Number Of Patient Discharges Research Articles

Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study: a multicentre, prospective cohort analysis.

To determine the percentage of patients across Ireland who are discharged from the Emergency Department (ED) with an antimicrobial prescription, the indication, classification of infections, and guideline compliance. To identify potential areas for antimicrobial stewardship (AMS) interventions in the ED. A multicentre, prospective cohort analysis study in EDs across eight hospitals in Ireland. At each site, patients aged 1 month and older who presented to the ED and were discharged directly from the ED were included. A random selection of records of patients discharged from the ED were reviewed until a minimum of 30 records with an infection diagnosis resulting in an antibiotic prescription were obtained per hospital. The number of patient discharges with no antibiotic prescriptions were included to calculate the denominator. The indication, infection classification and guideline compliance data were collected on the 30 prescriptions in the participating hospitals. A total of 2619 patient records were reviewed. Of these, 249 (9.5%) patients were discharged with antimicrobial prescriptions from the ED. Most (158; 63%) were classified as probable bacterial infection, 21 (8%) as probable viral, and 18 (7%) had no documented evidence of infection. Three indications accounted for 73% of antimicrobial prescriptions: skin/soft tissue infection; ear, nose and throat infection; and urinary tract infection. Overall guideline compliance was 64%. Several areas for AMS interventions to optimize antimicrobial prescribing in the ED were identified, including targeted local and national guideline reviews, delayed prescribing, improved point-of-care testing and prescriber and patient education.

Physician characteristics correlate with hospital readmission rates.

Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates.In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians’ discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year.Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates.Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians’ 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.

Clinical, humanistic, and economic outcomes between drug-eluting stent (DES) and bare metal stent (BMS): 18-month follow-up study

Background: Percutaneous coronary intervention (PCI) is one of the most performed interventions for ischemic heart diseases. In Hong Kong, the total number of patient discharges and deaths for ischemic heart diseases in 2009 was 33,363, including 4,360 deaths. There are over 5,000 cases of PCI yearly. This study aimed to compare clinical, economic, and humanistic outcomes among patients receiving drug-eluting stent (DES) or bare metal stent (BMS) in Hong Kong.Methods: Patients who received stent implantation between September 15, 2009 and October 11, 2010 in Prince of Wales Hospital, Hong Kong, were recruited and followed for 18 months. Occurrence of major adverse cardiac events (cardiac death, non-fatal MI, TLR and TVR) was employed as the clinical outcome measurements. Improvement in quality-of-life by stent interventions was measured as quality-adjusted life-year (QALY). EQ-5D questionnaire was adopted to assess the QALY gained. Cost-utility analysis and cost-effectiveness analysis for BMS and DES were employed as the economic outcome measurement.Results: Six hundred and eighty-four patients (DES = 402; BMS = 282) were included. From 0–18 months, TLR rate (2.7% vs 3.5%, p = .549) and TVR rate (3.7% vs 6.4%, p = .111) were lower in the DES group, but without statistical significance. EQ VAS (71.06 ± 14.56 vs 71.07 ± 16.57, p = .998) and utility score (0.81 ± 0.17 vs 0.78 ± 0.16, p = .162) were comparable between DES and BMS group. Overall, the cost per QALY gained was HKD + 1,178,100 and ICER was HKD + 187,000 (1USD = 7.8 HKD).Conclusions: No significant difference in TVR, TLR rates, EQ VAS, and utility score was found between the DES and BMS group. The higher cost of index procedure for the DES group was found to be partly offset by reduced cost of follow-up, offering cost-effectiveness in ACS patients, predominantly in STEMI patients. DES was recommended for STEMI patients.

Discharge planning in a cardiology out-patient clinic: a clinical audit.

The purpose of this paper is to audit the active discharge (DC) planning process in a general cardiology clinic, by pre-assessing patients' medical notes and highlighting those suitable for potential DC to the clinic physician. The cardiology clinical nurse specialist (CNS) identified patients' for nine- to 12-month return visits one week prior to attendance. The previous consultation letter was accessed and information was documented by the CNS in the medical record. The key performance indicator (KPI) used was patient DCs for each clinic visit. The process was audited at three separate times to reflect recommended action carried out. The CNS pre-assessment and presence at the clinics significantly increased total DCs during the first period compared to usual care, 11 vs 34 per cent (p < 0.0001). During the third audit period, DCs fell (9 per cent) with a reduction in CNS pre-assessed DCs (10 per cent). Recommendations were implemented. The process was continued by clinic administration staff, colour coding all nine- to 12-month returns, resulted in a 19 per cent DC rate in 2012. CNS pre-assessment and highlighting DC suitability increased the number of patient DCs. As the CNS presence at the clinic reduced so did the rate of DC. Specific personnel need to be responsible for monitoring and reminding staff of the process; this does not always have to be medical or nursing. Implementing positive discharging procedures is aimed at improving quality, increasing efficiency and accessibility of services for patients. This audit describes a process to promote DC planning from cardiology outpatients.

