Patient Administration System Research Articles

Patient influx to emergency departments at two Norwegian university hospitals from 2012-21.

The increase in patient visits to emergency departments is a global challenge. We wished to survey patient inflow and patient composition over time at two Norwegian university hospitals. A retrospective, descriptive study of patient contacts (patients ≥16 years of age) in the emergency departments of Haukeland University Hospital, Bergen, and St Olav's Hospital, Trondheim University Hospital in the period 2012-21. Data were retrieved from patient records and the patient administration system. A total of 585780 patient contacts were included. The number of patient contacts in the emergency departments was 30696 in 2012 and 40396 in 2021 at Haukeland University Hospital, and 18967 in 2012 and 28822 in 2021 at St Olav's Hospital. The largest increase during the study period appeared to be in the age group 67-79 years, with an increase of 57% (from 6190 to 9691) at Haukeland University Hospital, and 77% (from 3849 to 6817) at St Olav's Hospital. The proportion of patient contacts that ended in hospitalisation was 82% in 2012 and 74% in 2021 at Haukeland University Hospital, and 87% in 2012 and 61% in 2021 at St Olav's Hospital. Of the patients that were admitted, the median age was 65 years, while the median age of those who were discharged from the emergency department was 48 years at Haukeland University Hospital and 52 years at St Olav's Hospital. The study showed an increase in patient contacts in the emergency departments at Haukeland University Hospital and St Olav's Hospital over a period of ten years. The number of older adults in the population will continue to increase in the years ahead, and the need for urgent care assessments will correspondingly increase. It is important that the health services are aware of changes in patient influx and patient composition in order to ensure patient safety and the working environment of emergency departments in the future.

Use of drugs with pharmacogenomics (PGx)-based dosing guidelines in a Danish cohort of persons with chronic kidney disease, both on dialysis and not on dialysis: Perspectives for prescribing optimization.

The objective of this registry study is to assess the utilization of pharmacogenomic (PGx) drugs among patients with chronic kidney disease (CKD). This study was a retrospective study of patients affiliated with the Department of Nephrology, Aalborg University Hospital, Denmark in 2021. Patients diagnosed with CKD were divided into CKD without dialysis and CKD with dialysis. PGx prescription drugs were retrieved from the Patient Administration System. Actionable dosing guidelines (AG) for specific drug-gene pairs for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were retrieved from the PharmGKB homepage. Out of 1241 individuals, 25.5% were on dialysis. The median number of medications for each patient was 9 within the non-dialysis group and 16 within the dialysis group. Thirty-one distinct PGx drugs were prescribed. Altogether, 76.0% (943 individuals) were prescribed at least one PGx drug and the prevalence of prescriptions of PGx drugs was higher in the dialysis group compared to the non-dialysis group. The most frequently prescribed drugs with AG were metoprolol, pantoprazole, atorvastatin, simvastatin and warfarin. This study demonstrated that a substantial proportion of patients with CKD are exposed to drugs or drug combinations for which there exists AG related to PGx of CYP2D6, CYP2C19, CYP2C9 and SLCO1B1.

Surveillance for Diabetes in Hospital-Evaluation of Dashboard Effectiveness.

There is a large burden of diabetes in Western Sydney, and this descriptor is also valid for the inpatient population. Optimizing diabetes care in hospital is important to prevent inpatient morbidity. A surveillance system was developed to address this need and a diabetes dashboard was developed around a data model built around the patient journey that integrated key data feeds from the pathology, medication, and patient administration systems. This facilitated the rapid identification and triaging of individuals with diabetes. We evaluated this dashboard using high level clinical and financial indicators. This implementation resulted in an improved time to patient review, and a reduction in 28-day readmission rates but the inpatient length of hospital stay was unchanged. (116 words).

Major immediate insertion-related complications after central venous catheterisation and associations with mortality, length of hospital stay, and costs: A prospective observational study.

