Number Of Unplanned Admissions Research Articles

Is treatment of hypogonadism safe for men after a solid organ transplant? Results from a retrospective controlled cohort study.

Male solid organ transplant patients are at increased risk of hypogonadism and the safety of treating these patients for hypogonadism is unknown. We sought to evaluate the safety of treating hypogonadism in the solid organ transplant recipient. To accomplish this, we performed a retrospective review between 2009 and 2017 of patients treated at a single academic urology clinic. Men who underwent a solid organ transplant with a diagnosis of hypogonadism (Testosterone <350 ng/dl) were included. In total, 87 hypogonadal transplant recipients were included (29 no treatment; 58 treated). Treatment modalities included non-testosterone therapies (human chorionic gonadotropin, clomiphene), topical, injectable, and subcutaneous T preparations. There was no difference between groups for baseline characteristics including age, length of follow-up since transplant, baseline testosterone, and transplant type. There was no difference in prostate cancer diagnoses, erythrocytosis, rejection, infections, number of unplanned admissions per patient. While there was no difference in the proportion of deaths in untreated (21%; n = 6) and treated transplant recipients (7%; n = 4; p = 0.08), the median survival was longer in men treated with T (p = 0.03). Treatment of hypogonadism in solid organ recipients did not increase the risk for adverse effects related to treatment of hypogonadism or solid organ transplant.

Can we predict who we will see in hospital next year?

Background : The Integrated Care Program on the Central Coast, Australia has initiated a project to assess new ways of providing coordinated care to vulnerable older people in the community. It is hoped that this new way of delivering care will mean people spend less time in hospital. Identifying those people who would most benefit from increased care is an important step in ensuring the program is focused on the right people. Methods : We used Central Coast Local Health District’s routinely collected hospital admissions and emergency department data for people aged 65 and over between 2010 and 2015 to predict unplanned admission in the next year. Two approaches were tested. The first was to group patients by number of unplanned admissions in a year and number of chronic conditions to find a group that had a high rate of unplanned admission in the next year. The second was to use a range of variables in the data to define a statistical equation for predicting the likelihood of unplanned admission. Results : On average, 27% of 65+ year olds with an admission in a calendar year have an unplanned admission in the next year, accounting for 36% of people with an unplanned admission in that year. Using the first approach we found that, of the 65+ year olds that were admitted each calendar year, 40% had at least 1 unplanned admission and at least 2 chronic conditions. Of these, 41% had an unplanned admission in the next calendar year, accounting for 21% of people with an unplanned admission in that year, and 46% of those with 3 or more unplanned admissions. Using the second approach, by taking the top 40% of people ranked using the statistical equation, we found 43% had an unplanned admission in the next year, accounting for 22% of people in that year, and 48% of those with 3 or more unplanned admissions. Conclusion : Locally held administrative data can be used to define a target group for intervention. Using this approach, it may be possible to identify patients who are at risk of 1 or more unplanned hospital admissions in the future.

Medical Emergency Team: How do we play when we stay? Characterization of MET actions at the scene.

BackgroundThe creation, implementation and effectiveness of a medical emergency team (MET) in every hospital is encourage and supported by international bodies of quality certification. Issues such as what is the best composition of the team or the interventions performed by the MET at the scene and the immediate outcomes of the patients after MET intervention have not yet been sufficiently explored. The purpose of the study is to characterize MET actions at the scene and the immediate patient outcome.MethodsRetrospective cohort study, at a tertiary care, university-affiliated, 600-bed hospital, in the north of Portugal, over two years.ResultsThere were 511 MET activations: 389 (76 %) were for inpatients. MET activation rate was 8.6/1,000 inpatients. The main criteria for activation were airway threatening in 143 (36.8 %), concern of medical staff in 121 (31.1 %) and decrease in GCS > 2 in 98 (25.2 %) patients; MET calls for cardiac arrest occurred in 68 patients (17.5 %). The median (IQR) time the team stayed at the scene was 35 (20–50) minutes. At the scene, the most frequent actions were related to airway and ventilation, namely oxygen administration in 145 (37.3 %); in circulation, fluid were administered in 158 (40.6 %); overall medication was administered in 185 (47.5 %) patients. End-of-life decisions were part of the MET actions in 94 (24.1 %) patients. At the end of MET intervention, 73 (18.7 %) patients died at the scene, 190 (60.7 %) stayed on the ward and the remaining 123 patients were transferred to an increased level of care. Crude hospital mortality rate was 4.1 % in the 3 years previously to MET implementation and 3.6 % in the following 3 years (p < 0.001).DiscussionDuring the study period, the rate of activation for medical inpatients was significantly higher than that for surgical inpatients. In our hospital, there is no 24/7 medical cover on the wards, with the exception of high-dependency and intensive care units; assuming that the number of unplanned admissions and chronic ill patients is greater in medical wards that could explain the difference found, which prompts the implementation of a 24/7 ward residence.The team stayed on site for half an hour and during that time most of the actions were simple and nurse-driven, but in one third of all activations medical actions were taken, and in a forth (24%) end-of-life decisions made, reinforcing the inclusion of a doctor in the MET. A significant decrease in overall hospital mortality rate was observed after the implementation of the MET.ConclusionsThe composition of our MET with an ICU doctor and nurse was reinforced by the need of medical actions in more than half of the situations (either clinical actions or end-of-life decisions). After MET implementation there was a significant decrease in hospital mortality. This study reinforces the benefit of implementing an ICU-MET team.

