Percent Of Discharge Research Articles

An Economic Evaluation of a Proactive Consultation-Liaison Psychiatry Pilot as Compared to Usual Psychiatric Consultation on Demand for Hospital Medicine.

A growing literature demonstrates the value of the proactive consultation-liaison psychiatry model for health care systems through reductions in hospital length of stay. Few studies include financial outcomes. We evaluated the return on investment of a 1-year proactive consultation-liaison psychiatry pilot in a hospital medicine unit. We used a pre-post method with an active comparison of three hospital medicine units with regular psychiatric consultation on demand. We staffed the pilot unit with one full-time psychiatrist who focused on early case finding, close communication with unit staff, frequent follow-up visits, and proactive discharge planning. We assessed the 1-year change in mean length of stay for all patients receiving psychiatric consultation, from which we estimated the direct contribution margin from bed-backfills and the program's return on investment. On the pilot unit, the percent of discharges that received psychiatric consultation increased from 7.34% to 13.79%, and the length of stay for patients who consulted declined by a mean of 1.82 days (P < 0.05), as compared to an increase of 0.15 days (P > 0.05) on the usual-care units. The pilot unit reduction in length of stay saved 451.71 days in total, allowing for 73.81 bed-backfills, a direct contribution margin of $419,343 (95% confidence interval, $50,754 to $787,933), a net direct contribution margin of $298,245 (-$70,344 to $666,835), and an return on investment of 132% (-31% to 295%). This study strengthens existing evidence for the relative cost-effectiveness of proactive consultation-liaison psychiatry for hospital medicine compared with usual psychiatric consultation on demand.

PERFORMANCE FIELD EVALUATION OF DRIP IRRIGATION SYSTEMS UNDER CONDITIONS OF THE DESERT REGION IN WESTERN IRAQ

A field experiment was carried out at Al-Saqlawiya township Al-Anbar governorate at north in latitude 33°24´57" and east longitude 43°41´23", during period from 15/10/2018 to 15/1/2019 in order to evaluate the performance of 5 units of surface drip irrigation system, components and periods of use, by the steps recommended by the American Agriculture Engineers Association, at 50 kPa operational pressure. Results showed that there was a disparity in values of emitters actual discharge, uniformity coefficient, emission uniformity and variation percent of discharge. Although the similarity of most measurement conditions such as land area, design, management and the operational pressure except of the periods of using these systems which ranged 2-5 years. The decrease percent of actual discharge values 8.06%, 8.74%, and 19.04% when comparing the actual discharge for the system 1 with the values of systems 2,3 and 4, respectively. While the increase percent of the actual discharge value reached 29.74% when comparing of system 1 with system 5. Uniformity coefficient of system decreased were 5.32%, 19.95%, 3.81% and 7.21%, respectively, and 10.73%,37.25%,7.51% and 14.36% for the decrease percent of emission uniformity comparing the system 1 with the systems 2, 3, 4 and 5, respectively, as for the increase percent for the variation emitters discharge, it were 7.70%, 118.73%, 7.70%, respectively. Non- compliance of users of these systems with regular maintenance of the end of agriculture seasons, poor storage conditions, not maintained at high temperature or cold conditions and increase use periods, all had caused the expansion of emitters' holes, which affected negatively in some values of the followed evaluation standard.

Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals.

ABSTRACTBackground:Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals.Methods:Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission.Results:Eight percent of discharges were readmitted to the same hospital within 30 days after discharge. Factors significantly related with rapid readmission included white (odds ratio, 1.23; 95% confidence interval, 1.13–1.34), non-Hispanic (1.48, 1.26–1.73), not married (1.53, 1.32–1.76), voluntarily admitted (1.18, 1.05–1.33), with length of stay (LOS) ≤ 7 days (3.52, 3.04–4.08), or LOS 8–31 days (3.20, 2.79–3.66), or LOS 32–92 days (1.91, 1.65–2.22), with a schizophrenia or other psychotic disorders (1.69, 1.46–1.96) or personality disorder (1.76, 1.50–2.06), referred to a setting different from the outpatient (1.27, 1.16–1.40), or with a living arrangement different from private residence (1.54, 1.40–1.68).Conclusions:Disparities in rapid readmission rates exist among state psychiatric hospitals. A national overview of the individuals with mental illness at risk of being prematurely discharged may suggests insights into quality initiatives aimed at reducing rapid readmissions into psychiatric inpatient care.