Abstract 154: Acute Stroke Recognition by Paramedics after Regionalization of Stroke Care: Outcomes Based Study

Background: Early evidence supports preferential transport of patients with stroke symptoms to primary stroke centers. While validated stroke tools exist for screening of stroke symptoms in the prehospital setting, system wide triage performance of prehospital providers in a regionalized system has not been reported. The objective of this study is to assess the diagnostic ability of prehospital providers, before and after regionalization of care, using outcomes based approach. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. One county remained non-regionalized (NR) during the study period and the other initiated and completed regionalization(R) of the system during the study period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and physician diagnosis was obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Sensitivity, specificity and predictive values for were determined before and after implementation of regionalization. Data analysis was performed using SAS version 9.2. Results: The total number of medical related EMS transports for 3 years was 310,731 and the number of patient discharges with a primary diagnosis of stroke was 10,298. We were able to link 3736 stroke records which indicate EMS use by 36% (3736/10,298) stroke patients. The sensitivity, specificity, PPV and NPV in the pre-regionalization phase was 28%, 80%, 53%, 58% and during the implementation phase of regionalization was 39% 78%,57% and 63% (p &lt;0.05). The performance in the NR County during the entire period was 23%, 76%, 40% and 58%. Conclusions: Diagnostic accuracy remained low although improved prehospital provider performance was observed after regionalization of stroke care.

Outcome of Planned Discharge from Case Management: A 3 Year Retrospective Study

To investigate the rates of relapse of mental illness in adults requiring acute intervention at a mental health service following a planned discharge process from community case management. A planned approach to identifying and facilitating patient discharge was identified and incorporated into clinical team reviews. Data regarding service contacts of all discharged patients were collected at 1 year and then 3 years following planned discharge and reviewed in detail. Demographic factors and clinical variables were collected in anticipation that useful predictors for successful discharge might be identified. Using a planned approach, a greater number of patients were discharged from case management to the care of a primary treating practitioner. Discharges increased from 11 in 2000 to 46 in 2001. Of the 46 patients discharged from case management, 22 patients (47.8%) had no contact with the service during the first 12 months. Twenty-four patients accessed the Service requiring no further action, but at some point nine (19.6%) required acute intervention. The remaining 15 patients (32.6%) were managed successfully either by the triage service or non-urgent referral for psychiatric consultation. During the 3 year period 10 patients (21.7%) continued to have no contact with the service. Nineteen patients (41.3%) required acute intervention; the remaining 17 (36.9%) were successfully managed through triage or via non-urgent psychiatric review requiring no further action by the Service. Of the seven patients who had been on a community treatment order during their treatment, only one had further contact with the Service. A planned approach to the discharge of patients from case management to the community resulted in an increased number of patient discharges. While most patients did not rapidly relapse, a number of patients did have contact with the Service and 19 (41.3%) required at least one acute intervention during the 3 year follow-up period. The findings reflect the importance of relapse prevention and management and service re-entry planning with triage services, patients, carers and other key workers. The frequency of service use and the variation of services required by patients highlight the importance of availability of a variety of adequately resourced levels of service response.

Impact of enforcing the Labour Ordinance, with 1-in-7-day off for hospital doctors, on weekend hospital discharge rate

After enforcing the Labour Ordinance, hospital doctors must have 1 day off-work every week. In this study, we aimed to evaluate its impact on the discharge pattern from an acute medical hospital. We undertook a hospital-based ecologic study with before-after design using the clinical management database of patient discharge records of all acute medical wards in a hospital from January to March 2002 (1 year before new system) and from January to March 2004 (1 year after restricted weekend service). The main outcome measures were the daily discharge rates for the two periods. The odds of being discharged on a Saturday were estimated by multivariate analyses. The number of patient discharge on a Saturday was substantially lower in 2004 as compared to 2002 (47.5 +/- 8.5 per Saturday versus 70.5 +/- 11.1 per Saturday, respectively, p < 0.001). A statistically significant decreased trend was noted in the weekend discharge rate in 2002 and 2004 (Poisson p-value for change in discharge rate, p < 0.001). On the other hand, the number of patient discharges on weekdays did not differ between the two periods. Consistently fewer patients were being discharged on Sundays and Mondays as compared to the rest of the week days in both periods. Compared with study period 2002, patients hospitalized in 2004 (with limited weekend service) had significantly lower multivariate-adjusted odds of being discharged on a Saturday (odds ratio of 0.70; 95 percent confidence interval 0.72-0.89, p < 0.0001). Length of hospital stay is influenced by the health care system delivery apart from clinical factors. Restricted weekend services in an acute medical hospital setting substantially lengthen the hospital stay, and might therefore entail a major financial burden.