It is well-known that infectious complications after central venous catheterisation are associated with increased mortality, length of hospital stay and costs. However, there are limited data regarding such associations for immediate insertion-related complications. Therefore, the aim of this study was to investigate whether major immediate insertion-related complications are associated with mortality, length of hospital stay and costs. This was a preplanned substudy to the CVC-MECH trial on immediate insertion-related complications after central venous catheterisation in the ultrasound-guided era. Patients receiving central venous catheters at Skåne University Hospital from 2 March 2019 to 31 December 2020 were prospectively included. Patient characteristics, clinical data and costs were automatically collected from medical journals and the patient administration system. Associations between major immediate insertion-related complications and mortality, length of hospital stay and costs were studied by multivariable logistic and linear regression analyses. In total, 6671 patients were included, of whom 0.5% suffered major immediate insertion-related complications. Multivariable analyses, including surrogates for general morbidity, showed associations between major immediate insertion-related complications and 30-day (odds ratio 2.46 [95% CI 1.05-5.77]), 90-day (2.90 [1.35-6.21]) and 180-day (2.26 [1.05-4.83]) mortality. There were no associations between major immediate insertion-related complications and increased length of hospital stay or costs. This study showed that major immediate insertion-related complications, although not directly responsible for any death, were associated with increased 30-day, 90-day and 180-day mortality. These findings clearly demonstrate the importance of using all possible means to prevent avoidable insertion-related complications after central venous catheterisation.

Pengembangan Sistem Perangkat Lunak Administrasi Pasien Berbasis Mobile (Studi Kasus : Sanggar Sehat Gurubansa)

Sanggar sehat Gurubansa patient administration system application is a software application designed to manage the administrative data of Sanggar Sehat Gurubansa to be more structured and organized. The administration system here is in the form of managing Sanggar patient data, medical records and payments. The purpose of this research is to develop the administration system of Sanggar Sehat Gurubansa by replacing the manual handwriting process with a mobile-based system. The system development method used at this time is the waterfall method. The waterfall method is a step that must be done sequentially one by one (cannot move on to the next part before the part being worked on is complete). The data collection methods applied in the administrative management process of Sanggar Sehat Gurubansa are interviews, location surveys, and literature studies while the system testing method uses blackbox analysis. This program was developed using several tools, including Android Studio, XAMPP, VSC and MySQL as the database. So that in the end the application developed can provide the information needed by users of the Sanggar Sehat Gurubansa quickly and efficiently.

Sociodemographic and hospital characteristics for patients with severe functional disorder receiving specialized treatment at hospital. A regional register-based cross-sectional study from Denmark

Objective10% of all adult Danish citizen has a functional disorder (FD). This study aimed to describe how patients referred to specialized treatment (CFD; Clinic for Functional Disorders) differentiate from those not referred to specialized treatment in terms of sex, comorbidty, different types of hospital contacts and affiliation to labour market 12 and 60 months prior discharged from the hospital with a FD-diagnosis between 2019 and 2021. MethodsThe study was a register-based cross-sectional study of patients discharged with a FD in North Denmark Region between 2019 and 2021 (study period). Patients between 18 and 65 years of age with FD were identified in the regional patient administrative system. ResultsA total of 6831 patients were discharged from the hospital with a FD, of which 160 were referred to CFD. Patients with FD were more likely to be referred to CFD, if they were female, had reduced or no affiliation to the labour market or most hospital contacts were as outpatient. Moreover, an increase in hospital contacts as outpatient and a reduction in affiliation to labour market over time increased the chance of being treated at CFD. ConclusionPatients referred to CFD differed from patients not referred to CFD. Patients referred to CFD were to a lesser extent affiliated to the labour market but had more often hospital contacts as outpatient prior to being discharged with FD. In addition, patients referred to CFD increased their contacts to the hospital as outpatient more than those not referred during the preceding 5 years from discharge with FD.

