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Early morning discharge

V Radosavljevic, G Belojevic, N Pavlovic
OBJECTIVES: To propose a simple and effective tool for decision-making regarding general evacuation during a rapid river flood. STUDY DESIGN: Virtual testing of a tool in a real event. METHOD: A four-component tool was applied to build an alternative scenario of the catastrophic river flood in Obrenovac, Serbia, on May 2014. The components of this tool are: (1) the amount of precipitation above the 95th percentile of all previous measurements; (2) upstream river discharge above the 95th percentile of all previous measurements; (3) upstream river level above the 95th percentile of all previous measurements; and (4) worsening of the hydrometeorological situation in the following 48 h...
February 23, 2017: Public Health
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
Jitender Mokta, Subash Kumar, Neeraj Ganju, Kiran Mokta, Prashant Kumar Panda, Swatantra Gupta
BACKGROUND: Abnormal glucose metabolic status at admission is an important marker of future cardiovascular events and long-term mortality after acute coronary syndrome (ACS), whether or not they are known diabetics. OBJECTIVE: The aims were to study the prevalence of abnormal glucose metabolism in ACS patients and to compare the different methods of diagnosing diabetes in ACS patients. METHODS: We did a prospective study. About 250 consecutive nondiabetic patients (200 men and 50 women) with ACS admitted to a tertiary care institute of Himachal Pradesh in 1 year were enrolled...
January 2017: Indian Journal of Endocrinology and Metabolism
Isil Sayman Muslubas, Mumin Hocaoglu, Serra Arf, Murat Karacorlu
We report a case of morning glory syndrome (MGS) associated with persistent hyperplastic primary vitreous (PHPV) and Peters' anomaly. A 2-day-old girl, born at term with a birth weight of 3,350 g was diagnosed with Peters' anomaly, cataract, microphthalmia, PHPV, and MGS. A right limbal lensectomy and vitrectomy with stalk cauterization was performed 8 days later. No early postoperative complication occurred, the family was discharged with advice on medication, and follow-up examination was scheduled. The case report reveals the coexistence of PHPV, Peters' anomaly, and MGS, which may suggest a genetic link...
2017: GMS Ophthalmology Cases
Fadiyla Dopwell, John Maypole, Bharati Sinha, Heidi Currier, William DeBassio, Marilyn Augustyn
Nadia is a 7-year-old girl who you have followed since her discharge from the Neonatal Intensive Care Unit (NICU). Her parents are here today for an urgent visit with behavioral concerns, such as inattention, hyperactivity, and aggression.Nadia is a former 40-weeker born through vacuum-assisted vaginal delivery at 9 pounds 7 ounces. Her delivery was complicated with shoulder dystocia, which resulted in resuscitation. Her Apgar scores were 1, 3, and 4 at 1, 5, and 10 minutes, respectively. After intubation and stabilization on mechanical ventilation, Nadia was transferred to the NICU...
February 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
Drew A Bednar
STUDY DESIGN: This is a prospective cohort study. OBJECTIVE: To define the probability of successful morning-after discharge after adult spine surgery achieved with a standard care protocol as applied to patients with a large variety of common degenerative spine disorders. SUMMARY OF BACKGROUND DATA: Qualifying criteria for ambulatory or overnight-stay adult spine surgery are not well defined in either the spine or anesthesia literature. Most reports simply go to ASA risk classification or surgical technique alternatives and do not present a clearly defined patient care and case management protocol...
November 18, 2016: Spine
Chia-Ying Kuo, Hung-Yi Chiou, Jia-Wei Lin, Shin-Han Tsai, Mau-Roung Lin, Yung-Hsiao Chiang, Chien-Min Lin, Shu-Fen Chu, Tsan-Hon Liou, Wen-Ta Chiu
OBJECTIVE: Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rates are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic accident-related head injuries among cyclists in urban and rural areas. METHODS: Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study...
February 17, 2017: Traffic Injury Prevention
M L Mamalyga, L M Mamalyga
Circadian peculiarities of HR regulation and functional capacities of the heart in WAG/Rij rats with genetically determined absence epilepsy are related to spike-wave activity of the brain. The number of spike-wave discharges (SWD) is maximum at night, early morning, and evening time and decreases to minimum at 08.00-16.00. At night, functional capacities of the heart are reduced and stress test at night induces ischemic changes in the myocardium at a lower functional load than in the daytime (low level of SWD activity)...
September 2016: Bulletin of Experimental Biology and Medicine
Marcius Vinícius M Maranhão, Dyluzia Kelly Amaral da Nóbrega, Carlos Eduardo Caiado Anunciação, Barbara de Alcântara Brito Maia, Paulo Virgílio Dantas Mariano
We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used...
