Short-stay Hospitals Research Articles

P-748. Evaluation of Risk Factors for Short Inpatient Hospital Stays for the Treatment of Cellulitis

Abstract Background Cellulitis is a common cause of hospitalization and imposes significant financial burden on healthcare systems. This study aimed to identify patient risk factors associated with short-stay hospitalizations for cellulitis with a goal to develop a dalbavancin protocol for use in the emergency department (ED) to mitigate short hospital stays. Methods A retrospective cohort study was conducted at a 350-bed community teaching hospital in Michigan evaluating adult patients diagnosed with cellulitis February 1, 2020 - August 1, 2023, who received initial treatment with monotherapy targeting beta-hemolytic streptococci or Staphylococcus aureus. Three cohorts were identified based on length of hospitalization or ED discharge. The primary outcome was to identify risk factors associated with short-stay (< 72 hour) hospitalizations. Multivariate logistic regression was used to identify independent patient factors associated with short-stay hospitalization in contrast to long-stay (≥ 72 hours) or ED discharge. Patients were excluded if they required surgical intervention, received polymicrobial therapy, required ICU admission, received cellulitis treatment in the past 90 days, or were being treated for multiple infections. Results A total of 161 patients were included (ED discharge, n = 75; Short-stay, n = 46; and Long-stay, n = 40). Patient and treatment characteristics are summarized in Table 1. Logistic regression demonstrated that need for incision and drainage (I&D) (OR 7.23; 95% CI 1.69-38.04), Charlson Comorbidity Index ≥ 3 (OR 1.23; 95% CI 1.04-1.46), or presenting with fever (OR 31.62; 95% CI 5.67 – 596.30) were independent risk factors for short-stay hospitalization compared to ED discharge. Charlson Comorbidity Index > 3 (OR 1.25, 95% CI 1.06-1.48) and purulent cellulitis (OR 4.29, 95% CI 1.22-15.38) were predictive of long-stay hospitalizations. Characteristics such as fever, recurrent cellulitis, history of MRSA, and BMI were not associated with longer hospital stays. Conclusion A protocol to evaluate ED patients with cellulitis for dalbavancin use could reduce unnecessary hospitalizations and healthcare cost. Patients with more comorbidities, purulent cellulitis needing I&D, and those with unstable vital signs may be less ideal candidates for ED dalbavancin use. Disclosures All Authors: No reported disclosures

The in-patient substituting technologies in maxillofacial surgery: characteristics of organization and ways of further development

The social economic crisis and international sanctions significantly affected health care system that requires implementation of new organizational approaches with medical, social and economic benefits. Currently, up to 80% of budgetary funds for health care are spent on in-patient care, although 20-50% of patients could be effectively treated in less expensive short-stay hospitals. The purpose of the study is to assess efficiency of specialized care in maxillofacial surgery in conditions of short-stay hospitals. In maxillofacial surgery, implementation of in-patient substitution technologies is justified that ensure availability of minimally invasive surgeries and reduction of treatment time. The analysis of data of 2,022 patients hospitalized in the Maxillofacial Hospital for War Veterans of the Moscow Health Department from January 1 to December 31 2023 demonstrated that 1,518 patients (65.37%) were treated in the 24-hour in-patient department and 504 patients (34.63%) in the short-stay in-patient department. Among them, 738 males (36.3%) and 1,284 females (63.7%), average age of patients was 42.5 ± 17.82 years. In the 24-hour in-patient department, females accounted for 62.85% and males 37.15%. In short-stay in-patient department, females accounted for 65.48%, males for 34.52%. The average stay in 24-hour hospital was 5.6 bed days and in short-stay hospital - 6-8 hours. The economic efficiency of short-stay hospitals was demonstrated in significant savings of medications and services. The level of patient satisfaction is higher in short-stay hospital (8.4 points versus 8.1 points in 24-hour hospital). The development of short-stay hospitals in maxillofacial surgery contributes into improving of quality and accessibility of medical care, modernizing medical infrastructure and optimizing budget expenditures.

Экономическая эффективность лечения недержания мочи в условиях стационара кратковременного пребывания.

