lebanon Clinical Trials Registry (LBCTR2020124680).

Predicting mortality of individual patients with COVID-19: a multicentre Dutch cohort

ObjectiveDevelop and validate models that predict mortality of patients diagnosed with COVID-19 admitted to the hospital.DesignRetrospective cohort study.SettingA multicentre cohort across 10 Dutch hospitals including patients from 27 February to...

Risk factors associated with unintentional medication discrepancies at admission in an internal medicine department.

At admission, unintentional medication discrepancies (UMDs) can occur and may led to severe adverse events. Some of them are preventable through medication reconciliation (MR). As MR is a time-consuming activity, a better identification of high-risk patients of UMDs is mandatory. The objective was to identify risk factors associated with UMDs at admission in an internal medicine department. This prospective observational study was conducted from April 2017 to June 2019. At admission, inpatients had MR to obtain a complete list of home medications. This list was compared to prescriptions made at admission. All discrepancies were classified as intentional or UMDs. Univariate and multivariate analyses to identify the risk factors associated with UMDs were performed. MR was performed on 1157 patients (70.1 ± 16.8years old); 550 MR (47.5%) contained at least one UMD. More than half of the UMDs (n = 892, 65.6%) corresponded to drug omission. The univariate analysis showed that age (> 60years old), "living at home", medication preparation not performed by patient, medication-intake difficulties, number of sources consulted, MR duration, presence of a high-risk drug and the number of home medications were associated with UMDs. In the multivariate analysis, adjusted on the number of sources consulted, independent risk factors were "living at home" and the number of home medications. At admission to an internal medicine department, UMDs were frequent and associated with "living at home" and poly-medication. Our findings might help physicians to identify high-risk patients of UMDs since their admission.

Potentially inappropriate home medications among older patients with cardiovascular disease in a Moroccan population

Abstract Funding Acknowledgements Type of funding sources: None. Background : Patients with cardiovascular diseases use often multi-drugs regimen , which can often be associated with use of potentially inappropriate medications PIMs especially in elderly , which may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among this population . Methods A Prospective study was conducted in a tertiary care hospital in Morocco where home medications of out patients were reviewed during follow-up consults and analyzed over three months, from October till December 2020. Inclusion criteria were age of 65 years and above, history of cardiovascular disease. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. Results A total of 214 patients were included in the study and were taking a total of 1498 medications at home, an average of 7 ± 3 medications per patient. The proportion of PIMS was 32 % of all medications reported, with an average of 2.2 PIM per patient, and 84% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, self medication , and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, rheumatological diseases, cerebrovascular accident, and insomnia/depression . The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (27.3%), NSAIDs use in patients under anticoagulants (21.2%) , use of proton pump inhibitors (PPIs) &amp;gt; 8 weeks in non-high-risk patients (10.5%), and benzodiazepines (5.7%). Conclusions A high prevalence of PIMs in older patients with cardiovascular disease was observed. Health care giver’s education and detailed assessment of medication lists upon follow-up consults or hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

Quality Improvement Incorporating a Feedback Loop for Accurate Medication Reconciliation.

Medication reconciliation errors on hospital admission can lead to significant patient harm. A pediatric intermediate care unit initiated a quality improvement project and aimed to reduce errors in admission medication reconciliation by 50% in 12 months. From August 2017 to December 2018, a multidisciplinary team conducted a quality improvement project with plan-do-study-act methodology. Continuous data collection was achieved by reviewing medications with home caregivers within 18 hours of admission to identify errors. Cycle 1 consisted of nursing training in accurate and thorough medication history documentation. Cycle 2 was aimed at improving data collection. Cycle 3 was aimed at improving pediatric housestaff processes for medication reconciliation. In cycle 4 intervention, the reconciliation process was redesigned to incorporate the bedside nurse reviewing final medication orders with the patient's home caregivers once the medication reconciliation process was complete. Intermittent maintenance data collection continued for 12 months thereafter. Cycle 1 and 2 interventions resulted in improvement in the medication reconciliation error rate from 9.8% to 4.7%. In cycle 2, the data collection rate improved from 61% to 80% of admissions sustained. Cycle 3 resulted in a further reduction in the medication error rate to 2.9%, which was sustained in cycle 4 and over the 12-month maintenance period. A patient's number of home medications did not correlate with the error rate. Reductions in admission medication reconciliation errors can be achieved with staff education on medication history and process for medication reconciliation and with process redesign that incorporates active medication order review as a closed-loop communication with home caregivers.

