Number Of Previous Admissions Research Articles

'Patient Satisfaction' in Hospitalized Cancer Patients

Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n=1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

Admitting service influences the outcomes of patients with small bowel obstruction

Background. Small bowel obstruction (SBO) is a common problem that often requires operation. We tested the hypotheses that patients admitted to a surgical service have improved outcomes and that these outcomes are related to early operation. Methods. Retrospective review of 281 patients with 336 episodes of SBO between 1992 and 1998 was performed. Parametric and nonparametric analysis was used as appropriate. Results. There were 222 admissions to a surgical service and 114 admissions to a medical service. Patient characteristics were similar between groups. Eighty-seven percent of patients had a previous abdominal or pelvic operation. There were 211 patients (217 admissions) who required operation. Operated patients admitted to the surgical service had a shorter preoperative (2.7 vs 6.3 days, P <.01) and overall length of stay (LOS) (17.9 vs 22.8 days, P <.0001). There was no difference in time to resumption of diet between groups. The number of previous admissions or operations did not affect the need for operative intervention. Unoperated patients admitted to a medical service had a shorter time to resumption of diet (3.1 vs 4.3 days) and LOS (4.8 vs 7.2 days, both P <.05) than the surgical service group. Operative mortality was 3.4%. The likelihood of developing a complication was related to the occurrence of an enterotomy (n = 21, odds ratio = 2.69; 95% confidence interval [CI]: 1.1-6.7, P =.014) or the need for bowel resection (odds ratio = 1.97; 95% CI: 1.2-3.5, P =.02). The occurrence of a complication resulted in a 46% increase in LOS (P <.0001). Patients operated on within 24 hours of admission had a decreased LOS (P <.05) and mortality, with no difference in the occurrence of postoperative complications. Conclusions. Patients with SBO who require operation benefit from a shorter time to operation and reduced LOS when admitted to a surgical service. Early operation is associated with a reduction in mortality, and avoidance of enterotomy decreases the risk of complications. (Surgery 2001;130:706-13.)

Psychiatric inpatients' satisfaction with services: A pilot study

INTRODUCTION: Fifty-three patients admitted to a psychiatric inpatient unit in South London were interviewed to ascertain their satisfaction with services provided for them. METHOD: The level of satisfaction with various aspects of treatment was evaluated using a 45-item questionnaire. RESULTS: Results showed that patients were generally satisfied with the staff attitudes and care, although two-thirds felt that they had not been sufficiently involved in their own treatment planning. Younger patients reported more frequent difficulties in the relationship with staff. Patients were generally satisfied with the physical environment. Patients with a higher number of previous admissions were more satisfied with the planning of care, and they were less often in conflict with the staff. Patients admitted compulsorily were less satisfied than voluntary patients with the overall quality of the help received and said they would rarely re-contact the service in the future. There was virtually no effect of ethnicity on the levels of satisfaction in different aspects of care. The only worry expressed more frequently by African-Caribbean patients was about re-contacting the service in the future, even though they felt the help received in planning their discharge was good. CONCLUSION: It would be useful to carry out such surveys more often.

The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: A randomized, double-blind, controlled study

Objective: The study compared the efficacy of methylprednisolone with that of promethazine for the treatment of hyperemesis gravidarum. Study Design: Patients with a normal-appearing intrauterine pregnancy of ≤16 weeks’ gestation with hyperemesis gravidarum (persistent vomiting and large ketonuria despite outpatient therapy) were admitted to the hospital for continuous intravenous hydration and offered participation in the study. Patients meeting study criteria were randomly assigned to receive (from identical-appearing dispensers packaged in advance with a 2-week supply) oral methylprednisolone, 16 mg 3 times daily, or oral promethazine, 25 mg 3 times daily. After 3 days the methylprednisolone was tapered completely during the course of 2 weeks whereas the promethazine was continued without change for 2 weeks. For patients who continued to vomit after 2 days the study medication was discontinued. Patients receiving study medication at discharge continued to take the remainder of the assigned medication from the packaged pill dispensers. Patients were followed up weekly. The study outcomes, as established in advance, were (1) improvement of symptoms within 2 days of starting therapy and (2) readmission for hyperemesis within 2 weeks of starting the study. Results: Forty patients were enrolled in the course of 11 months (20 per group). There were no significant differences between the groups with respect to maternal age, gravidity, parity, gestational age at entry, number of previous admissions, or >5% body weight loss. Three patients in the methylprednisolone group and 2 in the promethazine group failed to stop vomiting within 2 days. One patient from the promethazine group was unavailable for follow-up. No patient from the methylprednisolone group but 5 of the 17 patients receiving promethazine were readmitted for hyperemesis within 2 weeks of discharge (P = .0001). There were no adverse effects noted for either drug. Conclusion: A short course of methylprednisolone is more effective than promethazine for the treatment of hyperemesis. (Am J Obstet Gynecol 1998;179:921-4.)