Introduction. The high prevalence of stress urinary incontinence in women increases the demand for surgical treatment. Modern minimally invasive techniques and improvements in anesthetic care significantly reduce the complications risk and improve the rehabilitation process. Short-stay hospital (SSH) facilitates faster patients return to normal life and reduces the burden on the healthcare system. Materials and methods. Economic department of the S.I. Spasokukotsky City Clinical Hospital (now State Autonomous Healthcare Institution of the City of Moscow «Moscow Scientific and Practical Center for Medical Rehabilitation and Sports Medicine named after S.I. Spasokukotsky Department of Health of the City of Moscow» Branch No. 3) calculated the cost of stress urinary incontinence treating (midurethral sling, medical cod 200511) in SSH and 24-hour hospital. Results. The cost of performing midurethral sling in the SSH conditions was 78144,27 rubles, a similar intervention in a 24-hour hospital – 88211,27 rubles. Cost-effectiveness was 11,41%. According to the calculations, treatment in SSH conditions is economically justified what means an adequate level of resource management. Conclusion. Treatment in SSH is more cost-effective particularly for patients with stress urinary incontinence. Patients should be encouraged to undergo treatment in SSH.

Short-stay hospitalisation for thyroid surgery – a feasible option in a resource constrained community

Short-stay hospitalisation for thyroid surgery – a feasible option in a resource constrained community

Emergency Department Visit Rates by Selected Characteristics: United States, 2022.

This report presents characteristics of emergency department (ED) visits by age group, sex, race and ethnicity, payment source, and mention of COVID-19, using data from the 2022 National Hospital Ambulatory Medical Care Survey (NHAMCS). Data for this report are from NHAMCS, an annual, nationally representative survey of nonfederal, general, and short-stay hospitals. Data analyses were performed using the statistical packages SAS version 9.4 and SAS-callable SUDAAN. Two-tailed t tests with a significance level of p < 0.05 were used to determine statistically significant differences between ED visit rates. The overall ED visit rate was 47 visits per 100 people in 2022, and the ED visit rates were highest for infants younger than age 1 year (99 visits per 100 infants) and adults ages 75 and older (76 per 100 adults). The ED visit rate for Black or African American non-Hispanic people (91) was the highest among the selected racial and ethnic groups. In 2022, a COVID-19 diagnosis was confirmed for 4.8% of all ED patient visits.

Hospital costs and reimbursement for short-stay inpatient versus observation status hospitalizations for children with medical complexity.

There is a lack of uniformity across hospitals in applying inpatient versus observation status for short-stay (<48 h) pediatric hospitalizations, with negative financial implications associated with observation. Children with medical complexity (CMC) represent a growing population and incur high costs of care. The financial implications of inpatient and observation status for CMC have not been studied. To compare costs and reimbursement for short-stay hospitalizations for CMC by inpatient and observation status, overall and stratified by payor. We performed a cohort study of short-stay hospitalizations for CMC from 2016 to 2021 at 10 children's hospitals reporting reimbursement in the Pediatric Health Information System and Revenue Management Program. The primary outcome was the cost coverage ratio (CCR), defined as an encounter's reimbursement divided by the estimated cost. There were 89,282 encounters included. The median costs per encounter were similar across observation ($5206, IQR $3604-$7484) and inpatient ($6547, IQR $4725-$9349) encounters. For government payors, the median CCR was 0.6 (IQR 0.2-0.9) for observation encounters and 1.2 (IQR 0.8-1.9) for inpatient. For nongovernment payors, the median CCR was 1.6 (IQR 1.3-1.9) for observation and 1.6 (IQR 1.4-2) for inpatient. Government reimbursement was associated with increased risk for financial loss (OR 13.91, 95% CI 7.23, 26.77) and with a median net loss of $985,952 (IQR $389,871-$1,700,041) per hospital annually for observation encounters. Government-paid observation encounters for CMC are associated with significant financial loss at children's hospitals. This reimbursement model may pose a threat to children's hospitals'ability to care for CMC.

Short Stay Hospitalizations Following Interhospital Transfer for Acute Stroke (P7-5.006)

Short Stay Hospitalizations Following Interhospital Transfer for Acute Stroke (P7-5.006)

One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018–19)