The effect of increased unplanned surgical admissions at a 12 bed critical care unit

Unplanned surgical admissions to critical care are indicative of poor outcome in surgical patients [1].There has been an increase in the number of unplanned admissions to critical care units, which impacts on the allocation of resources, affecting mortality [2].The hospital where this study took place has seen a doubling of admissions in the last 5 years [3].A large proportion appeared to be surgically related, prompting a review if outcomes have been jeopardised by the increased strain.

270 EUS Guided Drainage of Peripancreatic Fluid Collections and Necroses Using a Novel Lumen-Apposing Stent: a Large Multicenter U.S. Experience

and the clinical success rates were similar (93.1% and 100%, P Z 0.119). When comparing EGBD with PC, significantly more patients in PC group suffered from adverse events (25.9% vs 70.7%, P! 0.001) and required more frequent unplanned admissions (6.9% vs 70.7%, P! 0.001). The most common causes of readmission in the PC group were due to tube dislodgement and blockade. The 30-day adverse event rates were similar between the groups (29.3% vs 15.5%, P Z 0.118). The rates of recurrent acute cholecystitis were low in both groups (0% vs 3.4%, PZ 0.244) and no difference in overall mortality was observed (P Z 0.115). Conclusion: EGBD and PC were both effective means of obtaining gallbladder drainage. In the absence of percutaneous tubing, EGBD reduced the overall morbidities and number of unplanned admissions while the 30-day adverse event rates were similar. Thus, EGBD may potentially replace PC as the treatment of choice in patients that are unfit for surgery. Table 1. Comparison in background demographics between the groups www.giejournal.org EGBD

Potentially avoidable hospitalisation for constipation in Victoria, Australia in 2010-11.

BackgroundWhen primary care of constipation fails, the patient may need emergency hospitalisation for disimpaction. This study aimed to provide population-based data on the number of unplanned admissions and the cost to the healthcare system for constipation in Victoria, Australia in financial year 2010–11.MethodsThe Victorian Admitted Episodes Dataset was examined to find the number of emergency hospital separations coded as constipation (ICD-10-AM Code K390). An estimate of costs was determined from the number of weighted inlier equivalent separations (WIES) multiplied by the WEIS price, used by the Victorian Government for funding purposes.ResultsThere were 3978 emergency separations for constipation in Victoria in 2010–2011, 92% in public hospitals. Fifty-five percent were female and 38% > 75 years old. One third stayed overnight and 1/3 more than 1 day. The emergency bed day rate was 7.1 per 10,000 of population. The estimate of cost, based on WEIS, was approximately $8.3 million. Potential savings could be made by reducing the number of separations in 6 Local Government Areas (LGAs).ConclusionsThis study shows that the burden (in number of admissions, emergency bed days and overall direct costs) in managing emergency admissions for constipation in Victoria, Australia, is very significant and likely to be similar in other developed countries. Improved primary healthcare and alternative ways to achieve faecal disimpaction without emergency admission could save the public health system a proportion of this $8.3 million.

