Length Of Hospitalization In Patients Research Articles

Predictors of prolonged length of stay in adult patients with respiratory syncytial virus infections - a multi-center historical cohort study.

Several studies have reported risk factors for severe disease and mortality in hospitalized adults with RSV infections. There is limited information available regarding the factors that affect the duration of a patient's hospital length of stay (LOS). This was a multicenter historical cohort study of adult patients hospitalized for laboratory-confirmed RSV in Southeast Michigan between January 2017 and December 2021. Hospitalized patients were identified using the International Classification of Diseases, Tenth Revision 10 codes for RSV infection. Mean LOS was computed; prolonged LOS was defined as greater than the mean. We included 360 patients with a mean age (SD) of 69.9 ± 14.7 years, 63.6% (229) were female and 63.3% (228) of white race. The mean hospital LOS was 7.1 ± 5.4 days. Factors associated with prolonged LOS in univariable analysis were old age, body mass index (BMI), smoking status, Charlson Weighted Index of Comorbidity (CWIC), home oxygen, abnormal chest x-ray (CXR), presence of sepsis, use of oxygen, and antibiotics at the time of presentation. Predictors for prolonged LOS on admission in multivariable analysis were age on admission (p < 0.001), smoking status (p = 0.001), CWIC (p = 0.038) and abnormal CXR (p = 0.043). Our study found that age on admission, smoking history, higher CWIC and abnormal CXR on admission were significantly associated with prolonged LOS among adult patients hospitalized with RSV infection. These findings highlight the significance of promptly recognizing and implementing early interventions to mitigate the duration of hospitalization for adult patients suffering from RSV infection.

A standardized educational program to improve peripheral vascular access outcomes in the emergency department: A quasi-experimental pre-post trial.

Difficult intravenous access (DIVA) patients are known to have disproportionately poorer vascular access outcomes. The impact of education and training on vascular access outcomes in this vulnerable population is unclear. We aim to demonstrate the success of a program (Operation (O) STICK) on improving vascular access outcomes in DIVA patients. This was a quasi-experimental pre-post interventional study conducted at a tertiary care emergency department (ED) with 120,000 annual visits and 1100 hospital beds. Adult patients requiring an ultrasound-guided (US) peripheral intravenous catheter (PIVC) in the ED were eligible participants. Traditional (palpation method) insertions were excluded. Using multivariable linear regression and inverse probability weighted (IPW) linear regression, the standard group inclusive of PIVCs inserted by staff without formalized OSTICK training were compared to the interventional group inclusive of PIVCs inserted by staff with training and competency in the OSTICK training model. Data were collected over two time intervals: 4/1/21-9/30/21 (pre; non-OSTICK) and 10/1/22-3/31/23 (post; OSTICK). 2375 DIVA patients included 1035 (43.6%) non-OSTICK and 1340 (56.4%) OSTICK PIVCs. Overall, OSTICK PIVCs had a higher proportion of upper arm or forearm placements (94.6% vs 57.4%; p < 0.001), 20 gauge catheters (97.1% vs 92.3%; p < 0.001), and left-sided placements (54.4% vs 43.5%; p < 0.001). 62.7% of OSTICK PIVCs were placed by ED technicians, compared to 25.5% in the non-OSTICK group (p < 0.001). OSTICK PIVCs were placed on the first attempt 86.2% of the time and by the second attempt 95.4% of the time. In a subanalysis of 1343 hospitalized patients (689 (51.3%) OSTICK vs 654 (48.7%) non-OSTICK), OSTICK PIVCs survived for a median of 92% of the patient's hospital length of stay, compared to non-OSTICK PIVCs at 74% (p < 0.001). Formalized vascular access training in the ED leads to improved adherence to best practices for PIVC insertion, high success of cannulation with minimal attempts, and improved PIVC functionality during hospitalization for DIVA patients. Importantly, these outcomes are sustainable as they were captured 12 months after implementation of the program.

Methodological progress note: Machine learning methods in healthcare research.

Methodological progress note: Machine learning methods in healthcare research.

Reducing Opioid-Induced Constipation Post-Cardiac Surgery: An Improvement Project in a Pediatric Cardiac Intensive Care Unit.