Elective Surgery in People with Dementia in Northern Ireland

AbstractBackgroundElective care is defined as care that is planned in advance for those that require a procedure or treatment for an existing condition. Elective surgery aims to improve the physical or psychological quality of life for a patient and may extend the life of an individual. Evidence has shown that surgery in people with dementia (PwD) carry even more risk than those in the general ageing population particularly in terms of post‐operative complications and mortality rates. Whilst thousands of elective surgeries take place every year, it is unclear how many of these are conducted on PwD. This study explores the types and rates of elective surgery in PwD in Northern Ireland and the contributing factors to patient referral for elective surgery.MethodData was accessed through the Honest Broker Service (NI) and was retrospectively analysed. Dementia was defined in people who received one or more dementia medications (as outlined in the British National Formulary (BNF)) or when dementia was identified as a primary or secondary cause of death. Elective surgeries were identified by elective surgery referrals (Patient Administration System) (dementia cohort: n = 26,780; control: n = 24,056).ResultOverall, significantly less PwD were referred for an elective surgery compared to controls. Within the PwD group those who had higher odds to undergo an elective surgery were male, of younger age, lived in rural areas, did not transition to a care home, and were married instead of single or widowed. PwD were less likely to have an elective surgery if they received antipsychotics, but they were more likely to have a surgery if they received lipid lowering drugs, antihypertensives, hypnotics and anxiolytics, antidepressants, or antiarrhythmics. The most common surgeries from both PwD and controls were surgeries for lens, bladder and skin. Having an elective surgery was associated with lower odds of death for PwD and controls compared to people who did not undergo a surgery.ConclusionThis paper can inform health policy through insight into factors contributing to the rate and types of elective surgery referrals for PwD to ensure PwD are afforded the same care when it comes to elective surgery compared with the general population.

Comparing transfusion practice at multiple hospitals using electronically collected and analysed data.

Comparisons of transfusion practice between organisations are time-consuming using manual methods for data collection. We performed a feasibility study to determine whether large-scale transfusion data from three English hospitals could be combined to allow comparisons of transfusion practice. Clinical, laboratory and transfusion data from patients discharged between 1 April 2016 and 31 March 2017 were extracted from Patient Administration Systems (PAS), Laboratory Information Management Systems (LIMS), and electronic transfusion systems at three NHS hospitals, which are academic medical centres based in large cities outside London. A centralised database and business intelligence software were used to compare the data. The dataset contained 748 982 episodes of patient care with 91 410 blood components transfused. The study confirms the results of previous studies finding peaks in the ages of transfusion in the 0-4 years age range, in women of childbearing ages, and in males over 60 years. The number of components transfused per 1000 bed days was used as a standardised comparator. Red cell utilisation was 42.4, 40.4 and 49.5 units/1000 bed days and platelet utilisation 11.69, 7.76, and 11.66 units/1000 bed days. 60.5% (6848/11 310) of Group O D negative red cell units were transfused to non-group O D negative recipients. An analysis of component usage highlighted variations in practice, for example platelet usage for cardiac surgery varied from 2.4% to 7.3% across the three hospitals. This feasibility study demonstrates that large electronic datasets from hospitals can be combined to identify areas for targeted interventions to improve transfusion practice.

P49 Epidemiology of skin cancer by ethnicity in England, 2013–2020: a cohort study