BackgroundThis study was designed to identify factors associated with at least one emergency department (ED) visit and those associated without consultation by a general practitioner or paediatrician (GPP) before ED visit. Levels of annual consumption of healthcare services as a function of the number of ED visit were reported.MethodsThis retrospective study focused on children < 18 years of age living in mainland France and followed for one-year after their birth or birthday in 2018. Children were selected from the national health data system, which includes data on healthcare reimbursements, long-term chronic diseases (LTD) eligible for 100% reimbursement, and individual complementary universal insurance (CMUc) status granted to households with a low annual income. Adjusted odds ratios (OR) were estimated using multivariate logistic regression.ResultsThere were 13.211 million children included (94.2% of children; girls 48.8%). At least one annual ED visit was found for 24% (1: 16%, 2: 5%, 3 or more: 3%) and 14% of visits led to hospitalization. Factors significantly associated with at least one ED visit were being a girl (47.1%; OR = 0.92), age < 1 year (9.1%; OR = 2.85), CMUc (22.7%, OR = 1.45), an ED in the commune of residence (33.3%, OR = 1.15), type 1 diabetes (0.25%; OR = 2.4), epilepsy (0.28%; OR = 2.1), and asthma (0.39%; OR = 2.0). At least one annual short stay hospitalisation (SSH) was found for 8.8% children of which 3.4% after an ED visit. A GPP visit the three days before or the day of the ED visit was found for 19% of children (< 1 year: 29%, 14–17 years: 13%). It was 30% when the ED was followed by SSH and 17% when not. Significant factors associated with the absence of a GPP visit were being a girl (OR = 0.9), age (1 year OR = 1.4, 14–17 years OR = 3.5), presence of an ED in the commune of residence (OR = 1.12), epilepsy LTD (OR = 1.1).ConclusionThe low level of visits to GPP prior to a visit to the ED and the associated factors are the elements to be taken into account for appropriate policies to limit ED overcrowding. The same applies to factors associated with a visit to the ED, in order to limit daily variations.

Using Video-Reflexive Ethnography on an Acute Medical Unit: Methodological Challenges, Solutions and Opportunities within a Complex and Busy Clinical Setting

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and taking time out to discuss issues collectively. VRE has increasingly been used across a range of different healthcare settings. However, one setting that has received less attention is the Acute Medical Unit (AMU). AMUs are busy short-stay hospital departments with very high patient throughput and large multidisciplinary teams where patients receive initial assessment, diagnosis and treatment before being moved to other wards or settings. The aim of this study was to examine how VRE as a research and improvement methodology can be applied, in the busy and complex setting of an AMU. In this paper we outline some of the methodological challenges encountered in this setting and discuss how these were transformed into opportunities and solutions. Then, we evaluate our work by using the four guiding principles at the heart of VRE (care, collaboration, reflexivity and exnovation) to test if, and how, the methodology can be used in such a complex and busy setting without losing its methodological rigor and impact. We show how it is possible to initiate and achieve the core principles of VRE in the complex and busy AMU setting through careful planning, constant revision of data collection methods, remaining highly flexible and adaptable to the spatial and temporal rhythms of the ward and being sensitive to hierarchical inter- and intra-professional relationships and vulnerabilities. Finally, we share recommendations for using VRE in other busy and complex settings.

Patient Outcomes After Long-Term Acute Care Hospital Closures

Long-term acute care hospitals (LTCHs) are common sites of postacute care for patients recovering from severe respiratory failure requiring mechanical ventilation (MV). However, federal payment reform led to the closure of many LTCHs in the US, and it is unclear how closure of LTCHs may have affected upstream care patterns at short-stay hospitals and overall patient outcomes. To estimate the association between LTCH closures and short-stay hospital care patterns and patient outcomes. This retrospective, national, matched cohort study used difference-in-differences analysis to compare outcomes at short-stay hospitals reliant on LTCHs that closed during 2012 to 2018 with outcomes at control hospitals. Data were obtained from the Medicare Provider Analysis and Review File, 2011 to 2019. Participants included Medicare fee-for-service beneficiaries aged 66 years and older receiving MV for at least 96 hours in an intensive care unit (ie, patients at-risk for prolonged MV) and the subgroup also receiving a tracheostomy (ie, receiving prolonged MV). Data were analyzed from October 2022 to June 2023. Admission to closure-affected hospitals, defined as those discharging at least 60% of patients receiving a tracheostomy to LTCHs that subsequently closed, vs control hospitals. Upstream hospital care pattern outcomes were short-stay hospital do-not-resuscitate orders, palliative care delivery, tracheostomy placement, and discharge disposition. Patient outcomes included hospital length of stay, days alive and institution free within 90 days, spending per days alive within 90 days, and 90-day mortality. Between 2011 and 2019, 99 454 patients receiving MV for at least 96 hours at 1261 hospitals were discharged to 459 LTCHs; 84 LTCHs closed. Difference-in-differences analysis included 8404 patients (mean age, 76.2 [7.2] years; 4419 [52.6%] men) admitted to 45 closure-affected hospitals and 45 matched-control hospitals. LTCH closure was associated with decreased LTCH transfer rates (difference, -5.1 [95% CI -8.2 to -2.0] percentage points) and decreased spending-per-days-alive (difference, -$8701.58 [95% CI, -$13 323.56 to -$4079.60]). In the subgroup of patients receiving a tracheostomy, there was additionally an increase in do-not-resuscitate rates (difference, 10.3 [95% CI, 4.2 to 16.3] percentage points) and transfer to skilled nursing facilities (difference, 10.0 [95% CI, 4.2 to 15.8] percentage points). There was no significant association of closure with 90-day mortality. In this cohort study, LTCH closure was associated with changes in discharge patterns in patients receiving mechanical ventilation for at least 96 hours and advanced directive decisions in the subgroup receiving a tracheostomy, without change in mortality. Further studies are needed to understand how LTCH availability may be associated with other important outcomes, including functional outcomes and patient and family satisfaction.