Pain management with opioids and underutilization of prophylaxis for constipation can prolong a patient's hospital length of stay and impede pain management efforts. In pediatric postoperative cardiac patients, opioid therapy is a common approach to pain management but often places them at greater risk for constipation due to anatomy and age. A retrospective review of 50 patients' medical records for baseline data was conducted, and a survey evaluated providers' current knowledge and practice. The intervention was an electronic order set that provided decision support. Additionally, prophylactic measures were supported by a validated assessment tool that created a common language to report constipation risk. Although not statistically significant, postintervention data demonstrated a 21.5% decrease in postoperative constipation and a 57% increase in ordered bowel regimens. More focus is needed toward prophylactic bowel regimens to reduce the risk in this already high-risk population.

Impact of a Hospitalist-Run Procedure Service on Time to Paracentesis and Length of Stay.

Hospitals are establishing procedure services to address resident training and patient safety. We examined whether a hospitalist procedure service affects a patient's hospital length of stay (LOS) and the time from admission to paracentesis (A2P). We queried our electronic medical records for all inpatient peritoneal fluid samples from July 1, 2016, to May 31, 2019. LOS and A2P time were compared among patients who had paracentesis by the procedure service, by residents, or by radiology. Of the 1,321 procedures, 509 (38.5%) were performed by the procedure service. In the adjusted analysis, as compared with procedure service, the group that underwent paracentesis by the radiology service had a 27% longer LOS (95% CI, 2%-58%) and 40% longer A2P time (95% CI, 5%-87%). The resident group had shorter A2P (-19%; 95% CI, -33% to 0.2%; P = .05) than the procedure service group but similar LOS. To our knowledge, this is the first study that suggests patient-centered benefits of a hospitalist procedure service.

Bipolar disorder, cardiac comorbidity and therapeutic impasse: A case report

IntroductionBipolarDisorders (BD) are regarded as a multidimensionaldiseaseinvolvingbothpsychological and physicaldeterminants. Althoughmood dimension andthymicinstability areconsidered as the « core » aspect of bipolardisorders, itis crucial to note thatsomaticproblemsfrequentlyoccur in BD,deeplyworsening the prognosis.ObjectivesHerewedescribea case of atwentyyearshistory of psychiatricimpairment, diagnosedlaterwithcardiac malformation.MethodsFemale patient H.G has been admitted for the first time to psychiatric department ‘A’ of Razi Hospital,treated for type 1 bipolar disorder since 2004 with poor therapeutic compliance. We reviewed the clinical and paraclinical data.ResultsThe patient was hospitalized for a severe manic episode with psychotic features, without cardiac personal history. The patient was asymptomatic and physical examination showed no abnormalities. Following a routine electrocardiogram, an acute coronary syndrom was discovered (inverted T waves seen in V1 to V6). Cardiac troponins were not elevated. According to cardiology recommandations, ischemic heart disease could not be ruled out and extensive cardiovascular investigations were needed. Antipsychotics and mood stabilizors were contraindicated.Therefore, the manic episode could only be managed using benzodiazepines. Given contradictions between clinical, electrocardioagraphic and imaging findings,coronary angiography was necessary. Results showed no significant stenosis of coronary arteries and a myocardial bridging of the left anterior descending artery and we were able to put her on antipsychiotics and moodstabilizer, almost two months after her admission.ConclusionsThis case underlines the significant impact of somatic comorbidities in therapeutic management of bipolar disorders. Cardiovascular diseases in particular cause a delay in treatment initiation and an increase in patient length of hospital stay.DisclosureNo significant relationships.

Fast-Track in der Hüft- und Kniegelenkendoprothetik

Fast-track treatment concepts were developed decades ago in general and abdominal surgery and have been adapted in recent years for the special requirements of hip and knee arthroplasty. In this field, Hendrik Husted in particular was able to demonstrate scientific evidence for the components of fast-track concepts. The primary aim is not so much to shorten the patient's hospital length of stay (LOS) but rather to effectively increase the quality of medical treatment for the patient and to reduce complications. The optimization of organizational processes as well as intraoperative and perioperative surgical approaches are essential components regarding the introduction of fast track into the clinical routine. This article gives acomprehensive overview of fast-track treatment concepts and explains the scientific principles for the approach.

Effective Antibiotic Stewardship Program: Controlling Antibiotic Resistance and Optimizing Drug Use in Ahmadi Hospital

An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.

Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?

