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Hospital readmission

Geraldine A Lee, Daniel Freedman, Penelope Beddoes, Emily Lyness, Imogen Nixon, Vivek Srivastava
BACKGROUND: Readmissions within 30-days of hospital discharge are a problem. The aim was to determine if the Better Outcomes for Older Adults through Safe Transitions (BOOST) risk assessment tool was applicable within the UK. METHODS: Patients over 65 readmitted were identified retrospectively via a casenote review. BOOST assessment was applied with 1 point for each risk factor. RESULTS: 324 patients were readmitted (mean age 77 years) with a median of 7 days between discharge and readmission...
2016: Acute Medicine
Daniel J Beckett, Elaine Thomson, Lindsay Em Reid, Robert C Lloyd
Although there are national recommendations on the function of Acute Medicine Units (AMUs), there is no single agreed best model of care. Additionally, robust data is not always available to determine whether system changes have resulted in improvement. We designed an Excel file to interface with the hospital patient management system to provide real-time data on a number of metrics including AMU length of stay (AMULOS), mortality and readmissions. This demonstrated that improving consultant continuity of care was associated with a reduction in AMULOS and reduced variation in AMULOS...
2016: Acute Medicine
Kim Tran, Chaim Bell, Nathan Stall, George Tomlinson, Allison McGeer, Andrew Morris, Michael Gardam, Howard B Abrams
BACKGROUND: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE: To examine the effect of isolation precautions on hospital-related outcomes and cost of care. DESIGN: Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012...
October 17, 2016: Journal of General Internal Medicine
Jason Suh, Amishi Desai, Anish Desai, Josephine Dela Cruz, Anusiyanthan Mariampillai, Alexander Hindenburg
Venous thromboembolism (VTE) remains the number one preventable cause of hospital acquired mortality and morbidity. Each year, more than 12 million patients are at risk for VTE. The delivery of appropriate and timely VTE prophylaxis is still suboptimal in many healthcare institutions and can lead to increased readmissions, morbidity, as well as costs. To clarify this issue further, we performed a retrospective case control study at our institution to determine if poor adherence to the VTE prophylaxis guidelines could lead to an increase in VTE events...
October 17, 2016: Journal of Thrombosis and Thrombolysis
Choung Ah Lee, Joon Pil Cho, Sang Cheon Choi, Hyuk Hoon Kim, Ju Ok Park
OBJECTIVE: Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. METHODS: We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group...
June 2016: Clin Exp Emerg Med
Samuel A Silver, Ziv Harel, Eric McArthur, Danielle M Nash, Rey Acedillo, Abhijat Kitchlu, Amit X Garg, Glenn M Chertow, Chaim M Bell, Ron Wald
BACKGROUND: The risk of hospital readmission in acute kidney injury (AKI) survivors is not well understood. We estimated the proportion of AKI patients who were rehospitalized within 30 days and identified characteristics associated with hospital readmission. METHODS: We conducted a population-based study of patients who survived a hospitalization complicated by AKI from 2003-2013 in Ontario, Canada. The primary outcome was 30-day hospital readmission. We used a propensity score model to match patients with and without AKI, and a Cox proportional hazards model with death as a competing risk to identify predictors of 30-day readmission...
October 14, 2016: American Journal of Medicine
Anthony J Weekes, Angela K Johnson, Daniel Troha, Gregory Thacker, Jordan Chanler-Berat, Michael Runyon
BACKGROUND: Right ventricular dysfunction (RVD) in pulmonary embolism (PE) has been associated with increased morbidity. Tools for RVD identification are not well defined. The prognostic value of RVD markers to predict serious adverse events (SAE) during hospitalization is unclear. OBJECTIVE: Prospectively compare the incidence of SAE in normotensive emergency department patients with PE based upon RVD by goal-directed echocardiography (GDE), cardiac biomarkers, and right-to-left ventricle ratio by computed tomography (CT)...
October 14, 2016: Journal of Emergency Medicine
Alexander Y Li, Tej D Azad, Anand Veeravagu, Inderpreet Bhatti, Amy Li, Tyler Cole, Atman Desai, John K Ratliff
STUDY DESIGN: Propensity score matched retrospective study using a nationwide longitudinal database. OBJECTIVE: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. SUMMARY OF BACKGROUND DATA: VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal follow-up...
October 12, 2016: Clinical Spine Surgery
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
Raya Elfadel Kheirbek, Janusz Wojtusiak, Sorina O Vlaicu, Farrokh Alemi
BACKGROUND: Heart failure is the leading cause for 30-day all-cause readmission. Although racial disparities in health care are well documented, their impact on 30-day all-cause readmission rate is inconclusive. OBJECTIVE: We examined the impact of racial disparity on 30-day readmission for hospitalized patients with heart failure. METHODS: This is a retrospective secondary data analysis for a large veteran cohort in 130 Veterans Affairs Medical Centers...