Proton Pump Inhibitors in the Elderly Hospitalized Patient: Evaluating Appropriate Use and Deprescribing.

Background: Proton pump inhibitors (PPIs) are often prescribed for elderly patients without appropriate indication, or for longer durations than recommended. Objective: To review appropriateness of PPI use prior to and in hospital, and deprescribing rates across different hospital units. Methods: Retrospective analysis of patients ≥65 years admitted to 5 acute care units: intensive care unit, acute care for elderly, orthopedics, surgery, and medicine. Patients who were "non-naive" (prehospital PPI use) or "naive" (new PPI initiated in hospital) users were included. For both groups, demographics, reason for admission, length of stay, comorbidities, name and number of home medications, PPI name, dose and indication, and PPI discharge instructions were collected. For naive patients, duration of in-hospital use and prescriber specialty was recorded. Results: Among non-naive patients (n = 377), for 37 patients (10%), the indication for a PPI was not appropriate, and for 92 patients (24%), the indication was unclear. Most patients had their home PPI continued while in hospital (87%) and at discharge (90%). Among naive (n = 93) patients, for 8 patients (9%), the indication for a PPI was not appropriate, and for 25 (27%) patients, the indication was unclear. PPI was prescribed to only 16 (18%) by the gastrointestinal consult service. Most patients had their new PPI continued at discharge (74%); only 7 (9%) were discharged with a plan to reassess PPI indication. Conclusion: PPIs are infrequently deprescribed during hospital admission, despite inappropriate or unclear indications for use. Thorough medication reconciliation, documentation of PPI indication and duration, and institutional focus on deprescribing are encouraged.

Impact of pharmacy-led medication reconciliation on admission to internal medicine service: experience in two tertiary care teaching hospitals

BackgroundThe Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service.MethodsThis is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The “total number of unintended discrepancies” was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05.ResultsDuring the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03–1.19) p = 0.007).ConclusionsPharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes.

Development of a multivariable prediction model for identification of patients at risk for medication transfer errors at ICU discharge.

IntroductionDischarge from the intensive care unit (ICU) is a high-risk process, leading to numerous potentially harmful medication transfer errors (PH-MTE). PH-MTE could be prevented by medication reconciliation by ICU pharmacists, but resources are scarce, which renders the need for predicting which patients are at risk for PH-MTE. The aim of this study was to develop a prognostic multivariable model in patients discharged from the ICU to predict who is at increased risk for PH-MTE after ICU discharge, using predictors of PH-MTE that are readily available at the time of ICU discharge.Material and methodsData for this study were derived from the Transfer ICU Medication reconciliation study, which included ICU patients and scored MTE at discharge of the ICU. The potential harm of every MTE was estimated with a validated score, where after MTE with potential for harm were indicated as PH-MTE. Predictors for PH-MTE at ICU discharge were identified using LASSO regression. The c statisticprovided a measure of the overall discriminative ability of the prediction model and the prediction model was internally validated by bootstrap resampling. Based on sensitivity and specificity, the cut-off point of the prediction model was determined.ResultsThe cohort contained 258 patients and six variables were identified as predictors for PH-MTE: length of ICU admission, number of home medications and patient taking one of the following medication groups at home: vitamin/mineral supplements, cardiovascular medication, psycholeptic/analeptic medication and medication for obstructive airway disease. The c of the final prediction model was 0.73 (95%CI 0.67–0.79) and decreased to 0.62 according to bootstrap resampling. At a cut-off score of two the prediction model yielded a sensitivity of 70% and a specificity of 61%.ConclusionsA multivariable prediction model was developed to identify patients at risk for PH-MTE after ICU discharge. The model contains predictors that are available on the day of ICU discharge. Once external validation and evaluation of this model in daily practice has been performed, its incorporation into clinical practice could potentially allow institutions to identify patients at risk for PH-MTE after ICU discharge, on the day of ICU discharge, thus allowing for efficient, patient-specific allocation of clinical pharmacy services.Trial registrationDutch trial register: NTR4159, 5 September 2013, retrospectively registered.