"Inspiratory muscle weakness in acutely hospitalized patients 75years and over": a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training.

The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay. This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW. In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention. IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization. ClinicalTrials.gov; No.: NTC03604640. May 3, 2018.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. Pain-related visits to the ED by Black or White patients. Prescriptions for opioid and non-opioid analgesics. A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

BackgroundNationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night.MethodsChildren were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome.ResultsAmong 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable.ConclusionHigher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.

Effect of removing the 4-hour access standard in the ED: a retrospective observational study

BackgroundTime-based targets are used to improve patient flow and quality of care within EDs. While previous research often highlighted the benefits of these targets, some studies found negative consequences of...

Preoperative Prediction and Risk Factor Identification of Hospital Length of Stay for Total Joint Arthroplasty Patients Using Machine Learning.

The aim of this study was to improve understanding of hospital length of stay (LOS) in patients undergoing total joint arthroplasty (TJA) in a high-efficiency, hospital-based pathway. We retrospectively reviewed 1401 consecutive primary and revision TJA patients across 67 patient and preoperative care characteristics from 2016 to 2019 from the institutional electronic health records. A machine learning approach, testing multiple models, was used to assess predictors of LOS. The median LOS was 1day; outpatients accounted for 16.5%, 1-day inpatient stays for 38.0%, 2-day stays for 26.4%, and 3-days or more for 19.1%. Patients characteristically fell into 1 of 3 broad categories that contained relatively similar characteristics: outpatient (0-day LOS), short stay (1- to 2-day LOS), and prolonged stay (3days or greater). The random forest models suggested that a lower Risk Assessment and Prediction Tool score, unplanned admission or hospital transfer, and a medical history of cardiovascular disease were associated with an increased LOS. Documented narcotic use for surgery preparation prior to hospitalization and preoperative corticosteroid use were factors independently associated with a decreased LOS. After TJA, most patients have either an outpatient or short-stay hospital episode. Patients who stay 2days do not differ substantially from patients who stay 1day, while there is a distinct group that requires prolonged admission. Our machine learning models support a better understanding of the patient factors associated with different hospital LOS categories for TJA, demonstrating the potential for improved health policy decisions and risk stratification for centers caring for complex patients.

Health Care Use among Medicare Beneficiaries with HIV and Depression during the COVID-19 Pandemic-United States, 2020.

Access and use of health care services are essential to health and well-being for people with HIV and HIV-related comorbidities. Health care use during the COVID-19 pandemic among Medicare beneficiaries (MBs) with concurrent HIV and depression has not been investigated. We used 2020 Medicare data to assess the percentage of MBs with claims for HIV and depression who also received hospitalization, outpatient diagnostic services, drug treatment, and outpatient procedures. We assessed person-level association between service receipt and HIV and depression, adjusting for known risk factors. MBs with claims for HIV and depression were more likely than those with neither claim to have claims for short-stay hospitalization, long-stay hospitalization, outpatient diagnostic services, prescription drugs, or outpatient procedures, supplies, and products. Non-White beneficiaries were more likely than White beneficiaries to be hospitalized but were less likely to receive drug treatment, outpatient diagnostic services, or outpatient procedures, supplies, and products during the pandemic. Significant disparities in health care use by race/ethnicity existed among MBs. Policymakers and practitioners can use these findings to implement public health policies and programs that reduce disparities in health care access and optimize use among vulnerable populations during a public health emergency.

Laparoscopic interventions in pediatric short-stay surgical units

Introduction. One-day surgery in pediatrics is the most preferred form of elective surgical care for children. However, today issues of laparoscopic surgical interventions in children in a one-day hospital unit remain debatable, since these interventions often require tracheal intubation which increases risks of anesthetic complications at early postoperative period.Material and methods. From 2017 to 2021, 2401 laparoscopic interventions were performed on patients with varicocele, inguinal hernia and non-palpable testicular syndrome in the short-stay department of Morozovskaya Children’s City Clinical Hospital. Average age of patients was 7 years (range 1–18 years). 910 laparoscopic herniorrhaphies, 1412 laparoscopic testicular vein ligations and 79 diagnostic laparoscopies were performed. The department has developed a unique algorithm of anesthesia for laparoscopic surgeries in children in a short-stay unit.Results. There were no anesthesia-related complications or other intraoperative complications. Restoration of independent motor activity in patients is registered in 1.5–2 hours after surgery. Average length of stay in the department is 7.1 hours (6–8 hours).Conclusion. Thus, currently, modern high-tech laparoscopic surgeries are carried out in short-stay surgical departments, while previously they were performed only in round-clock surgical departments. The researchers could achieve such successful results because of an original algorithm of safe anesthesia which has been developed in the department. This anesthetic support is highly effective for laparoscopic interventions in children with elective surgical pathologies in a short-stay hospital.