Predicting length of stay in an acute psychiatric hospital.

Multivariate statistical methods were used to identify patient-related variables that predicted length of stay in a single psychiatric facility. The study investigated whether these variables remained stable over time and could be used to provide individual physicians with data on length of stay adjusted for differences in clinical caseloads and to detect trends in the physicians' practice patterns. Data on all patients discharged over two six-month periods were collected at an acute psychiatric inpatient facility. Stepwise multiple regression analyses were conducted on the two datasets. The results from both analyses revealed that five variables significantly predicted length of stay and were stable over time. They were a primary diagnosis of schizophrenia, the number of previous admissions, a primary diagnosis of a mood disorder, age, and a secondary diagnosis of an alcohol- or other drug-related disorder. For some physicians, the mean length of stay of their patients differed significantly from the length predicted by the regression model--generally, it was shorter. The results demonstrate that patient-related predictors of length of stay in a single psychiatric hospital can be identified using relatively simple statistical procedures and can be consistent across a large dataset and over time.

Gender differences in the receipt of aftercare and psychiatric hospitalization among adults with severe mental illness

Gender differences in receiving aftercare and being hospitalized for persons with severe mental illness were examined. For women, unique predictors for receiving aftercare were primarily treatment system responsiveness variables. For men, unique predictors of aftercare were from all categories and included being accompanied to the psychiatric emergency room (PER) by family or friends and having previous psychiatric admissions. More recent outpatient treatment and a greater number of previous admissions predicted hospitalization for both men and women. Receiving less intense aftercare predicted hospitalization for women but not men. Unique predictors of hospitalization for men were a higher level of education and a psychotic disorder diagnosis.

Risk factors for acute psychiatric readmission

A retrospective case note study explored readmissions to an acute psychiatric in-patient unit within six months of discharge. The study aimed to calculate a hospital readmission rate, to investigate the timing of readmissions, and to identify risk factors associated with readmission. The readmission rate was 27% with the majority of readmissions occurring within three months after discharge, suggesting the need for investigation of such early readmissions. The three factors found to predict readmission were: discharge against medical advice, number of previous admissions, and living alone or with family rather than in care. Implications for hospital service planning are considered.

Ethnic differences in satisfaction with mental health services among representative people with psychosis in south London: PRiSM study 4.

Previous studies show that among Black Caribbeans there is a higher prevalence of schizophrenia and higher levels of both voluntary and compulsory admissions. These suggest that Black Caribbean patients may find psychiatric services less appropriate to their needs. The aim of this study was to establish the satisfaction with mental health services of representative psychosis patients in South London, especially in relation to ethnic group. A random sample of all cases of psychotic disorder identified in the two sectors was interviewed using the Verona Service Satisfaction Schedule. Questionnaires from 50 Black Caribbean patients and 134 White patients were analysed. Black Caribbean patients, particularly those of second generation born in the UK, were significantly less satisfied with almost every aspect of the services that they received than either older Black Caribbean patients born in the Caribbean or White patients. Using multiple regression analysis it was found that among the younger Black Caribbean patients, unlike the other patients, the number of previous admissions was a significant predictor of dissatisfaction. Patients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.

Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study.

BACKGROUND: Re-admissions to hospital in childhood asthma are common with studies reporting that 25% or more of children will be re-admitted within a year. There is a need for strategies...

Antipsychotic dose: from research to clinical practice

A case note study of antipsychotic prescribing in an inner London hospital showed that although doses of individual drugs were below the British National Formulary limits, polypharmacy occurred in a third of cases. Multiple regression analysis showed high doses were associated with a current risk to the self or others and increasing number of previous admissions in patients with mania and treatment non-responsiveness in schizophrenia.

Absent without leave – can we predict those who go AWOL?

AbstractObjective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.

Prediction of the need for mechanical ventilation in acute severe asthma.