Potentially inappropriate home medications among older patients with cardiovascular disease admitted to a cardiology service in USA

BackgroundThe use of potentially inappropriate medications (PIMs) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among older patients.MethodsA retrospective chart review was conducted in a tertiary care center in USA where home medications of the older patients were reviewed and analyzed upon hospital admission over three months, from March till May 2016. Inclusion criteria were age of 65 years and above, history of cardiovascular disease, and admission to the cardiology service. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria.ResultsA total of 404 patients were included in the study and were taking a total of 4669 medications at home, an average of 11.6 ± 4.5 medications per patient. The proportion of PIMS was 20% of all medications reported, with an average of 2.4 PIM per patient, and 87.4% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, history of falls/fractures, cerebrovascular accident, and depression. The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (29.7%), scheduled use of proton pump inhibitors (PPIs) > 8 weeks in non-high-risk patients (11.3%), and benzodiazepines (8.1%).ConclusionsA high prevalence of PIMs in older patients with cardiovascular disease was observed. Provider education and detailed assessment of medication lists upon hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

POTENTIALLY INAPPROPRIATE HOME MEDICATIONS AMONG OLDER PATIENTS WITH CARDIOVASCULAR DISEASE ADMITTED TO A CARDIOLOGY SERVICE IN USA

The use of potentially inappropriate medications (PIMs) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among older patients. A retrospective chart review was conducted in a tertiary care center in USA where home medications of the older patients were reviewed and analyzed upon hospital admission over three months, from March till May 2016. Inclusion criteria were age of 65 years and above, history of cardiovascular disease, and admission to the cardiology service. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. A total of 404 patients were included in the study and were taking a total of 4669 medications at home, an average of 11.6 ± 4.5 medications per patient. The proportion of PIMS was 20% of all medications reported, with an average of 2.4 PIM per patient, and 87.4% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, history of falls/fractures, cerebrovascular accident, and depression. The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (29.7%), scheduled use of proton pump inhibitors (PPIs) > 8 weeks in non-high-risk patients (11.3%), and benzodiazepines (8.1%). A high prevalence of PIMs in older patients with cardiovascular disease was observed. Provider education and detailed assessment of medication lists upon hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

Abstract 358: Patient Satisfaction and Preference Assessment Post Outpatient Electrophysiology Procedures: Same Day versus Next Day Discharge

Objectives: Multiple studies have reported the safety of same day discharge (SDD) post-electrophysiology (EP) procedures, while patient satisfaction associated with this approach has not been well- studied. We sought to evaluate whether SDD would be associated with a comparable patient satisfaction rate compared with next day discharge (NDD) in various EP procedures. Furthermore, we aimed to assess patient preferences regarding discharge timing. Methods: A cohort of patients was identified using our institutional record of all outpatient EP lab procedures from August 2013 to November 2014. From this list, 6 groups were created based on discharge timing “SDD/NDD” and procedure “Ablation (A)/Pacemaker (P)/ICD (I)”. All operators offered SDD and were included. We excluded generator change and lead extraction procedures. Patients who stayed more than one night were also excluded. Post-discharge phone surveys were conducted starting from the most recent procedure until the target number was reached. The research team gathering surveys was blind to patient characteristics. The survey was composed of 24 questions, 10 of which were for Post-Discharge Coping Difficulty Scale (PDCDS). Results: We surveyed 132 patients, 53F/79M, 66 SDD/66 NDD with mean age (SD) of 63 (15). We had 29 patients in each A group, 17 in each I group, and 20 in each P group. Patients’ rating of overall satisfaction and readiness for discharge, as well as, calculated PDCDS outcomes were not significantly different in SDD vs. NDD for all procedures, I+A only, and A only ( p &gt;.05). Patient characteristics and procedural complications between groups did not differ significantly, though different operators did differ in numbers of SDD or NDD procedures. No significant interactions were found between various covariates and study outcomes including age, gender, BMI, number of home medications, operator, and type of procedure. Approximately1/3 of patients (43/132) were given the choice of the two discharge strategies by the operator. The majority of them (93%; 40/43) opted for SDD and rated “the opportunity for this choice” with a mean of 9.1 (1-10 scale, 10 excellent) in comparison to a mean of 6.7 for those who were not given the choice ( p &lt;. 0001). Only 12% (8/66) of SDD patients wished they had the alternative discharge strategy (P &lt; .0001), in comparison to 38% of NDD patients (25/66) ( p &lt;. 07). Overall, 51% (67/132) of all patients preferred SDD if they were to undergo similar procedure in the future. Conclusions: SDD strategy resulted in similar patient satisfaction to NDD strategy across different EP procedures and operators. Patients significantly appreciated the choice of SDD. The SDD group was more willing to repeat their discharge experience. This further supports following SDD strategy, whenever possible, to improve quality of care; in addition to the cost savings and increased efficiency associated with this approach.