Safety of Anterior Cervical Discectomy and Fusion Performed as Outpatient Surgery

Retrospective review of a prospectively collected database. To determine the complications and safety of anterior cervical discectomy and fusion performed on an outpatient basis. Anterior cervical discectomy and fusion performed as outpatient surgery is an appealing alternative and has many potential benefits. The safety of this practice, however, has not been thoroughly investigated. This study aims to examine the frequency of acute complications and rates of unplanned admissions for anterior cervical discectomy and fusions scheduled as outpatient procedures. Data were collected prospectively on 645 consecutive patients undergoing anterior discectomy and fusion by a single surgeon for either stenosis or herniated nucleus pulposus involving 1 level. These data were then retrospectively reviewed for acute complications occurring within 48 hours of surgery. A subset consisting of the last 392 patients were further reviewed to better characterize this population. Complications after surgery as well as procedures requiring postoperative admission for any reason were detailed. Two of 645 (0.3%) patients developed acute complications, both of which were epidural hematomas. Both occurred within the protocol's mandatory 4 hours postoperative observation time. Both resolved without permanent neurologic deficit. There were no retropharyngeal hematomas and no deaths. Six percent of patients required an unplanned admission. More than 80% of unplanned admissions were secondary to either pain or nausea. One-level anterior cervical discectomy and fusion can be safely performed in an outpatient setting with a 4-hour observation period. There is a low rate (6%) of unplanned admission to the hospital. The number of unplanned admissions can be decreased by more than one-third if autogenous iliac crest bone graft is not harvested. The use of postoperative drains for 1-level anterior discectomy and fusion is called into question.

Impact of early warning on paediatric intensive care

Aims To evaluate the impact of an early warning system and paediatric emergency team training on unplanned admissions to paediatric intensive care unit (PICU). Methods An early warning system, which asks staff to respond to breaches of physiological criteria, was introduced to a paediatric teaching hospital. This was accompanied by a change in role of the resuscitation team to an “early response team”, reinforced by weekly 2-hourly simulation team training. The multidisciplinary training focuses on identifying deteriorating patients, communication within the team, and early escalation to consultant staff. A prospective audit covering the year before and after this intervention was conducted. Results The number of unplanned admissions to PICU increased from 90 to 115, reflecting a similar increase of activity within the hospital. The year before introduction, the resuscitation team was called 11 times, in contrast to 36 involvements of the early response team the year after. The average time from breach of early warning criteria to first response (defined as: nursing intervention including increased observations, medical review, transfer to higher dependency unit) was reduced from 4.6 to 1.1 h. The proportion of deteriorating patients seen by a consultant, from the time of breach to PICU admission, increased from 49% to 82%. The time from breach to PICU admission fell from 21 to 10 h. Level of sickness at the time of admission to PICU was reduced by 24% (PIM1)/13% (PIM2). Length of PICU stay fell from an average 6.9 to 5.0 days, with the absolute number of bed days reducing by 10%. The number of deaths fell from 12 to 4. Conclusion The authors observed major changes in the management of deteriorating paediatric inpatients: the response within the hospital was faster, involved more senior staff and lead to earlier PICU admission. This also applied when the paediatric emergency team was not called. Subsequently, predicted and actual PICU mortality and length of stay was reduced. This suggests that weekly team training, a local innovation to support early warning implementation, influences the judgement of key decision makers in the care of deteriorating patients both within the team and as individuals.

Safe and efficacious prolonged use of an olive oil-based lipid emulsion (ClinOleic ©) in chronic intestinal failure

Background & aims: Injectable lipid emulsion is an important component of parenteral nutrition. ClinOleic © is a lipid emulsion composed of olive oil (80%) and soybean oil (20%). This study evaluated the efficacy and safety of ClinOleic in adults already receiving parenteral nutrition, comparing it to their usual lipid (soybean-oil-based). Methods: Thirteen adults dependent on home parenteral nutrition were recruited from a single hospital. ClinOleic was administered for 6 months. Two-monthly assessments were made. In addition, clinical and adverse events were recorded for 6-month periods before, during and after the study. Results: Total numbers of important complications for the 6 months before, during and after the study were 13, 9 and 9, respectively. There were, respectively, 5, 3 and 2 line infections, and 2, 0 and 5 thrombotic episodes in the 3 periods. The numbers of unplanned admissions were, respectively, 8, 5 and 7, with in-patient days accounting for 3.4%, 1.5%, and 2.6% of feeding days, respectively. One patient died (pneumonia). One new case of cholecystolithiasis appeared. Conclusion: ClinOleic may be used as a safe alternative to standard soybean-oil-based lipid emulsions.