Abstract Skin cancer rates are increasing worldwide and predominantly affect people of white ethnicity. Although less common, skin cancers in people with skin of colour (SOC) are more likely to experience diagnostic delays and higher mortality. High-quality epidemiological data on skin cancers in SOC are limited. SOC and skin phototype are not recorded in registry data; however, the ethnic group can be used as a somewhat limited proxy. The aim of this retrospective national cancer registry cohort study was to describe skin cancer epidemiology by the ethnic group. We identified a cohort of patients diagnosed with skin cancer in England (2013–2020) from the National Disease Registration Service (NDRS). The ethnic group is routinely recorded as self-reported during hospital visits in Patient Administration System and Hospital Episode Statistics datasets collected by the NDRS. We analysed data by the broad ethnic group [White, Asian (excluding Chinese), Black, Chinese, mixed, other, unknown]. We report counts, incidence, stage at presentation (melanoma only), referral pathway, anatomical location and geographical variation. The first basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) per patient were reported. More cases of skin cancers were diagnosed in Asian ethnicities than in Black and Chinese ethnicities, except for melanoma, which was more frequently diagnosed in Black ethnicities. Of 713 615 BCCs, 571 396 (80.1%) were reported in White, 799 (0.1%) in Asian, 634 (0.1%) in mixed, 413 (0.1%) in Black, 156 (0.02%) in Chinese and 3122 (0.4%) in people of ‘other’ ethnicities; 137 095 (19.2%) were of ‘unknown’ ethnicity. Of 244 072 cSCCs, 225 534 (92.4%) were in White, 609 (0.2%) in Asian, 354 (0.1%) in Black, 279 (0.1%) in mixed, 66 (0.03%) in Chinese and 1137 (0.5%) in people of ‘other’ ethnicity; 16 093 (6.6%) were of ‘unknown’ ethnicity. Of 111 676 melanomas, 102 273 (91.6%) were in White, 199 (0.2%) in Black, 180 (0.2%) in Asian, 125 (0.1%) in mixed, 25 (0.02%) in Chinese and 695 (0.6%) in ‘other’ ethnicities; 8179 (7.3%) were of ‘unknown’ ethnicity. This is the first national study of skin cancer types by ethnicity in England. National datasets allow for the better evaluation of rare subgroups of patients. The main limitation is the high proportion of unknown ethnicity reporting, which is higher for keratinocyte cancers than for other cancers, presumably due to their automated processing and lack of data sources (i.e. inpatient or multidisciplinary team datasets). These data will support a better understanding of unmet clinical needs in underserved populations.

BT07 Creation of a skin lesion image pipeline: key steps in developing a mobile application with DICOM® fields and metadata

Abstract A key issue facing artificial intelligence (AI) for dermatology is the lack of standardization around capture, transfer and storage of skin images and clinical data. To assist systematic capture of clinical data, we developed a nationally agreed proposed minimum dataset, based on Digital Imaging and Communications in Medicine (DICOM®) standards. Subsequently, we collaborated with an established image management system (IMS) supplier, Waba [supported by grants from our local National Health Service (NHS) innovation department], to incorporate these fields into a dermatology-specific mobile application (app), facilitating real-time capture and data transfer. We describe our steps in developing this app. The app integrates with the national Patient Administration System (SCI Store), allowing retrieval of real-time patient demographics linked to hospital or Community Health Index number. Each care episode captures a standardized dataset, including lesion views, clinical information and consent level. On episode completion, datasets are securely transferred to the IMS via WiFi or GPRS signal, following a fully auditable pathway. The IMS is a web-based app developed on a Microsoft Structured Query Language server, which allows authenticated users to access our trust’s centralized repository of nonradiological images. Adherence to industry-standard data storage format, patient safety reporting and specific access rights ensure compliance with Caldicott recommendations and data protection standards. For AI research, we are exploring conversion of datasets into DICOM format. Close collaboration between software developers and end users, including clinical photography, dermatology and general practice, was essential for app design. We worked on design architecture through fortnightly technical meetings, scheduled to progress development in months 1–8. Installation and functionality testing was performed in months 9 and 10, followed by comprehensive user testing in months 10–12. Live app test-of-change rollout was performed in months 13–16, with continued usability refinement during this period. To develop a standardized minimum dataset, we conducted a consensus exercise with the British Association of Dermatology AI working group. Based on DICOM standards, a comprehensive international standard for medical imaging, this could improve the quality, availability and interoperability of data for AI development. In summary, we have developed an app to standardize the capture, transmission and storage of skin lesion images and associated metadata. By collaborating with an industry partner with NHS experience, iterative user-led design and national engagement for standard-setting, we believe this is a useful step toward a national UK skin database for training and validating AI systems. Future work is planned to evaluate the output of this data pipeline.

