scholarly journals Implementation of an Accelerated Rehabilitation Protocol for Total Joint Arthroplasty in the Managed Care Setting: The Experience of One Institution

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Nicholas B. Robertson ◽  
Tibor Warganich ◽  
John Ghazarossian ◽  
Monti Khatod
Keyword(s):  
Patient Outcomes ◽  
Total Joint Replacement ◽  
Care Delivery ◽  
Average Length ◽  
Urgent Care ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Average Length Of Stay ◽  
Accelerated Rehabilitation ◽  
Perioperative Pain Management

Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic practice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. We describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education, standardization of perioperative pain management, therapy, and next day in-home services consultation following discharge. Outcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency Department (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA, 572 THA). ALOS was reduced from 3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing reduced from 25% to 14%. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved patient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as well as safe without increased utilization of UC, ER, or readmissions.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

scholarly journals Retrospective Analysis of Injuries and Hospitalizations of Patients Following the 2009 Earthquake of L’Aquila City

2019 ◽  
Vol 16 (10) ◽  
pp. 1675 ◽  
Author(s):  
Jacopo Del Papa ◽  
Pierpaolo Vittorini ◽  
Francesco D’Aloisio ◽  
Mario Muselli ◽  
Anna Rita Giuliani ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Average Length ◽  
Central Italy ◽  
International Classification Of Diseases ◽  
Discharge Data ◽  
Discharge Disposition ◽  
Average Length Of Stay ◽  
Multiple Injured ◽  
Classification Of Diseases ◽  
The Impact

The aim of this study was to investigate the injury patterns and the hospitalizations of patients who were admitted to hospital following the 2009 earthquake in the city of L’Aquila, Central Italy. To the best of our knowledge, this is the first study to analyze the patterns of earthquake-related injuries in Italy. We reviewed the hospital discharge data of 171 patients admitted to hospital within the following 96 h from the mainshock. This is an observational and descriptive study: We controlled for variables such as patient demographics, primary and secondary ICD-9-CM (International Classification of Diseases) diagnosis codes in order to identify the multiple injured patients, main type of injury that resulted in the hospital admission, discharge disposition, and average length of stay (LOS). Seventy-three percent of the 171 patients were admitted to hospital on the first day. Multiple injuries accounted for 52% of all trauma admissions, with a female to male ratio of 63% versus 37%. The most common type of injuries involved bone fractures (46.8%), while lower extremities were the most frequently affected sites (38.75%). The average LOS was 12.11 days. This study allows the evaluation of the impact of earthquake-related injuries in relation both to the health needs of the victims and to the use of the health care resources and assistance.

scholarly journals Comparison of three antimicrobial strategies in diabetic foot infections post-amputation

2019 ◽  
Vol 6 ◽  
pp. 204993611986454
Author(s):  
Samarth P. Shah ◽  
Ana Negrete ◽  
Timothy Self ◽  
Jaclyn Bergeron ◽  
Jennifer D. Twilla
Keyword(s):  
Patient Outcomes ◽  
Diabetic Foot ◽  
Hospital Admissions ◽  
Average Length ◽  
Primary Diagnosis ◽  
Antimicrobial Treatment ◽  
Optimal Route ◽  
Average Length Of Stay ◽  
Diabetic Foot Infections ◽  
Selection Of

Background: The 2012 Infectious Disease Society of America (IDSA) guidelines recommend antimicrobial treatment of diabetic foot infections (DFIs) post-amputation, but the optimal route and duration are poorly defined. Objective: The objective of this study was to determine whether the selection of a specific antimicrobial treatment modality affected hospital and patient outcomes. Methods: This was a retrospective review of hospital admissions of adults admitted to ourhealthcare system with a primary diagnosis of DFIs post-amputation. The groups were separated into patients who received intravenous antimicrobials (IV), oral antimicrobials (PO), or no antimicrobials (NA). Outcomes included average length of stay among others. Results: Of the 200 patients screened, 120 patients were included (IV n = 72; PO n = 20; NA n = 28). No statistically significant differences were identified in average LOS (IV = 9.97 ± 5.85, PO = 8.83 ± 7.37, NA = 9.33 ± 5.91 days; p = 0.73). However, post-operative (post-op) LOS was significantly shorter in the PO group (PO = 3.43 ± 2.56, IV = 7.34 ± 5.95, NA = 5.81 ± 4.18 days; p = 0.0001). Conclusion: The results of our study indicate that a PO antimicrobial treatment strategy post amputation for DFIs has the potential to decrease post-op LOS without increasing the risk of readmission. Based on the results of our study, we feel consideration should be given to transition to oral antimicrobials soon after amputation to facilitate discharge and decrease the utilization of intravenous antimicrobials.