July 2016: Brazilian Journal of Anesthesiology
Krisda H Chaiyachati, Andre N Sofair, Jeremy I Schwartz, David Chia
OBJECTIVES: Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital's patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1 day ahead and prioritizing these discharges the next day...
May 2016: Southern Medical Journal
Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P Casaer, Gonzalo Garcia Guerra, Jan Hanot, Ari Joffe, Dick Tibboel, Koen Joosten, Greet Van den Berghe
BACKGROUND: Recent trials have questioned the benefit of early parenteral nutrition in adults. The effect of early parenteral nutrition on clinical outcomes in critically ill children is unclear. METHODS: We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding parenteral nutrition for 1 week (i.e., providing late parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early parenteral nutrition...
March 24, 2016: New England Journal of Medicine
Claire Sutton, Prue Standen, Jade Acton, Christopher Griffin
A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm...
2016: Case Reports in Obstetrics and Gynecology
Sundeep Chowdhry, Urmi Khanna, Paschal D'Souza, Tapan Kumar Dhali
Tuberculosis verrucosa cutis (TVC), also known as warty tuberculosis, anatomist's wart or prosector's wart is characterized by the presence of verrucous plaque-like lesions, resulting from direct inoculation of the causative organism into the skin of a previously infected patient. A 59-year-old man presented with a hyperpigmented plaque on the chest wall which closely mimicked a keloid. He was a case of sputum-positive pulmonary tuberculosis and had repeatedly been applying early morning saliva on the lesion as a part of the indigenous practices for quick healing...
September 2014: International Journal of Mycobacteriology
Asad Shabbir, Gorav Wali, Alan Steuer
Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result...
2015: BMJ Quality Improvement Reports
Natalia Hernandez, Dinesh John, Joan Mitchell
Faced with inherent inefficiencies built into transfer of a patient from emergency department (ED) to an inpatient bed, we determined that the timely availability of an inpatient bed was essential to improving efficiency and flow. Lack of beds early in the day was a major cause for delays and backup in the ED, which in turn placed the ED at risk for overcrowding and diversion. Review of the discharge process revealed that only 33.4% of discharges were completed prior to noon, and on average took 126 minutes from the time a discharge order was written to the time the patient actually left their inpatient bed...
2014: BMJ Quality Improvement Reports
Mamatha B, Anand Alladi
A prospective nonrandomized study of 31 children aged <16 years over a period of 14 months was conducted to evaluate the effects of early oral feeding (EOF) in children with intestinal anastomosis. Patients undergoing elective or emergency intestinal anastomosis below the ligament of Trietz with no contamination were included while contaminated cases and neonatal atresias were excluded. First feed was the direct oral feed started within 24 h, usually the morning after surgery. Liquid feeds were started initially and increased at 4 hourly increments to appropriate feed for age...
December 2015: Indian Journal of Surgery
Gerald Moss
BACKGROUND: Surgical stress accelerates postoperative metabolism, while simultaneously compromising gut activity. The dysfunction may be worsened by early feeding. These patients are not expected to fully meet their optimum metabolic requirements using current nutritional regimens. For optimum postoperative enteral nutrition, we must automatically match the patients' feeding site inflows to their impaired peristaltic outflows. An essential adjunct is virtually complete exclusion of swallowed air...
2015: Annals of Surgical Innovation and Research
M-V Sénat, L Sentilhes, A Battut, D Benhamou, S Bydlowski, A Chantry, X Deffieux, F Diers, M Doret, C Ducroux-Schouwey, F Fuchs, G Gascoin, C Lebot, L Marcellin, G Plu-Bureau, B Raccah-Tebeka, E Simon, G Bréart, L Marpeau
OBJECTIVE: To determine the post-partum management of women and their newborn whatever the mode of delivery. MATERIAL AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus)...
December 2015: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
L Genser, C Vons
INTRODUCTION: The performance of emergency abdominal surgery in an outpatient setting is increasingly the order of the day in France. This review evaluates the feasibility and reliability of ambulatory surgical treatment of the most common abdominal emergencies: appendectomy for acute appendicitis and cholecystectomy for acute complications of gallstone disease (acute cholecystitis and gallstone pancreatitis). METHODS: This study evaluates surgical procedures performed on an ambulatory basis according to the international definition (admission in the morning, discharge in the evening with a hospital stay of less than 12 hours)...
December 2015: Journal of Visceral Surgery
John C Probasco, Gina Hawley, Margie Burnett, Lorrie Gibson, Kathryn Carter, Elizabeth Harlow, Holly Russell, Linda Huffman, Jane Adams, Terry Ziegler, Hilary Sporney, Michael Levy, Hans A Puttgen
BACKGROUND AND PURPOSE: Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone. METHODS: We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment...
October 2015: Neurohospitalist
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