Characteristics Associated with Home Health Care Referrals at Hospital Discharge: Results from the 2012 National Inpatient Sample.

To assess patient- and hospital-level factors associated with home health care (HHC) referrals following nonelective U.S. patient hospitalizations in 2012. The 2012 National Inpatient Sample (NIS). Retrospective, cross-sectional multivariable logistic regression modeling to assess patient- and hospital-level variables in patient discharges with versus without HHC referrals. Analysis included 1,109,905 discharges in patients ≥65years with Medicare. About 29.2 percent of discharges were referred to HHC, which were more likely with older age, female sex, urban location, low income, longer length of stay, higher severity of illness scores, diagnoses of heart failure or sepsis, and hospital location in New England (referent: Pacific). As health policy changes influence postacute HHC, defining specific diagnoses and regional patterns associated with HHC is a first step to optimize postacute HHC services.

Impact of Drug Label Changes on Propofol Use in Pediatrics for Moderate Conscious Sedation

Background Drug product labeling is a critical component of communication regarding the appropriate use of medications. The information contained in a drug label is often complex, including contraindications and warnings that may be difficult to understand. In an attempt to further examine this issue, this article looks at one such difficult-to-understand label concerning anesthetic propofol and its use in the pediatric population. Objective The objective of this study was to describe the use of propofol for moderate conscious sedation (MCS) in pediatric patients (0–17 years) after drug warnings were disseminated. Methods This study was a retrospective, observational study from January 2001 to December 2007 that used data from the Premier Perspective Comparative Hospital database. This database includes approximately 425 hospitals with a broad range of hospital types and contains a weighting scheme that allows for the generation of national estimates in the United States. The main outcome measure was use of propofol during hospitalization. Results The study included 307,779 discharges in which MCS was used. Both the number of discharges for MCS and the percent of discharges using propofol increased from 2001 to 2007. After multivariable adjustment, there was more than a 3-fold increase in the odds of receiving propofol between 2001 and 2007 (odds ratio [OR] = 3.32; 95% CI, 2.96–3.72) for MCS. Conclusions The results of this study suggest that the label changes and a “Dear Doctor” letter did not affect propofol utilization. A more cohesive approach to the assessment of safety and the dissemination of label change information to practitioners is needed.

Opioid Administration Post-operatively: Reviewing the Process and Identifying Standards and Expectations for Safe, Effective Care

As healthcare faces demands to decrease length of stay and increase patient satisfaction, hospital staff seeks to streamline the discharge process. Evidence suggests an interdisciplinary discharge process results in increased nurse satisfaction, reduced incidence of medical errors and hospital acquired infections. The purpose of the Vascular Surgery and Transplant Unit (VSTU) Discharge by Eleven Project is to identify barriers to discharge and increase efficiency throughout the discharge process. A patient database was developed to detect variables affecting early discharge. An improvement plan was implemented focusing on timeliness of writing discharge orders by surgical residents and early recognition of potential discharge by nursing, medical and casemanagement staff. Subsequently, the ‘VSTUResidentSurvival Guide’was createdhighlighting the expectationsof nurses rounding daily with attending physicians and residents to identify discharges for the next day. Methods of communication included the team leaders, who served as discharge champions, and utilization of the assignment board as a visual cue.Nurseswere instructed to communicate that discharge occurs before eleven to every admission. Discharge times and customer satisfaction scores were posted weekly. The five month study showed an increase in the satisfaction with speed of the discharge process (75 to 89.3) and overall satisfaction with the process (83.6 to 89.3) based on Press Ganey raw scores. The percent of discharges by eleven increased from 11% to 15% and late discharges decreased from 50% to 37%. These findings suggest that by targeting unit specific variables early discharges can be increased.

Discharges against medical advice at regional acute care hospitals.

Data from 67 acute care hospitals in the Philadelphia metropolitan area indicate that there were 7,613 discharges against medical advice (AMA) in fiscal year 1987, or 1.20 percent of all discharges that year. Diagnosis-related group (DRG), type of insurance, and sex had independent effects on the rate of AMA discharges. Urban community hospitals had the highest percent of AMA discharges. Previous studies, done in teaching facilities, may have underestimated the rate of AMA discharges.