Unwarranted long delays in treating asthmatic patients requiring assisted mechanical ventilation (AMV) could be associated with higher death rates. The objective of the study was to identify which were the best predictive characteristics of patients with acute severe asthma (ASA) who required AMV. For this purpose, we reviewed retrospectively the hospital record of every patient with ASA admitted to the intensive care unit (ICU) from 1981 to 1991 (38 with AMV and 38 without AMV). Twenty-seven variables were obtained from the history, physical examination, laboratory tests, blood gases and treatment. Using a multivariate discriminant analysis, the most powerful predictor of patients needing AMV was a function that consisted of eight variables: arterial pH, number of previous admissions to ICU, asthma severity, time elapsed since last visiting a physician, respiratory rate, age, systolic pressure and heart rate. With this function, 33 of 38 mechanically ventilated patients were well classified (sensitivity: 0.89) and the overall accuracy of the test was 92% (70 out of 76 cases). The positive and negative predictive values of the function for mechanical ventilation were 0.96 and 0.90, respectively. We conclude that the application of the calculated final discriminant function could be appropriate to decide which patients with ASA require AMV.

A multivariate analysis of mental hospital recidivism.

This study identifies health problems, instrumental activities of daily living, employment status, and number of previous admissions as significant factors of recidivism to a mental health residential facility. The study, conducted over a 5-year period, includes measures on 32 predictor variables collected either on admission, on discharge, or 12-15 months following discharge or on readmission. The study's results are interpreted in light of current changes in the mental health service delivery system including the interactive role of physical and mental illnesses, expanding access to community-based generic services, focusing on functional skills and their development or remediation, and the changing criteria for measuring mental health effectiveness.

Failed discharges from the psychogeriatric ward

‘Failed discharge’ was used as a measure of service efficacy on a psychogeriatric unit. Thirty-eight failed discharges from hospital were compared with 38 controls. Failed discharge was associated with a diagnosis of depression and a greater number of previous admissions. Possible underlying causes are discussed.In the current NHS climate, it is increasingly important to measure the outcome of medical care. In psychiatry, the most appropriate methodology is not clear-cut (Garden &amp; Oyebode, 1989). Tailed discharge’, or readmission to hospital within a short period of discharge, has been advocated as a possible outcome measure (Jones, 1991). This point prevalence study, of patients under 65 years, yielded a ‘failed discharge’ rate of 27%. Recurrence of original symptoms, poor treatment compliance and failure of follow-up arrangements emerged as important factors.

Symptom severity and number of previous psychiatric admissions as predictors of readmission.

The study examined factors predicting early readmission (within 30 days of discharge) to a state hospital. A total of 189 patients with acute symptoms who were admitted to a state hospital were evaluated at discharge using the Brief Psychiatric Rating Scale (BPRS) and the Nurses Observation Scale for Inpatient Evaluation (NOSIE). Patients who were readmitted within 30 days were compared with those who were not on BPRS and NOSIE ratings and on other variables, including length of stay, number of previous admissions, demographic characteristics, and diagnosis. Scores on the thought disorder factor and self-neglect question on the BPRS and the number of previous admissions were significantly higher among patients who where readmitted within 30 days of discharge. The variables correctly predicted readmission for 86 percent of cases in the study. The characteristics of high scores at discharge on the BPRS thought disorder factor and the BPRS item on self-neglect, along with a high number of previous admission, may be helpful in identifying patients at risk for readmission to inpatient psychiatric settings.

Prodromal Symptoms in Schizophrenia

This paper describes a prospective study of the relationship between non-psychotic prodromal symptoms and psychotic symptoms in 55 schizophrenic (DSM-III-R) out-patients. Once a month, a number of non-psychotic symptoms generally regarded as prodromal symptoms in schizophrenia were assessed, as well as psychotic symptoms, with standardised self-administered instruments and rating scales for a minimum of 12 months (range 12-29). The data were analysed for each patient using a longitudinal correlational design with a 1-month lag between the prodromal and psychotic symptoms over the total period. Results showed that in less than one-fifth of subjects did any of the prodromal symptoms, individually or in combination, show a significantly positive correlation with the subsequent level of psychotic symptoms. Such relationships were significant in an even smaller proportion of subjects when the confounding effect of concurrent psychotic symptoms on prodromal symptoms was partialled out. High levels of prodromal symptoms appeared to have adequate specificity but low sensitivity in their power to predict high levels of subsequent psychotic symptoms. There were no differences in age, gender, medication levels, and the number of previous admissions between the subjects who did or did not show a relationship between putative prodromal symptoms and psychotic symptoms.