Successful transition for adolescent survivors of CHD: the Cambridge cardiac transition pathway.

National standards to ensure effective transition and smooth transfer of adolescents from paediatric to adult services are available but data on successful transition in CHD are limited. The aim of this study is to assess the effectiveness of our transition pathway. Adolescents with CHD, aged 15-19 years, who attended the joint cardiac transition clinic between 2009 and 2018 were identified from the Patient Administration Systems. Patient attendance at their first adult CHD service appointment at Royal Papworth Hospital was recorded. 179 adolescents were seen in the joint cardiac transition clinic in the 9-year study period. The median age of the patients when seen was 16 (range 15-19) years. 145 patients were initially planned for transfer to the Royal Papworth Hospital adult CHD service. Three patients were subsequently excluded and the success of the transfer of care in 142 patients were analysed. 112 (78%) attended their first follow-up in the adult CHD clinic as planned, 28 (20%) attended after reminders were sent out with 5/28 requiring multiple reminders, and only 2 (1.4%) failed to attend. Overall, transfer of care was achieved in 140 (98.6%) patients. A dedicated joint cardiac transition clinic involving multi-professional medical and nursing teams from paediatric and adult cardiology services appears to achieve high engagement rates with the adult services. This approach allows a 'face' to be put on a named clinician delivering the adult service and should be encouraged.

Cyber-shock and “digital withdrawal”: Organizational lLeadership and Crisis Management During a Hospital-wide Computer Shutdown Following a Ransomware Attack

Introduction:In October 2021, Hillel Yaffe, MC, suffered a ransomware attack which shutdown most hospital computer systems, including patient EMR, pharmacy, communications, administration and backup systems. Staff were left in a state of “cyber-shock” without access to essential information for maintaining safety, quality and continuity of care. The aim of this presentation is to share the hospitals' experience and insights of this cyber-attack, outlining preparedness and response strategies.Method:This attack required a multifaceted emergency response strategy, including: Immediate response activated according to specific pre-prepared emergency scenario action listsLeadership decision making in real time under conditions of uncertaintyIdentifying the extent of systems affectedEstablishing alternative communication across the organizationDistributing real-time status updates and proactive guidelines, based on pre-existing emergency preparedness protocolsFinding alternative access to patient health historiesAdaptation and distribution of alternative hardcopy versions of patient evaluation and documentation normally done by EMRDistribution of instruction materials for staff via alternative communication, ensuring quick and correct adoption of alternative protocolsSpecial emphasis on patient safety, risk management, quality and continuity of careRecognition, support and resilience-building for staff facing uncertainty and unprecedented conditionsResults:Required preparations include pre-prepared standing orders and procedures, exercises and simulations. Advanced preparation of alternative documentation and care protocols will enable uninterrupted, safe, high-quality patient care. Familiarity with pen-and-paper documentation may minimize shock and disorientation from “digital withdrawal”, especially among younger workers lacking manual documentation experience. Staff members should also be instructed in maintaining “digital hygiene”, such as using strong passwords and awareness about cyber-security threats.Conclusion:Hospitals must prepare for potential cyber-attacks and EMR/digital system shutdowns. Cyber-attack should be treated by organizations as an emergency event, and they should prepare incident response and contingency plans, to assure business continuity and quick disaster recovery.

More emergency patients presenting with chest pain.

