Rivaroxaban versus Heparin Bridging to Warfarin Therapy: Impact on Hospital Length of Stay and Treatment Costs for Low-Risk Patients with Pulmonary Embolism

2016 ◽  
Vol 36 (10) ◽  
pp. 1109-1115 ◽  
Author(s):  
Erin R. Weeda ◽  
Christine G. Kohn ◽  
W. Frank Peacock ◽  
Gregory J. Fermann ◽  
Concetta Crivera ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Warfarin Therapy ◽  
Hospital Length ◽  
Treatment Costs ◽  
Low Risk ◽  
Hospital Length Of Stay ◽  
Risk Patients

Use of hospital resources in the care of patients with intermediate risk pulmonary embolism

2020 ◽  
pp. 204887262092160
Author(s):  
Alexander E Sullivan ◽  
Tara Holder ◽  
Tracy Truong ◽  
Cynthia L Green ◽  
Olamiji Sofela ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
High Risk ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intermediate Risk ◽  
Risk Patients

Background Risk stratification and management of hemodynamically stable pulmonary embolism remains challenging. Professional societies have published stratification schemes, but little is known about the management of patients with intermediate risk pulmonary embolism. We describe the care of these patients at an academic health system. Methods Patient encounters from 1 January 2016 to 30 June 2017 were retrospectively identified utilizing a multihospital, electronic health record-based data warehouse. Using the 2019 European Society of Cardiology criteria, differences in hospital resource utilization, defined as intensive care unit admission, use of invasive therapies, and length of stay, were examined in patients with intermediate risk characteristics. Results A cohort of 322 intermediate risk patients, including 165 intermediate–low and 157 intermediate–high risk patients, was identified. Intermediate–high risk patients more often underwent catheter-directed therapy (14.0% vs. 1.8%; P<0.001) compared to intermediate–low risk patients and had a 50% higher rate of intensive care unit admission (relative risk 1.50; 95% confidence interval 1.06, 2.12; P=0.023). There was no difference in median intensive care unit length of stay (2.7 vs. 2.0 days; P=0.761) or hospital length of stay (5.0 vs. 5.0 days; P=0.775) between intermediate–high risk and intermediate–low risk patients. Patients that underwent invasive therapies had a 3.8-day shorter hospital length of stay (beta –3.75; 95% confidence interval –6.17, –1.32; P=0.002). Conclusion This study presents insights into the hospital resource utilization of patients with intermediate risk pulmonary embolism. The 2019 European Society of Cardiology risk stratification criteria are a clinically relevant scheme that identifies patients more often treated with intensive care unit admission and advanced therapies.

scholarly journals Predictors of Hospital Length of Stay among Patients with Low-risk Pulmonary Embolism

10.36469/9744 ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 84-94
Author(s):  
Li Wang ◽  
Onur Baser ◽  
Phil Wells ◽  
W. Frank Peacock ◽  
Craig I. Coleman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Troponin I ◽  
Hospital Length ◽  
Short Length ◽  
Low Risk ◽  
Cost Driver ◽  
Hospital Length Of Stay ◽  
Health Administration ◽  
Efficient Treatment

Background: Increased hospital length of stay is an important cost driver in hospitalized low-risk pulmonary embolism (LRPE) patients, who benefit from abbreviated hospital stays. We sought to measure length-of-stay associated predictors among Veterans Health Administration LRPE patients. Methods: Adult patients (aged ≥18 years) with ≥1 inpatient pulmonary embolism (PE) diagnosis (index date = discharge date) between 10/2011-06/2015 and continuous enrollment for ≥12 months pre- and 3 months post-index were included. PE patients with simplified Pulmonary Embolism Stratification Index score 0 were considered low risk; all others were considered high risk. LRPE patients were further stratified into short (≤2 days) and long length of stay cohorts. Logistic regression was used to identify predictors of length of stay among low-risk patients. Results: Among 6746 patients, 1918 were low-risk (28.4%), of which 688 (35.9%) had short and 1230 (64.1%) had long length of stay. LRPE patients with computed tomography angiography (Odds ratio [OR]: 4.8, 95% Confidence interval [CI]: 3.82-5.97), lung ventilation/perfusion scan (OR: 3.8, 95% CI: 1.86-7.76), or venous Doppler ultrasound (OR: 1.4, 95% CI: 1.08-1.86) at baseline had an increased probability of short length of stay. Those with troponin I (OR: 0.7, 95% CI: 0.54-0.86) or natriuretic peptide testing (OR: 0.7, 95% CI: 0.57-0.90), or more comorbidities at baseline, were less likely to have short length of stay. Conclusion: Understanding the predictors of length of stay can help providers deliver efficient treatment and improve patient outcomes which potentially reduces the length of stay, thereby reducing the overall burden in LRPE patients.