Pharmacist-led, checklist intervention did not improve adherence in ambulatory patients starting/resuming DOACs

High adherence to direct-acting oral anticoagulant (DOAC) is critical to treat and prevent thromboembolic disease. The Anticoagulation Forum recently endorsed a checklist (DOAC checklist) that recommends care processes that may improve adherence. This study aimed to determine whether checklist-driven care from a clinical pharmacist improves adherence in ambulatory patients starting a DOAC or resuming it after a setback. This study included ambulatory patients starting a DOAC or resuming it after setback (thromboembolic event or bleeding) in an ambulatory setting. Settings included office, emergency department, and short-stay hospital visit. Following the DOAC checklist, a clinical pharmacist verified DOAC appropriateness, instructed dose de-escalation, educated through 3 tele-visits, fielded hotline calls, and handed off to a continuity provider after 3 months. Intervention and control patients received coupons and help with completing manufacturer-based medication assistance applications. Using pharmacy dispense records, our group measured medication possession ratio (MPR) at 90 days (primary outcome) and proportion of days covered (PDC) at 90 days and MPR and PDC at 180 and 365 days (secondary outcomes). Given skewing, our team analyzed adherence as < 80%, 80%-89%, and 90% or more and conducted ordered logistic regression. Of 561 patients randomized, 427 had sufficient records to analyze. Adherence was high with only 41 patients (9.6%) having MPR less than 80% at 90 days. There was no difference in adherence between intervention and control patients for primary outcome (odds ratio 0.94 [95% CI 0.60-1.49]) or secondary outcomes. Our checklist-driven intervention did not appreciably improve adherence beyond that seen in control patients treated with usual care (plus coupons and medication assistance we provided to all patients) in ambulatory patients starting or resuming DOACs, although it should be noted that high levels of adherence in both study groups were noted. Given high adherence, reassessing the DOAC checklist outside of a traditional trial may be more fruitful.

Endoscopic methods of treatment of urolithiasis in children in a short-stay hospital. Experience in the treatment of 383 children

Endoscopic methods of treatment of urolithiasis in children in a short-stay hospital. Experience in the treatment of 383 children

Descriptive Epidemiology and Outcomes of Patients with Short Stay Hospitalizations for the Treatment of Congestive Heart Failure in the US.

Congestive heart failure (CHF) hospitalizations cost the US $35 billion annually. Two-thirds of these admissions, generally requiring </=3 days in the hospital, are solely for the purpose of diuresis, and may be avoidable. Among patients discharged with CHF as the principal diagnosis (PD), we compared characteristics and outcomes between those with hospital length of stay (LOS) </=3 days (short, SLOS) and >3 days (long, LLOS) in a cross-sectional multicenter analysis within the 2018 National Inpatient Sample. We applied complex survey methods to calculate nationally representative results. Among 4,979,350 discharges with any CHF code, 1,177,910 (23.7%) had CHF-PD, of whom 511,555 (43.4%) had SLOS. Patients with SLOS were younger (>/=65 years: 68.3% vs 71.9%), less likely covered by Medicare (71.9% vs 75.4%), and had a lower comorbidity burden (Charlson: 3.9 [2.1] vs 4.5 [2.2) than patients with LLOS; they less frequently developed acute kidney injury (0.4% vs 2.9%) or a need for mechanical ventilation (0.7% vs 2.8%). A higher proportion with SLOS than with LLOS underwent no procedures (70.4% vs 48.4%). Mean LOS (2.2 [0.8] vs 7.7 [6.5]), direct hospital costs ($6150 [$4413]) vs $17,127 [$26,936]), and aggregate annual hospital costs $3,131,560,372 vs $11,359,002,072) were all lower with SLOS than LLOS. All comparisons reached alpha = 0.001. Among patients admitted for CHF, nearly ½ have LOS </=3 days, and almost ¾ of them requires no inpatient procedures. A more aggressive outpatient heart failure management strategy may allow many patients to avoid hospitalizations and their potential complications and costs.