Throughout recent years the demand for prehospital emergency care has increased significantly. Non-traumatic chest pain is one of the most frequent complaints. Our aim was to investigate the trend in frequency of the most urgent ambulance patients with chest pain, subsequent acute myocardial infarction (AMI) diagnoses, and 48-hour and 30-day mortality of both groups. Population-based historic cohort study in the North Denmark Region during 2012-2018 including chest pain patients transported to hospital by highest urgency level ambulance following a 1-1-2 emergency call. Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System, and descriptive statistics (distribution, frequency) performed. We evaluated time trends using linear regression, and mortality (48 hours and 30 days) was assessed by the Kaplan Meier estimator. We included 18,971 chest pain patients, 33.9% (n = 6,430) were diagnosed with"Diseases of the circulatory system" followed by the non-specific R- (n = 5,288, 27.8%) and Z-diagnoses (n = 3,634; 19.2%). AMI was diagnosed in 1,967 patients (10.4%), most were non-ST-elevation AMI (39.7%). Frequency of chest pain patients and AMI increased 255 and 22 patients per year respectively, whereas the AMI proportion remained statistically stable, with a tendency towards a decrease in the last years. Mortality at 48 hours and day 30 in chest pain patients was 0.7% (95% CI 0.5% to 0.8%) and 2.4% (95% CI 2.1% to 2.6%). The frequency of chest pain patients brought to hospital during 2012-2018 increased. One-tenth were diagnosed with AMI, and the proportion of AMI patients was stable. Almost 1 in of 4 high urgency level ambulances was sent to chest pain patients. Only 1 of 10 patients with chest pain had AMI, and overall mortality was low. Thus, monitoring the number of chest pain patients and AMI diagnoses should be considered to evaluate ambulance utilisation and triage.

Predictors of hospitalization due to infection in rituximab-treated MS patients.

Rituximab is extensively used off-label to treat multiple sclerosis (MS), and long-term vigilance for adverse events is needed. This study was conducted to determine frequencies and predictors of hematological adverse events, including hypogammaglobulinemia, severe lymphopenia, neutropenia, and infections leading to hospitalization. This retrospective cohort study included all patients with MS initiating rituximab treatment at Haukeland University Hospital between January 1st, 2017, and July 1st, 2021. Patients were followed by clinical monitoring and repeated blood sampling every six months. Clinical outcomes and laboratory results were retrieved from the Norwegian MS Registry and Biobank and the patient administrative system at Haukeland University Hospital. Five hundred and fifty-six patients were included, 515 with relapsing-remitting MS (RRMS) and 41 with progressive MS. Overall, 33 patients (5.9%) experienced 56 episodes of infections requiring hospital admission. Sixty patients (10.8%) had confirmed hypogammaglobulinemia, 17 (3.1%) had confirmed severe lymphopenia, and 10 (1.8%) had confirmed severe neutropenia. Predictors of infection requiring hospital admission were progressive MS (adjusted OR (aOR): 4.81; 95%CI: 1.25-18.48), duration of treatment with rituximab (aOR: 1.52; 95%CI: 1.11-2.09) and confirmed severe lymphopenia (aOR: 13.58; 95%CI: 3.41-54.06) and neutropenia (aOR: 13.40; 95%CI: 2.93-61.25). Of the hematological abnormalities, only hypogammaglobulinemia was associated with treatment duration (aOR: 1.35; 95%CI: 1.09-1.69). The risk of hospitalization due to infection is associated with time on rituximab treatment, in patients with lympho- or neutropenia, and in patients with primary progressive MS. We observed a time-dependent decline in IgG values, in contrast to neutrophil and lymphocyte count, suggesting a cumulative dose-dependent response. These predictors can assist clinicians in assessing and monitoring MS patients receiving rituximab.

Pregnancies in Women with a Previous Complete Uterine Rupture.

To study the outcomes of new pregnancies after a previous complete uterine rupture. Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities. We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described. Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta. The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.

Health care costs and changes in subjective health-related quality of life among Finnish adolescents referred to secondary psychiatric out-patient services: a one-year follow-up study.