The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Retrospective. Urban level 1 trauma center. Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Orthopaedic surgery for geriatric hip fracture. Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Time in the Hospital is Not Always Normal: What does one year’s worth of studies tell us?

Abstract Context: Patient length of hospital stay (LOS) is an important measure of timeliness and efficiency in healthcare quality studies.Objective: Because conclusions drawn about LOS may be influenced by assumptions of variable distribution, we sought to determine the quality of LOS data analysis in published pediatric clinical studies. Study Selection: Articles from PubMed were included if they were of pediatric clinical studies published in English for a one year period of time between 6/1/2009 and 5/31/2010 where LOS was an outcome variable.Data Extraction: The reported statistical approach was extracted from published manuscripts by 2 independent reviewers and included hospital LOS: distribution, measures of central tendency, and methods of statistical comparisons. Results: Of 795 identified studies, 214 were included: only 33 reported LOS distribution of which 5 used the incorrect measure of central tendency. One hundred and two studies reported LOS means, 64 reported medians, and 22 reported both means and medians. Of 142 comparative studies, 61 used non-parametric methods, 53 parametric methods, 1 used both parametric and non-parametric methods, 7 transformed the variable, 18 did not specify, and 2 were missing.Conclusions: Although used frequently as a measure of healthcare outcomes, there is wide variation in the statistical approach and reporting of LOS. We recommend that, at a minimum, investigators should follow the International Committee of Medical Journal Editors Uniform Requirements for Manuscripts Submitted to Biomedical Journals reporting of statistical data. Furthermore, investigators should evaluate, report, and use LOS distributions to inform LOS analyses.

The Hospitalist Perspective on Treatment of Community–Acquired Bacterial Pneumonia

Community–acquired bacterial pneumonia (CABP) is an important health care concern in the United States and worldwide, and is associated with significant morbidity, mortality, and health care expenditure. Streptococcus pneumoniae is the most frequent causative pathogen of CABP. Other common pathogens include Staphylococcus aureus, Haemophilus influenzae, Enterobacteriaceae, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae. However, in clinical practice, the causative pathogen of CABP is most often not identified. Therefore, a common treatment approach for patients hospitalized with CABP is empiric antibiotic therapy with a β–lactam in combination with a macrolide, respiratory fluoroquinolones, or tetracyclines. An increase in the incidence of S. pneumoniae that is resistant to frequently used antibiotics, including β–lactams, macrolides, and tetracyclines, provides a challenge for the physician when selecting empiric antimicrobial therapy. When patients with CABP do not respond to initial therapy, they must be adequately reevaluated with further diagnostic testing, change in antimicrobial regimen, and/or transfer of the patient to a higher level of care. The role of hospital medicine physicians is crucial in treating patients who are hospitalized with CABP. An important focus of hospitalists is to provide care improvement in a way that addresses both patient and hospital needs. It is essential that the hospitalist provides best possible patient care, including adherence to quality measures, optimizing the patient's hospital length of stay, and arranging adequate post–discharge care in an effort to prevent readmission and provide appropriate ongoing outpatient care.

The challenges of implementing Enhanced Recovery Programme in urology

AbstractEnhanced Recovery Programme (ERP) or fast‐track programme involves the application of evidence‐based best practice into surgery to optimize patient recovery post‐operatively. Results have been very promising especially in complex surgical procedures, where patient length of hospital stay had been significantly reduced and there has not been a significant increase in patient complication or readmission rate. These favourable outcomes are potentially cost‐effective for the health care team and hospital trust especially in the present economic climate. Within our department, we have recently implemented ERP in all patients undergoing radical cystectomy procedure since September 2009. In this paper, we discuss the elements of ERP, share our experiences and challenges in the implementation of ERP at different stages from prior‐ to post‐surgery. We concluded that the key for successful implementation of ERP is the active collaboration involving the whole health care team including the nurses, nurse specialists, doctors, surgeons and anaesthetist, to ensure every team member is accountable and contribute to the implementation process. From the nursing perspective, there is a significant role to be played especially in the pre‐ and post‐operative care of patients.

