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cost of hospital emergency day

Msj Wilson, P Maniam, A Ibrahim, N Makaram, S R Knight, P Patil
Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015...
March 15, 2018: Annals of the Royal College of Surgeons of England
Maxine D Fisher, Ancilla W Fernandes, Temitope O Olufade, Paul J Miller, Mark S Walker, Moon Fenton
PURPOSE: The goal of this study was to describe patient characteristics, health resource utilization (HRU), and costs associated with treating recurrent or refractory head and neck cancer (HNC) among patients with disease progression in the community oncology setting. METHODS: This retrospective observational study was conducted by using data from the Vector Oncology Data Warehouse. Patients had been diagnosed with locally advanced or metastatic (stage III-IVc) HNC between January 1, 2007, and October 1, 2015...
March 9, 2018: Clinical Therapeutics
J Hiquet, E Christin, F Tovagliaro, J Fougas, O Dubourg, C Chevalier, F Abel, M Ebouat, M-E Ploquin, M Malo, S Gromb-Monnoyeur
BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care...
March 9, 2018: Revue D'épidémiologie et de Santé Publique
Charlotte L Kvasnovsky, Kimberly Lumpkins, Jose J Diaz, Jeannie Y Chun
BACKGROUND: The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources. STUDY DESIGN: We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013...
February 15, 2018: Journal of Pediatric Surgery
Matthew Cox, Catherine O'Connor, Katie Biggs, Daniel Hind, Oscar Bortolami, Matthew Franklin, Barbara Collins, Stephen Walters, Allan Wailoo, Julie Channell, Paul Albert, Ursula Freeman, Stephen Bourke, Michael Steiner, Jon Miles, Tom O'Brien, David McWilliams, Terry Schofield, John O'Reilly, Rodney Hughes
BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects > 3 million people in the UK. Acute exacerbations of COPD (AECOPD) are the second most common reason for emergency hospital admission in the UK. Pulmonary rehabilitation is usual care for stable COPD but there is little evidence for early pulmonary rehabilitation (EPR) following AECOPD, either in hospital or immediately post discharge. OBJECTIVE: To assess the feasibility of recruiting patients, collecting data and delivering EPR to patients with AECOPD to evaluate EPR compared with usual care...
March 2018: Health Technology Assessment: HTA
Heather S Kirkham, Francis Staskon, Nishita Hira, Darren McLane, Karl M Kilgore, Alexis Parente, Seung Kim, Gregory S Sawicki
OBJECTIVE: To compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy-based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations. METHODS: This retrospective, observational cohort study used claims data from the MORE2 claims Registry®...
March 7, 2018: Pediatric Pulmonology
Kristin Gee, Sandra Ngo, Lorrie Burkhalter, Alana L Beres
BACKGROUND: Appendicitis is the most common gastrointestinal pediatric surgical emergency. With the introduction of laparoscopic techniques in the 1990s, recovery, pain, and hospital stay after laparoscopic procedures have been significantly reduced. While many laparoscopic procedures are performed as outpatient surgeries, pediatric appendectomy patients continue to be hospitalized for postoperative observation. Our goal was to evaluate the safety and feasibility of same day discharge after laparoscopic appendectomy for uncomplicated appendicitis...
February 9, 2018: Journal of Pediatric Surgery
Vidhu Anand, David G Benditt, Wayne O Adkisson, Sushil Garg, Stephen A George, Selcuk Adabag
INTRODUCTION: Syncope/ collapse is a common reason for emergency department visits, and approximately 30-40% of these individuals are hospitalized. We examined changes in hospitalization rates, in-hospital mortality and cost of syncope/collapse-related hospital care in the U.S. from 2004 to 2013. METHODS: We used U.S. Nationwide Inpatient Sample (NIS) from 2004 through 2013 to identify syncope/collapse-related hospitalizations using ICD-9, code 780.2 as the principal discharge diagnosis...
March 5, 2018: Journal of Cardiovascular Electrophysiology
Haley Stevens, Emily Wells, Rachel Ross, Amanda Stricklen, Amir A Ghaferi
BACKGROUND: Reducing avoidable emergency department (ED) visits is an increasingly important target of quality improvement and cost containment efforts in bariatric surgery. Administrative and clinical registry data provide an incomplete picture of the factors contributing to postoperative ED utilization. Patient-centered interviews can help identify intervention opportunities. OBJECTIVES: We sought to understand the circumstances surrounding patient self-referral to the ED after elective, primary bariatric surgery...
January 31, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Glen T Hansen, Johanna Moore, Emily Herding, Tami Gooch, Diane Hirigoyen, Kevan Hanson, Marcia Deike
BACKGROUND: Emergency Departments (ED) are challenged during influenza season by patients who present acutely during sporadic ED visits. ED management is largely empiric, often occurring without reliable diagnostics needed for targeted therapies, safe outpatient discharge, or hospital admissions. OBJECTIVE: To evaluate the impact of the influenza diagnosis on physician decision making during ED visits using the Cobas Liat® influenza A + B assay. STUDY DESIGN: Prospective study assessing the impact of rapid (<30 min), reverse-transcriptase polymerase chain reaction (RT-PCR) influenza testing on physician decision making in the ED...
