The HALOS-ND model: a step in the journey of predicting hospital length of stay after liver transplantation

2013 ◽  
Vol 27 (6) ◽  
pp. 809-822 ◽  
Author(s):  
Kartik R. Krishnan ◽  
Renuka Bhattacharya ◽  
Arema Pereira ◽  
Annie K. Otto ◽  
Robert L. Carithers ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Results of using L-ornitin-L-aspartate in the treatment of hepatic encephalopathy in liver transplantation

2021 ◽  
Vol 13 (3) ◽  
pp. 235-247
Author(s):  
S. E. Voskanyan ◽  
E. V. Naydenov ◽  
A. I. Artemev ◽  
D. A. Zabezhinskiy ◽  
K. K. Gubarev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Encephalopathy ◽  
Length Of Stay ◽  
Cognitive Functions ◽  
Comparison Group ◽  
Hospital Length ◽  
Main Group ◽  
Stage Ii ◽  
Hospital Length Of Stay ◽  
Preoperative Period

The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.

Prolonged Length of Stay After Liver Transplantation

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 75-79
Author(s):  
Andrew T. Young ◽  
Gebhard Wagener
Keyword(s):  
Liver Transplantation ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Meld Score ◽  
Hospital Length Of Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Prolonged Hospital

Prolonged hospital length of stay after liver transplantation uses a large amount of hospital resources. The authors evaluated factors associated with prolonged hospital stay in a large single center series. Prolonged hospital stay was defined as more than 30 days. A total of 578 adult cadaveric liver transplants were included, and of these, 160 (27.7%) had a prolonged hospital stay. These patients had shorter waitlist time, higher preoperative MELD (model for end-stage liver disease) scores and received organs from donors with lower donor risk indices. In multivariate analysis, only preoperative MELD score remained significant. Postoperatively, there was no difference in the incidence of acute kidney injury; however, patients with prolonged hospital stay were more likely to have early allograft dysfunction and a higher 90-day mortality.

Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation

2017 ◽  
Vol 31 (12) ◽  
pp. e13141 ◽  
Author(s):  
Abbas Rana ◽  
Ellen D. Witte ◽  
Karim J. Halazun ◽  
Gagan K. Sood ◽  
Ayse L. Mindikoglu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Predictive Score

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

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