There has been growing interest in economic evidence regarding treatment of mental disorders. The purpose of this one-year follow-up study was to evaluate the secondary health care costs and changes in health-related quality of life (HRQoL) in three common adolescent psychiatric disorder groups. Further, HRQoL of patients was compared to that of population controls. Twelve- to fourteen-year-old adolescents with behavioral and emotional disorders (n = 37), mood disorders (n = 35), and anxiety disorders (n = 34), completed the 16D HRQoL questionnaire when they entered the adolescent psychiatric outpatient clinics (baseline) and at follow-up. The direct secondary health care costs were calculated using a clinical patient administration system. Population controls included 373 same-aged pupils from randomly selected 13 comprehensive schools. The direct secondary health care costs did not differ significantly between the three patient groups. However, in adolescents with mood disorders, this investment generated a significant and clinically important improvement in HRQoL, which was not observed in the other two patient groups. The costs of health care alone do not necessarily reflect its quality.

Introduction of a high dependency unit at a large paediatric and adolescent medicine department.

A goal has been set to establish paediatric high dependency units (PHDUs) in Norwegian hospitals. We sought to describe the patient population in one such unit, and to investigate whether the need for admission to an intensive care unit (ICU) changed after the unit was established. Information was obtained from electronic patient records, patient administration systems and the quality register for the PHDU at the Department of Paediatrics and Adolescent Medicine at Haukeland University Hospital. All patients admitted to the PHDU within five years of its opening in 2017 were included. A comparison was made between ICU patients in the five years before and the five years after the establishment of the PHDU. The PHDU had a total of 851 patient admissions in the period 2017-2021, increasing from 125 in 2017 to 247 in 2021. This accounted for 3.5% and 7.6% of the total number of patients admitted to the Department of Paediatrics and Adolescent Medicine in these years, respectively. The ICU had 185 paediatric patient admissions in the period 2012-2016 and 187 in the period 2017-2021, which constituted 0.9% and 1.1% of all patients admitted to the Department of Paediatrics and Adolescent Medicine during the periods, respectively. After the start-up of the PHDU, a lower proportion of patients were admitted to the ICU in the diagnostic groups diabetic ketoacidosis (15% in 2017-2021 versus 20% in 2012-2016) and sepsis (12% in 2017-2021 versus 19% in 2012-2016). The introduction of a PHDU was not associated with a simultaneous reduction in the number of ICU admissions overall. For diabetic ketoacidosis and sepsis, however, the proportion of transfers to the ICU was reduced.

Identifying pre-existing conditions and multimorbidity patterns associated with in-hospital mortality in patients with COVID-19

We investigated the association between a wide range of comorbidities and COVID-19 in-hospital mortality and assessed the influence of multi morbidity on the risk of COVID-19-related death using a large, regional cohort of 6036 hospitalized patients. This retrospective cohort study was conducted using Patient Administration System Admissions and Discharges data. The International Classification of Diseases 10th edition (ICD-10) diagnosis codes were used to identify common comorbidities and the outcome measure. Individuals with lymphoma (odds ratio [OR], 2.78;95% CI,1.64–4.74), metastatic cancer (OR, 2.17; 95% CI,1.25–3.77), solid tumour without metastasis (OR, 1.67; 95% CI,1.16–2.41), liver disease (OR: 2.50, 95% CI,1.53–4.07), congestive heart failure (OR, 1.69; 95% CI,1.32–2.15), chronic obstructive pulmonary disease (OR, 1.43; 95% CI,1.18–1.72), obesity (OR, 5.28; 95% CI,2.92–9.52), renal disease (OR, 1.81; 95% CI,1.51–2.19), and dementia (OR, 1.44; 95% CI,1.17–1.76) were at increased risk of COVID-19 mortality. Asthma was associated with a lower risk of death compared to non-asthma controls (OR, 0.60; 95% CI,0.42–0.86). Individuals with two (OR, 1.79; 95% CI, 1.47–2.20; P < 0.001), and three or more comorbidities (OR, 1.80; 95% CI, 1.43–2.27; P < 0.001) were at increasingly higher risk of death when compared to those with no underlying conditions. Furthermore, multi morbidity patterns were analysed by identifying clusters of conditions in hospitalised COVID-19 patients using k-mode clustering, an unsupervised machine learning technique. Six patient clusters were identified, with recognisable co-occurrences of COVID-19 with different combinations of diseases, namely, cardiovascular (100%) and renal (15.6%) diseases in patient Cluster 1; mental and neurological disorders (100%) with metabolic and endocrine diseases (19.3%) in patient Cluster 2; respiratory (100%) and cardiovascular (15.0%) diseases in patient Cluster 3, cancer (5.9%) with genitourinary (9.0%) as well as metabolic and endocrine diseases (9.6%) in patient Cluster 4; metabolic and endocrine diseases (100%) and cardiovascular diseases (69.1%) in patient Cluster 5; mental and neurological disorders (100%) with cardiovascular diseases (100%) in patient Cluster 6. The highest mortality of 29.4% was reported in Cluster 6.