In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical Thrombectomy Versus Routine Care

2021 ◽  
pp. 088506662110364
Author(s):  
Jennifer R. Buckley ◽  
Brandt C. Wible
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Routine Care ◽  
Hospital Length ◽  
Elevated Risk ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay

Purpose To compare in-hospital mortality and other hospitalization related outcomes of elevated risk patients (Pulmonary Embolism Severity Index [PESI] score of 4 or 5, and, European Society of Cardiology [ESC] classification of intermediate-high or high risk) with acute central pulmonary embolism (PE) treated with mechanical thrombectomy (MT) using the Inari FlowTriever device versus those treated with routine care (RC). Materials and Methods Retrospective data was collected of all patients with acute, central PE treated at a single institution over 2 concurrent 18-month periods. All collected patients were risk stratified using the PESI and ESC Guidelines. The comparison was made between patients with acute PE with PESI scores of 4 or 5, and, ESC classification of intermediate-high or high risk based on treatment type: MT and RC. The primary endpoint evaluated was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) length of stay, total hospital length of stay, and 30-day readmission. Results Fifty-eight patients met inclusion criteria, 28 in the MT group and 30 in the RC group. Most RC patients were treated with systemic anticoagulation alone (24 of 30). In-hospital mortality was significantly lower for the MT group than for the RC group (3.6% vs 23.3%, P < .05), as was the average ICU length of stay (2.1 ± 1.2 vs 6.1 ± 8.6 days, P < .05). Total hospital length of stay and 30-day readmission rates were similar between MT and RC groups. Conclusion Initial retrospective comparison suggests MT can improve in-hospital mortality and decrease ICU length of stay for patients with acute, central PE of elevated risk (PESI 4 or 5, and, ESC intermediate-high or high risk).

scholarly journals Dalbavancin Efficacy and Impact on Hospital Length-of-Stay and Treatment Costs in Different Gram-Positive Bacterial Infections

2021 ◽  
Author(s):  
Mariacristina Poliseno ◽  
Davide Fiore Bavaro ◽  
Gaetano Brindicci ◽  
Giovanni Luzzi ◽  
Domenico Maria Carretta ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bacterial Infections ◽  
Hospital Length ◽  
Treatment Costs ◽  
Hospital Length Of Stay ◽  
Gram Positive

Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin

2016 ◽  
Vol 12 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Erin R. Weeda ◽  
Philip S. Wells ◽  
W. Frank Peacock ◽  
Gregory J. Fermann ◽  
Christopher W. Baugh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Admitting Low-Risk Patients With Intracerebral Hemorrhage to a Neurological Step-Down Unit Is Safe, Results in Shorter Length of Stay, and Reduces Intensive Care Utilization: A Retrospective Controlled Cohort Study

2020 ◽  
Vol 10 (4) ◽  
pp. 272-276
Author(s):  
Lindsay Laws ◽  
Flavia Lee ◽  
Abhay Kumar ◽  
Rajat Dhar
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Low Risk ◽  
Hospital Length Of Stay ◽  
Hematoma Expansion ◽  
Care Utilization ◽  
Control Group ◽  
Risk Patients ◽  
Step Down

Background and Purpose: Patients suffering intracerebral hemorrhage (ICH) are at risk for early neurologic deterioration and are often admitted to intensive care units (ICU) for observation. There is limited data on the safety of admitting low-risk patients with ICH to a non-ICU setting. We hypothesized that admitting such patients to a neurologic step-down unit (SDU) is safe and less resource-intensive. Methods: We performed a retrospective analysis of patients with primary ICH admitted to our SDU. We compared this cohort to a control group of ICH patients admitted to a neurologic-ICU (NICU) at a partner institution. We analyzed patients with supratentorial ICH ≤15 cc, Glasgow Coma Scale ≥ 13, National Institutes of Health Stroke Scale ≤ 10, and no to minimal intraventricular hemorrhage. Primary end points were (re-)admission to an NICU and rates of hematoma expansion (HE). We also compared total NICU days and hospital length of stay (LOS). Results: Eighty patients with ICH were admitted to the SDU. Only 2 required transfer to the NICU for complications related to ICH, including 1 for HE. Seventy-four SDU patients met inclusion criteria and were compared to 58 patients admitted to an NICU. There was no difference in rates of NICU (re-)admission (7 vs 2, P = .17) or rates of HE (3 vs 5, P = .28). Median NICU days were 0 versus 1 ( P < .001). Step-down unit admission was associated with shorter LOS (3 vs 4 days, P = .05). Conclusions: Select patients with ICH can be safely admitted to an SDU. This may reduce LOS and ICU utilization. We also propose criteria for admitting patients with ICH to an SDU.