Hospital readmission in children with complex chronic conditions discharged from subacute care.

Children with complex chronic conditions (CCC) are responsible for a disproportionate number of hospital readmissions. This study sought to determine 30-day hospital readmission rates in children with CCC discharged from a rehabilitation and transitional care hospital and to identify factors associated with increased risk of readmission. We conducted a retrospective cohort study identifying children with CCC discharged over an 18-month period from a subacute care facility staffed by hospitalists from a freestanding children's hospital. The primary outcome measure was readmission to the referring acute care hospital within 30 days of the subacute discharge. Of the 272 discharged patients meeting inclusion criteria as children with at least 1 CCC, 19% had at least 1 readmission within 30 days of discharge. On univariate analysis, readmission was associated with the number of home medications (P = .001), underlying chronic respiratory illness (P < .001), home apnea or pulse oximetry monitor use (P = .02), tracheostomy and/or ventilator dependence (P = .003), length of stay (P = .04), and number of follow-up appointments (P = .02). On multivariate analysis, the number of discharge medications was associated with increased odds of readmission (odds ratio: 1.11 [95% confidence interval: 1.03-1.20]; P = .01). Receiver operating curve analysis identified a cutoff of 8 medications as most associated with readmission; in patients discharged with ≥8 medications, the hospital readmission rate was 29%. This is the first known study that investigated hospital readmission rates in children with CCC discharged from a subacute facility and specifically identified the number of discharge medications as a significant risk factor for readmission.

Difference between Pharmacist-Obtained and Physician-Obtained Medication Histories in the Intensive Care Unit

Purpose To quantify the differences between medication histories obtained by physicians and pharmacists from critically ill patients in the intensive care unit (ICU) and to identify patient types at greatest risk of medication errors. Methods Retrospective medical record review of 200 consecutively admitted critically ill patients to the medical/surgical ICU of a university-affiliated hospital. The pharmacist-obtained medication history was compared to the physician-obtained medication history. Variations assessed included the number of drugs identified, drug name, drug formulation, dose, and frequency of administration. Inpatient medication orders were reviewed to obtain the number and accuracy of home medications prescribed in the ICU. Patients were divided into predefined groups: trauma, medical, and nontrauma surgical to assess the risk of medication error by patient type. Results Pharmacists and physicians identified a total of 981 and 665 medications, respectively. The mean (± SD) number of home medications per history was 4.2 (±4.9) for physicians and 6.2 (±5.7) for pharmacists ( P &lt; .0001). Physician-obtained medication histories contained 1,628 variances relative to the pharmacist-obtained medication histories. The variances by type included the frequency of administration, 37%; drug dose, 34.6%; missing drugs, 22.3%; extra drugs, 3.6%; and drug formulation, 2.5%. Thirty-nine patients received continuation of their home medications in the ICU totaling 97 orders (9.9% of home medications identified by pharmacists). Thirty of these orders varied from the pharmacy history and 27 were subsequently corrected. Conclusion. Pharmacists identified more home medications than physicians when obtaining a medication history in the ICU. This may improve the accuracy of home medications ordered in the ICU.

What Factors Prompt Return Visits to the Emergency Department for CHF?