Comparing an on-site nurse practitioner with telemedicine physician support hospitalist programme with a traditional physician hospitalist programme

2018 ◽  
Vol 25 (4) ◽  
pp. 213-220
Author(s):  
Michelle Boltz ◽  
Norma G Cuellar ◽  
Casey Cole ◽  
Brent Pistorese
Keyword(s):  
Length Of Stay ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Provider Communication ◽  
Readmission Rates ◽  
Average Length Of Stay ◽  
Physician Support

Introduction Since 2010, more than 75 rural hospitals have closed in the USA and more than one-third are at risk of closure due to lower patient volumes, lower funding levels, decreased hospital revenue and lower physician employment pools. Telemedicine can provide new models of care delivery that maintain quality and reduce cost of healthcare in rural populations. The purpose of this project was to evaluate a cross-organizational pilot program by comparing a NP/telemedicine physician hospitalist programme with a traditional physician hospitalist model to assess effects on length of patient stay, mortality rates, readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings of provider communication, and total hospital costs. Methods The Standard for Quality Improvement Reporting Excellence (SQUIRE) guidelines were followed. Using a one-year retrospective chart review, average length of stay, mortality rates, 30-day readmission rates and provider communication ratings were compared between hospitalists that were nurse practitioners working with physicians through telemedicine support and physicians alone. Results There was no statistically significant variance in average length of stay, mortality rates, 30-day readmission rates, or provider communication ratings on HCAHPS surveys compared to the NP or physician hospitalist. Discussion This new model of care demonstrates that telemedicine can be used to provide safe and efficient physician support from a regional hub medical centre to nurse practitioners practising as hospitalists in rural Critical Access Hospitals at up to 58% cost savings while maintaining quality of care and increasing access to community-based physicians.

Impact of an oncology acute care clinic (ACC) in a comprehensive cancer care setting to reduce emergency visits and subsequent hospitalizations: A pilot study.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 110-110
Author(s):  
Anamika Chaudhuri ◽  
Andrew J. Wagner ◽  
Craig A. Bunnell ◽  
Anne Gross ◽  
Emma Green ◽  
...  
Keyword(s):  
Acute Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Urgent Care ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Emergency Visits ◽  
Care Clinic ◽  
Discharge Disposition ◽  
Ed Visits

110 Background: Emergency Department (ED) visits and subsequent hospitalizations are a major source of healthcare resource utilization and costs among cancer patients, compromising quality of care and patient satisfaction. Emerging evidence, including OCM and other alternative payment models suggest many of these visits may be preventable and effectively managed in oncology-specific urgent care clinics. Little is known about such care delivery models in the comprehensive cancer care arena. Methods: As part of larger effort to provide better, efficient, timely care to patients, an acute care clinic (ACC), appropriately staffed to provide ancillary services, was set up in an academic hospital outpatient setting with hours of operations 10:30- 8:00 pm to effectively manage patients with cancer-related symptoms. The objective was to change the site of care for patients who would otherwise be seen in the ED and discharged home as well as to potentially decrease the frequency of hospitalization following ED evaluation by providing oncology subspecialized care. A retrospective analysis of 4 months pre- and post-intervention was performed with emergency visits per 1000 visits per month as the primary outcome and subsequent hospitalizations as a secondary outcome. Results: A total of 1593 patients (821 pre-intervention and 772 post-intervention) were included. Preliminary analysis revealed a 7% observed reduction in ED visits (0.25 vs 0.23 visits per month per 1000 visits; p = 0.85) for oncology patients which otherwise would have seen a 12% increase, following the historical trend. Data also suggest more effective avoidance of acute care settings with discharge disposition for patients from ED pre-intervention versus ACC post-intervention being 32% vs 72% home, 67% vs 13% inpatient, 1% vs 6% ED respectively. Conclusions: The creation of an ACC to manage urgent patient visits in an ambulatory setting decreased ED visits and the likelihood of patient admission. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true impact of ACC intervention for reduction of ED and hospitalizations.

scholarly journals 446 - Persistent Delusional Disorder (Late Paraphrenia) - An innovative and cost effective clinical model in the community by older adult‘s mental health crisis and home treatment team