Comorbidities associated with COVID‑19 mortality: A retrospective study in an intermediate care facility in Cape Town, South Africa

Background. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues to place a significant burden on healthcare systems across the globe. Previous studies have shown that patients with comorbidities who contract SARS-CoV-2 develop more severe COVID‑19 disease and are at a higher risk of mortality. However, literature in the intermediate care setting is limited. Objectives. To evaluate the association between comorbidity and mortality in the intermediate care setting.Methods. A retrospective observational study was performed at Brackengate Intermediate Care Facility (BICF), a 330-bed field hospital, during the second wave of COVID‑19 in Cape Town, South Africa. Data of all adult patients admitted from 1 November 2020 to 28 February 2021 who met the inclusion criteria were analysed. Data were obtained from electronic hospital patient administration systems. Comparisons were made using χ2 or Fisher’s exact testing with a 5% level of confidence used to determine significance. Logistic regression models were used to investigate the independent association between clinical variables of interest and overall mortality.Results. A total of 2 508 patients were analysed, of whom 2 476 (98.7%) were laboratory confirmed cases of COVID‑19. The median number of admissions per day was 14. The mean age was 58 years, and 1 449 (57.8%) were female. The most prevalent comorbidities were hypertension (62.6%), diabetes (46.9%) and obesity (28.0%), while 8.0% of patients were HIV-positive. The overall mortality was 13.3% (333/2 508). Patients with at least one comorbidity were 1.4 times more likely to die (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.6 - 3.5), and this risk increased significantly with cumulative comorbidities. Patients who required &gt;40% oxygen were at 5.5 (95% CI 4.3 - 7.1) times higher mortality risk. Variables independently associated with mortality were age &gt;60 years, FiO2&gt;40%, previous cerebrovascular accident, concurrent tuberculosis infection and chronic kidney disease.Conclusion. Patients with comorbidities are at an increased risk of death in COVID‑19 disease, and should be monitored closely. Oxygen requirement &gt;40% is also associated with a higher likelihood of dying. Intermediate care facilities can provide valuable relief to acute care facilities by admitting high-risk patients for closer monitoring and management.

Implementing large-scale data quality validation in a national arthroplasty registry to improve compliance : the National Joint Registry data quality audit programme.

Data of high quality are critical for the meaningful interpretation of registry information. The National Joint Registry (NJR) was established in 2002 as the result of an unexpectedly high failure rate of a cemented total hip arthroplasty. The NJR began data collection in 2003. In this study we report on the outcomes following the establishment of a formal data quality (DQ) audit process within the NJR, within which each patient episode entry is validated against the hospital unit’s Patient Administration System and vice-versa. This process enables bidirectional validation of every NJR entry and retrospective correction of any errors in the dataset. In 2014/15 baseline average compliance was 92.6% and this increased year-on-year with repeated audit cycles to 96.0% in 2018/19, with 76.4% of units achieving > 95% compliance. Following the closure of the audit cycle, an overall compliance rate of 97.9% was achieved for the 2018/19 period. An automated system was initiated in 2018 to reduce administrative burden and to integrate the DQ process into standard workflows. Our processes and quality improvement results demonstrate that DQ may be implemented successfully at national level, while minimizing the burden on hospitals.Cite this article: Bone Jt Open 2022;3(9):716–725.