scholarly journals Early postpartum discharge during the COVID-19 pandemic

2020 ◽  
Vol 48 (9) ◽  
pp. 1008-1012 ◽  
Author(s):  
Eran Bornstein ◽  
Moti Gulersen ◽  
Gregg Husk ◽  
Amos Grunebaum ◽  
Matthew J. Blitz ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Hospital Length ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Hospital Length Of Stay ◽  
Time Interval ◽  
Successful Implementation ◽  
Early Postpartum ◽  
The Impact

AbstractObjectivesTo report our experience with early postpartum discharge to decrease hospital length of stay among low-risk puerperium patients in a large obstetrical service during the COVID-19 pandemic in New York.MethodsRetrospective analysis of all uncomplicated postpartum women in seven obstetrical units within a large health system between December 8th, 2019 and June 20th, 2020. Women were stratified into two groups based on date of delivery in relation to the start of the COVID-19 pandemic in New York (Mid-March 2020); those delivering before or during the COVID-19 pandemic. We compared hospital length of stay, defined as time interval from delivery to discharge in hours, between the two groups and correlated it with the number of COVID-19 admissions to our hospitals. Statistical analysis included use of Wilcoxon rank sum test and Chi-squared test with significance defined as p-value<0.05.ResultsOf the 11,770 patients included, 5,893 (50.1%) delivered prior to and 5,877 (49.9%) delivered during the COVID-19 pandemic. We detected substantial shortening in postpartum hospital length of stay after vaginal delivery (34 vs. 48 h, p≤0.0001) and cesarean delivery (51 vs. 74 h, p≤0.0001) during the COVID-19 pandemic.ConclusionsWe report successful implementation of early postpartum discharge for low-risk patients resulting in a significantly shorter hospital stay during the COVID-19 pandemic in New York. The impact of this strategy on resource utilization, patient satisfaction and adverse outcomes requires further study.

Shortened hospital length of stay and lower costs associated with rivaroxaban in patients with pulmonary embolism managed as observation status

2017 ◽  
Vol 71 (1) ◽  
pp. e12915 ◽  
Author(s):  
Erin R. Weeda ◽  
W. Frank Peacock ◽  
Gregory J. Fermann ◽  
Christopher W. Baugh ◽  
Philip S. Wells ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay

The Risk of Readmission after Early Postpartum Discharge during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Moti Gulersen ◽  
Gregg Husk ◽  
Erez Lenchner ◽  
Matthew J. Blitz ◽  
Timothy J. Rafael ◽  
...  
Keyword(s):  
New York ◽  
Hospital Length ◽  
Low Risk ◽  
Hospital Length Of Stay ◽  
Early Postpartum ◽  
Chi Squared ◽  
Risk Patients ◽  
Demographic Risk ◽  
Demographic Risk Factors ◽  
Low Risk Women

Objective To determine whether early postpartum discharge during the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in the odds of maternal postpartum readmissions. Study Design This is a retrospective analysis of uncomplicated postpartum low-risk women in seven obstetrical units within a large New York health system. We compared the rate of postpartum readmissions within 6 weeks of delivery between two groups: low-risk women who had early postpartum discharge as part of our protocol during the COVID-19 pandemic (April 1–June 15, 2020) and similar low-risk patients with routine postpartum discharge from the same study centers 1 year prior. Statistical analysis included the use of Wilcoxon's rank-sum and chi-squared tests, Nelson–Aalen cumulative hazard curves, and multivariate logistic regression. Results Of the 8,206 patients included, 4,038 (49.2%) were patients who had early postpartum discharge during the COVID-19 pandemic and 4,168 (50.8%) were patients with routine postpartum discharge prior to the COVID-19 pandemic. The rates of postpartum readmissions after vaginal delivery (1.0 vs. 0.9%; adjusted odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.39–1.45) and cesarean delivery (1.5 vs. 1.9%; adjusted OR: 0.65, 95% CI: 0.29–1.45) were similar between the two groups. Demographic risk factors for postpartum readmission included Medicaid insurance and obesity. Conclusion Early postpartum discharge during the COVID-19 pandemic was associated with no change in the odds of maternal postpartum readmissions after low-risk vaginal or cesarean deliveries. Early postpartum discharge for low-risk patients to shorten hospital length of stay should be considered in the face of public health crises. Key Points

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