Background: Risk factors for re-visits to the emergency department (ED) for CHF have not been clearly defined. Objectives: To identify which factors are associated with multiple visits to the emergency department in an eleven month period in congestive heart failure patients in New York City. Methods: We identified 49 patients who presented to the Mount Sinai Hospital Emergency Department multiple times during the study period for exacerbation of CHF. This “revisit” group was compared with two other groups: 399 consecutive CHF patients who presented to the Mount Sinai Hospital ED during the study period (“study-population” group) and a second group matched to those in the revisit group with respect to age, gender, and ethnicity. We compared the revisit group and the study-population group with respect to age, gender, ethnicity, common CHF symptoms on presentation, home CHF medications, admitting diagnoses, and length of stay, and compared the matched groups with respect to common CHF symptoms on presentation, home CHF medications, admitting diagnoses, and length of stay. In the pair-matched analysis, odds ratios for each risk factor for emergency department revisits are presented. Results: A comparison of the revisit group patients vs. the study-population group showed that revisits were significantly associated with caucasian ethnicity (inversely correlated; P=0.024), hispanic ethnicity (P=0.007), shortness of breath on presentation (P=0.027), orthopnea during the initial presentation (P=0.015), dyspnea on exertion (P=0.038), number of symptoms on presentation (P=0.001), home diuretic use (P=0.003), home nitrate use (P=0.014), number of home medications (P=0.012), diabetes (P<0.001). A comparison of the revisit group patients with the matched control group showed revisits were associated with orthopnea on initial presentation (odds ratio of revisit, 4.5; 95 percent confidence interval, 1.48 to 18.28; P= 0.005) and home diuretic use (odds ratio of revisit, 2.5; 95 percent confidence interval, 1.06 to 6.56; P= 0.038). Conclusions: Orthopnea on initial presentation and home diuretic use are strongly associated with revisits for CHF. Table 1Population Characteristics and Comparison of Patients Who Return to the ED in an 11 Month Period and Those Who do not Within this Population Study Population N = 399 (476 visits) Pair-Matched Non-revisitors N = 49 Revisit Group N = 49 Mean age range 71.5 (sd±15.2yrs)29-102 yo 69.2 (sd ±14.5yrs)35-95 yo 68.8 (sd±14.8yrs)35-95 yo Gender:% F 196 (61%) 28 (57%) 28 (57%) Ethnicity(unk=79) Caucasian 88 (27%) † variable associated with revisits at the p=0.05 level. 7 (14%) 7 (14%) African-Amer 104 (33%) 15 (31%) 15 (31%) Hispanic 111 (35%) † variable associated with revisits at the p=0.05 level. 25 (51%) 25 (51%) Other 17 (5%) 2 (4%) 2 (4%) Symptoms SOB 367 (92%) † variable associated with revisits at the p=0.05 level. 46 (94%) 49 (100%) orthopna /PND 149 (37%) † variable associated with revisits at the p=0.05 level. 10 (20%) 26 (53%) ⁎⁎ association of this variable remained associated with revisits when pair-matched at the p=0.01 level of significance. DOE 113 (38%) † variable associated with revisits at the p=0.05 level. 13 (27%) 20 (41%) avg # of sx 1.6 (sd±0.9) ‡ variable associated with revisits at the p=0.01 level. 1.4 (sd±0.8) 1.9 (sd±0.9) ⁎⁎ association of this variable remained associated with revisits when pair-matched at the p=0.01 level of significance. range 0-3 0-3 1-3 Home Meds beta-blocker 167 (42%) 18 (37%) 25 (49%) diuretic 224 (56%) ‡ variable associated with revisits at the p=0.01 level. 25 (51%) 37 (76%) ⁎ association of this variable remained associated with revisits when pair-matched at the p=0.05 level of significance. ACE-inhibitor 141 (35%) 16 (33%) 21 (41%) Nitrates 53 (13%) ‡ variable associated with revisits at the p=0.01 level. 5 (10%) 12 (25%) A2RB 19 (5%) 4 (8%) 4 (8%) av#homemeds 1.1 (sd±0.9) ‡ variable associated with revisits at the p=0.01 level. 1.0 (sd±1.0) 1.5 (sd±0.9) ⁎ association of this variable remained associated with revisits when pair-matched at the p=0.05 level of significance. range 0-4 0-4 0-3 Admitting dx hypertension 159 (40%) 23 (47%) 22 (45%) CAD 121 (30%) 19 (39%) 22 (45%) diabetes 101 (25%) ‡ variable associated with revisits at the p=0.01 level. 19 (39%) 24 (49%) valvular HD 42 (11%) 4 (8%) 5 (10%) dysrhythmia 95 (24%) 19 (39%) 12 (25%) infection 65 (16%) 12 (25%) 4 (8%) d/c home from ED 82 (21%) 0 patients 9 (18%) Mean LOS 7.2 days (sd±8.1) 5.2 days (sd±3.4) 6.6 days (sd±8.5) range 1-70 days 1-16 days 1-41 days † variable associated with revisits at the p=0.05 level. ‡ variable associated with revisits at the p=0.01 level. association of this variable remained associated with revisits when pair-matched at the p=0.05 level of significance. association of this variable remained associated with revisits when pair-matched at the p=0.01 level of significance. Open table in a new tab