February 21, 2018: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Brandon James, Andrew D Chang, Ryan A McTaggart, Morgan Hemendinger, Brian Mac Grory, Shawna M Cutting, Tina M Burton, Michael E Reznik, Bradford Thompson, Linda Wendell, Ali Mahta, Matthew Siket, Tracy E Madsen, Kevin N Sheth, Amre Nouh, Karen L Furie, Mahesh V Jayaraman, Pooja Khatri, Shadi Yaghi
OBJECTIVES: Early neurological deterioration prompting urgent brain imaging occurs in nearly 15% of patients with ischaemic stroke receiving intravenous tissue plasminogen activator (tPA). We aim to determine risk factors associated with symptomatic intracranial haemorrhage (sICH) in patients with ischaemic stroke undergoing emergent brain imaging for early neurological deterioration after receiving tPA. METHODS: We abstracted data from our prospective stroke database and included all patients receiving tPA for ischaemic stroke between 1 March 2015 and 1 March 2017...
February 27, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Satya Surbhi, Ilana Graetz, Jim Y Wan, Justin Gatwood, James E Bailey
BACKGROUND: Nonadherence to essential chronic medications has been identified as a potential driver of high health care costs in superutilizers of inpatient services. Few studies, however, have documented the levels of nonadherence and factors associated with nonadherence in this high-cost, vulnerable population. OBJECTIVE: To examine the factors associated with nonadherence to essential chronic medications, with special emphasis on mental illness and use of opioid medications...
March 2018: Journal of Managed Care & Specialty Pharmacy
Ali Elfandi, Jordan G Safirstein
PURPOSE OF REVIEW: The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD)...
February 24, 2018: Current Treatment Options in Cardiovascular Medicine
Paula Heikkilä, Minna Mecklin, Matti Korppi
BACKGROUND: This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, compared to normal saline inhalations or standard treatment without inhalations as controls. METHODS: The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitalization rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies...
February 23, 2018: World Journal of Pediatrics: WJP
Holly M Romero, Coral Ringer, Michael G Leu, Elaine Beardsley, Karen Kelly, Megan D Fesinmeyer, Wren L Haaland, James B Johnson, Darren Migita
OBJECTIVES: Seattle Children's Hospital sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway. METHODS: An evidence-based pathway for management of neonatal jaundice was created. This included multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end users, and ongoing pathway improvement...
February 21, 2018: Pediatrics
Christodoulos Kaoutzanis, Nishant Ganesh Kumar, Dillon O'Neill, Blair Wormer, Julian Winocour, John Layliev, Matthew McEvoy, Adam King, Stephane A Braun, K Kye Higdon
BACKGROUND: Enhanced Recovery Pathway (ERP) programs have demonstrated improved perioperative care and shorter length of hospital stay (LOS) in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue-based breast reconstruction (ABR) before and after the implementation of an ERP program. METHODS: We retrospectively reviewed consecutive patients who underwent ABR by two surgeons before and after the implementation of the ERP at a university center over a three-year period...
February 9, 2018: Plastic and Reconstructive Surgery
Siobhán O'Connor, Peta L Hitchens, Lauren V Fortington
Background: The most recent report on hospital-treated horse-riding injuries in Victoria was published 20 years ago. Since then, injury countermeasures and new technology have aimed to make horse riding safer for participants. This study provides an update of horse-riding injuries that required hospital treatment in Victoria and examines changes in injury patterns compared with the earlier study. Methods: Horse-riding injuries that required hospital treatment (hospital admission (HA) or emergency department (ED) presentations) were extracted from routinely collected data from public and private hospitals in Victoria from 2002-2003 to 2015-2016...
2018: BMJ Open Sport & Exercise Medicine
Charlotte Zerna, Thomas Jeerakathil, Michael D Hill
Stroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experienced physicians under the guidance of stroke neurology experts...
December 27, 2017: Canadian Journal of Cardiology
David G Li, Fan Di Xia, Hasan Khosravi, Anna K Dewan, Daniel J Pallin, Christopher W Baugh, Karl Laskowski, Cara Joyce, Arash Mostaghimi
Importance: Many inflammatory skin dermatoses mimic cellulitis (pseudocellulitis) and are treated with antibiotics and/or hospitalization, leading to unnecessary patient morbidity and substantial health care spending. Objective: To evaluate the impact of early dermatology consultation on clinical and economic outcomes associated with misdiagnosed cellulitis. Design, Setting, and Participants: This prospective cohort study enrolled patients with presumed diagnosis of cellulitis in the emergency department, in the emergency department observation unit, or within 24 hours of admission to an inpatient unit of a large urban teaching hospital between February and September 2017...
February 16, 2018: JAMA Dermatology
Thomas P O'Toole, Erin E Johnson, Matthew Borgia, Amy Noack, Jean Yoon, Elizabeth Gehlert, Jeanie Lo
INTRODUCTION: Although traditional patient-centered medical homes (PCMHs) are effective for patients with complex needs, it is unclear whether homeless-tailored PCMHs work better for homeless veterans. We examined the impact of enrollment in a Veterans Health Administration (VHA) homeless-tailored PCMH on health services use, cost, and satisfaction compared with enrollment in a traditional, nontailored PCMH. METHODS: We conducted a prospective, multicenter, quasi-experimental, single-blinded study at 2 VHA medical centers to assess health services use, cost, and satisfaction during 12 months among 2 groups of homeless veterans: 1) veterans receiving VHA homeless-tailored primary care (Homeless-Patient Aligned Care Team [H-PACT]) and 2) veterans receiving traditional primary care services (PACT)...
February 15, 2018: Preventing Chronic Disease
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