October 2016: Quality Management in Health Care
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Ong-Art Phruetthiphat, Michael Willey, Matthew D Karam, Yubo Gao, Brian O Westerlind, J Lawrence Marsh
OBJECTIVE: To compare patients with acetabular fractures that are isolated (acetabular fracture alone) and acetabular fracture presenting with additional non-acetabular injury using functional outcomes, complications, and readmissions. DESIGN: Retrospective review SETTING:: Level 1 Trauma CenterPatients/Participants: 215 patients underwent open surgical treatment for acetabular fracture between 2003 and 2012 with age ≥18 years and minimum one year follow-up inclusive of functional scores and complications...
October 5, 2016: Journal of Orthopaedic Trauma
Rachelle N Damle, Julie M Flahive, Jennifer S Davids, Justin A Maykel, Paul R Sturrock, Karim Alavi
BACKGROUND: Racial disparities in outcomes are well described among surgical patients. OBJECTIVE: The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery. DESIGN: Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach...
November 2016: Diseases of the Colon and Rectum
S M Wijayaratna, T Cundy, P L Drury, S Sehgal, S A Wijayaratna, F Wu
BACKGROUND/AIMS: Lower limb (LL) cellulitis related hospitalisations are prevalent in type 2 diabetes (T2DM) subjects. We assess its costs and factors associated with length of stay and readmissions. METHODS: A retrospective case-control study at an urban hospital servicing a multi-ethnic population in New Zealand, where 7% of the adult population is estimated to have diabetes. Admissions with LL cellulitis in 2008-2013 were identified using coding records. Subsequent hospitalisations after 1 month with the same diagnosis were classified as readmissions...
October 17, 2016: Internal Medicine Journal
A Parker Ruhl, Minxuan Huang, Elizabeth Colantuoni, Robert K Lord, Victor D Dinglas, Alexandra Chong, Kristin A Sepulveda, Pedro A Mendez-Tellez, Carl B Shanholtz, Donald M Steinwachs, Peter J Pronovost, Dale M Needham
OBJECTIVE: To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient healthcare resource use and estimated costs. DESIGN: Five-year longitudinal cohort study. SETTING: Thirteen ICUs at four teaching hospitals. PATIENTS: One hundred thirty-eight patients surviving greater than or equal to 2 years after acute respiratory distress syndrome. INTERVENTIONS: None...
September 29, 2016: Critical Care Medicine
Manon R Haverkate, Shayna Weiner, Karen Lolans, Nicholas M Moore, Robert A Weinstein, Marc J M Bonten, Mary K Hayden, Martin C J Bootsma
Background.  High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods.  We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions...
October 2016: Open Forum Infectious Diseases
Simon Couillard, Pierre Larivée, Josiane Courteau, Alain Vanasse
RATIONALE: A subset of patients with chronic obstructive pulmonary disease (COPD) demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophils and poor readmission outcomes are conflicting. OBJECTIVE: Investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophils. METHODS: With an observational study design, hospitalizations for severe COPD exacerbation were retrospectively gathered...
October 13, 2016: Chest
Margaret Fry, Lesley Fitzpatrick, Julie Considine, Ramon Z Shaban, Kate Curtis
INTRODUCTION: Older persons aged over 65years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. METHODS: A 12-month retrospective medical record audit of persons over 65years presenting to four EDs...
October 12, 2016: International Emergency Nursing
Matthew Da Silva, Michelle C Cleghorn, Ahmad Elnahas, Timothy D Jackson, Allan Okrainec, Fayez A Quereshy
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) is a marker that reflects systemic inflammation and organ dysfunction. Its use as a prognostic marker to predict complications following surgery has been recently described in the literature. OBJECTIVES: The objective of our study was to evaluate the use of postoperative day one (POD1) NLR as a predictor of 30-day outcomes in patients undergoing bariatric surgery. SETTING: University Hospital...
October 14, 2016: Surgical Endoscopy
German Cediel, Maribel Gonzalez-Del-Hoyo, Anna Carrasquer, Rafael Sanchez, Carme Boqué, Alfredo Bardají
OBJECTIVE: To identify patients with type 2 myocardial infarction (MI) and patients with non-ischaemic myocardial injury (NIMI) and to compare their prognosis with those of patients with type 1 MI. METHODS: A retrospective observational study was performed in 1010 patients admitted to the emergency department of a university hospital with at least one troponin I test between 2012 and 2013. Participants were identified using laboratory records and divided into three groups: type 1 MI (rupture of atheromatous plaque), type 2 MI (imbalance between myocardial oxygen supply and/or demand) and NIMI (patients who did not meet diagnostic criteria for type 1 or type 2 MI)...
October 14, 2016: Heart: Official Journal of the British Cardiac Society
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