Physicians’ perceptions of the definition of major bleeding in major orthopedic surgery: results of an international survey

Decisions regarding choice of thromboprophylaxis in patients undergoing major orthopedic surgery are based on assessment of individual patient risk for thrombosis versus risk for bleeding. An international survey sought physician views on definitions and relative importance of different types of major bleeding. A random sample of physicians from five countries (100 physicians per country, mainly surgeons) completed an internet-based 13-question survey on perceptions, concerns, and relevance of bleeding associated with thromboprophylaxis in major orthopedic surgery. Over 80% of responders were concerned or very concerned about bleeding with >70% considering surgical-site bleeding as the most concerning, and relevant type and site for bleeding. Nearly 80% of responders considered surgical-site bleeding to increase patient length of hospital stay, and >70% noted that it complicates patient rehabilitation. After fatal bleeding, bleeding leading to re-operation was ranked as the most concerning type of major bleed. Less than half of responders reported closely reading the major-bleeding definitions in clinical study publications. Most responders favored anticoagulants that could offer a reduced bleeding risk and similar venous thromboembolism (VTE) prevention compared to current anticoagulants rather than a decrease in VTE and similar bleeding risk. There is a disconnect between the definitions of major bleeding that surgeons would apply to describe bleeding associated with VTE thromboprophylaxis, and those used in clinical studies reporting the safety profiles of newer anticoagulant agents. Misperceptions about the benefit-to-harm profiles of thromboprophylactic therapies may incorrectly inform treatment choices in patients at high risk for post-operative VTE.

Expanding Education Technology to Meet the Needs of Patients, Families, and Clinicians

With the patient length of hospital stay continuously decreasing, health educators and nurses are continually challenged to adequately educate patients prior to discharge. Health education is recognized as a key component for reducing readmission rates by increasing patient compliance, yet health education resources must be readily accessible to patients throughout the entire hospital experience in order to achieve fulfillment. The Center for Consumer Health Information at Cleveland Clinic examined the existing in-hospital delivery systems in order to identify a means to reach patients at all access points in the health care process. This article demonstrates how a closed circuit television system may be utilized to deliver health education content to individuals in both in-patient and out-patient settings. The evaluation of vendors and identification of internal resources is imperative to the successful implementation of an in-patient education system.

An example of a research grant application comprehensive discharge planning for the elderly

Discharge planning for the elderly can potentially reduce patient length of hospital stay, prevent rehospitalization, enhance patient outcomes and lessen the burden of care on the families. While increased numbers of elderly are being discharged earlier, there are few data on the process and effects of discharge planning protocols developed specifically for this population. The proposed study will attempt to answer the following questions regarding hospitalized elderly with selected DRG classifications: Are there significant differences between elderly patients who receive the hospital's general discharge planning procedure used for all categories of patients and elderly who receive the hospital's general discharge planning procedure plus a comprehensive discharge planning protocol specific to the elderly and implemented by a gerontological nurse specialist in: (1) Patient Outcomes (length of initial hospitalization; post-discharge morbidity; post-discharge health services; functional status; mental status; satisfaction with care; self-esteem; patient's perception of health status; and stress level); (2) Family Related Outcomes (primary care giver's functional status; mental status; care giving demands; stress level and family functioning); (3) Cost of Care Outcomes (charges for initial hospitalization, rehospitalizations, post-discharge health services; family related costs; and gerontological nurse specialist costs). The study design is a randomized clinical trial with a total of 280 elderly (2 groups of 140). The control group will receive routine discharge planning; the treatment group will receive routine discharge planning plus an elder-specific comprehensive discharge planning protocol. Data analysis will include frequency distributions and summary statistics. For each of the research questions, multivariate analysis of variance or chi-square statistics will be used.

Length of hospitalization on a short-term therapeutic community. A multivariate study by sex across time.

Patient length of hospitalization was examined in a private short-term therapeutic community unit using a longitudinal, multimethod, -ultivariate approach, with data analyzed separately by patient sex. Patient data were entered into stepwise linear regression analyses for weeks 1, 2, and 4 of an average seven-week hospitalization for male and female patients separately. Results for men were not specifically replicated among the women. Longer-staying men were diagnosed more frequently as "personality disorders," tended to be somewhat aloof, perceived the ward as encouraging denial, facade, order, and organization. Among women, verbal behavior, interpersonal relations, discontentedness with family, and other variables were related to length of hospitalization. Shorter-staying male and female patients tended to exhibit characteristics at the "feminine" end of a hypothetical masculinity-femininity continuum. Conforming, accepting behavior seemed reinforced for all patients.