2020 ◽  
Vol 32 (S1) ◽  
pp. 165-166
Author(s):  
Sabarigirivasan Muthukrishnan ◽  
Kate Hydon
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Health Professionals ◽  
Care Delivery ◽  
Average Length ◽  
Home Treatment ◽  
Treatment Team ◽  
Model Of Care ◽  
Average Length Of Stay ◽  
Safe Care

AimsTo review the various available clinical models of care delivery for patients with persistent delusional disorder (PDD) in community and economically evaluate the REACT model of safe care delivery- REACT’s Assertive and Prudent- Model of Safe Care (RAP–MoSC).MethodsREACT (Response Enhanced Assessment Crisis and Home Treatment Team) is the only bespoke crisis and home treatment team for older adults with mental health problems in the whole of Wales available only for the residents of Cardiff and Vale of Glamorgan through Cardiff and Vale University Health Board..It was set up on 28 February 2012. The cases of PDD in REACT service since its inception to 31 Dec 2016 were studied in relation to the assertive and prudent health care model. The economic evaluation of this service model for PDD patients was studied in detail.Results of the studyThe RAP-MoSC model is economically effective in avoiding patients getting admitted to hospital under Mental Health Act by managing them safely in the community.During the period between 28 February 2012 and 31 December 2016 there were 44 patients with a diagnosis of PDD in REACT’s case load. Only 3 patients got admitted to mental health assessment ward with the average length of stay period of 120 days. 41 patients were safely managed in the community with REACT with an average length of stay period of 21 days in REACT. A PDD patient will cost NHS £21,000 if admitted to a mental health bed. If the patient is managed in the community with RAP-MoSC model of care the cost will be £1533. REACT saved £793,548 by avoiding 41 PDD patients being admitted into hospital during an episode of delusional intensification in the period February 2012 to December 2016. PDD patients need under the RAP-MoSC model a bespoke MDT approach with better communication between secondary mental health and primary care services. Assertive and Prudent Clinical leadership is needed to sustain the RAP-MoSC in the community. Clinical reflections of this model of care will be presented in the conference.ConclusionsOn reflection REACT found that the key points in working with PDD are; Using a ‘foot in the door approach’Mental health professionals introducing themselves as Health professionalsRemote prescribing

scholarly journals Impact of COVID -19 on the children’s hospital of Rabat activities during 2020: General profile and comparison with the year 2019

2021 ◽  
Vol 319 ◽  
pp. 01095
Author(s):  
Houda Oubejja ◽  
Adil Cherkaoui ◽  
Toualouth Lafia ◽  
Abdelrhani Mokhtari ◽  
Abdelmajid Soulaymani
Keyword(s):  
Hospital Admissions ◽  
Average Length ◽  
Urgent Care ◽  
Emergency Rooms ◽  
Children's Hospital ◽  
Average Length Of Stay ◽  
Children’S Hospital ◽  
The Mean ◽  
Surgery Department ◽  
General Profile

The Covid-19 pandemic has put stress on the healthcare system around the world and has had an impact on people’s access to healthcare. This study aims to underline the activities at the Rabat Children’s Hospital (HER), during the year 2020 which experienced a state of health emergency due to the Covid-19 pandemic. Material and methods: We have listed the data from the admission and billing service, about the activities of the hospitalization department of the children’s hospital, Rabat. Data was entered on WPS and analyzed by Jamovi software 1.6.23. We also calculated some performance indicators: Average occupancy rate, average length of stay, and bed turnover interval (BOR, LOS, and BTOI). Results: We distinguished between services providing « urgent care » (intensive care unit ICU and emergency rooms ER) and those providing « non-urgent care » (pediatry and surgery) department. The mean number of hospital admissions (NHA) was around 8123 + /− 3942. The average BOR, LOS and BTOI were respectively 72.0 days (SD: 32.6), 66.83 days (SD: 2.68) and 3.89 days (SD: 4.34). Conclusion : The COVID-19 pandemic had an impact on our hospital activities, disturbing its normal functioning. This study tried to have an overview on the current situation and should lead to other studies in the future, allowing a better managmnt of our hospital.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

2020 ◽  
Vol 41 (S1) ◽  
pp. s403-s404
Author(s):  
Jonathan Edwards ◽  
Katherine Allen-Bridson ◽  
Daniel Pollock
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Average Length ◽  
Bloodstream Infections ◽  
Central Line ◽  
Significant Shift ◽  
Care Hospital ◽  
Average Length Of Stay ◽  
Period 2 ◽  
Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

Sign in / Sign up

Export Citation Format

Share Document