Predictors for readmission risk in schizophrenia

Readmission risk was assessed at the first and subsequent discharges in a total Danish national sample consisting of 8705 first admitted patients who had been discharged alive at least once with a diagnosis of schizophrenia. Predictors for readmission risk were identified using the Cox proportional hazards model. Following the first discharge, 19% of the surviving patients had not been readmitted after 10 years of follow-up. Readmission risk increased with the number of previous admissions. At the first discharge readmission risk decreased with increasing age and was significantly predicted by clinical subtype and gender. At later discharges (5th, 10th, and 15th) the effect of these variables gradually disappeared. At the 15th discharge readmissions were mainly predicted by the duration of the latest admission and discharge periods. Both the increase in readmission risk with the number of previous admissions and the evolving pattern of predictors for readmission risk are interpreted as supporting the existence of a smaller subpopulation among schizophrenic patients with frequent relapses.

Risk factors for readmission to hospital for asthma in childhood.

Readmissions account for part of the increase in hospital admissions for asthma in childhood seen in many countries. This observational study recorded demographic features and the severity, treatment and management of asthma in 1034 individual children admitted to hospital over a one year period, followed for a maximum of 33 months. Readmissions were common, with 33% readmitted by six months and 51% by two years. After controlling for a wide range of variables, factors that significantly increased readmission were: female sex (relative risk (RR) 1.23; 95% confidence interval (CI) 1.03 to 1.46), young age (age < 5 years RR 1.71; 95% CI 1.41 to 2.08), number of previous admissions (one previous admission RR 1.32; two, RR 1.68; three, RR 2.00; four or more, RR 2.80), and inpatient intravenous treatment (RR 1.29; 95% CI 1.08 to 1.55). Inpatient treatment with theophylline was used frequently (98.4%), but was associated with decreased readmissions (RR 0.51, 95% CI 0.28 to 0.92). Factors which did not predict readmission included ethnicity, respiratory and pulse rate, medical team, prescribed prophylactic treatment, type of follow up, or the use of action plans. Risk factors for readmission relate to the characteristics of the individual (age and sex), severity of the condition (intravenous treatment), and number of previous admissions which may reflect severity or behaviour of the illness. Medical treatment and management did not influence readmissions. Strategies to reduce the high readmission rate for asthma in childhood need to be developed.

Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial

Because previous studies of day treatment as an alternative to inpatient treatment had major disadvantages or methodological shortcomings, the authors conducted a randomized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment. Of 160 patients, 57 were randomly assigned to the control condition and 103 were assigned to the experimental condition. Control patients received standard clinical care. In the experimental condition, day treatment was attempted as soon as the patient's condition permitted. The average number of nights per week that experimental patients spent away from the hospital was compared to the average number of nights away for patients under standard care. Day treatment was satisfactory for 40% of the experimental patients but was completely infeasible for another 40%. The level of surveillance needed in the first week, physical illness, number of previous admissions, depressive symptoms, and treatment by qualified psychiatrists versus registrars were variables predictive of these differences. In this unselected group of patients, no absolute contraindications against day treatment were found. This suggests that the selection criteria applied in nearly all other controlled studies on the subject were unwarranted. The approach used in this study facilitated treatment in the least restrictive environment possible.

Markers of risk of asthma death or readmission in the 12 months following a hospital admission for asthma.

A case-control study has previously been reported of asthma deaths in people aged 5-45 years who had a hospital admission for asthma (the index admission) in New Zealand during 1981-1987. The study has been re-analysed to examine the association between markers of asthma severity and risk of asthma death or hospital admission; patients prescribed fenoterol were excluded from this re-analysis because of the previously reported interaction between fenoterol, asthma severity, and asthma deaths. The re-analysis included 39 patients who died of asthma during the 12 months after their index admission, 226 patients who had a readmission for asthma during the 12 months after their index admission, and 263 controls chosen from all index admissions. An admission in the previous 12 months was the strongest marker of subsequent risk of death (odds ratio (OR) = 3.5, 95% confidence interval (CI): 1.8-6.9, P less than 0.01), and was also a strong marker of subsequent risk of readmission (OR = 3.0, 95% CI: 2.1-4.2, P less than 0.01); the risk increased with the number of previous admissions. Three or more categories of prescribed asthma drugs was also associated with subsequent death (OR = 1.7, 95% CI: 0.9-3.3, P = 0.13) or readmission (OR = 1.9, 95% CI: 1.3-2.7, P less than 0.01); prescribed oral corticosteroids was only weakly associated with subsequent death (OR = 1.3, 95% CI: 0.6-2.8, P = 0.59), but was more strongly associated with subsequent readmission (OR = 1.9, 95% CI: 1.2-2.8, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)