Characteristics of New Patient Admissions to Aftercare

1979 ◽  
Vol 30 (3) ◽  
pp. 199-202
Author(s):  
Frank Summers
Keyword(s):  
Patient Admissions

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

Abstract 173: A Comparison of Administrative Claims Discharge Diagnosis with Electronic Medical Record Problem List in the Diagnosis of Acute Myocardial Infarction

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Michael D McCulloch ◽  
Tim Sobol ◽  
Joy Yuhas ◽  
Bill Ahern ◽  
Eric D Hixson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Record ◽  
Chart Review ◽  
Claims Data ◽  
Administrative Claims ◽  
Problem List ◽  
Principal Diagnosis ◽  
Administrative Claims Data ◽  
Patient Admissions

Background: Administrative claims data are commonly used for measurement of mortality and readmissions in Acute Myocardial Infarction (AMI). With advent of the Electronic Medical Record (EMR), the electronic problem list offers new ways to capture diagnosis data. However, no data comparing the accuracy of administrative claims data and the EMR problem list exists. Methods: Two years of admissions at a single, quaternary medical center were analyzed to compare the presence of AMI diagnosis in administrative claims and EMR problem list data using a 2x2 matrix. To gain insights into this novel method, 25 patient admissions were randomly selected from each group to undergo physician chart review to adjudicate a clinical diagnosis of myocardial infarction based on the universal definition. Results: A total of 105,929 admissions from January 1, 2010 to December 31, 2011 were included. Where EMR problem list and administrative claims data were in agreement for or against AMI diagnosis they were highly accurate. Where administrative claims data, but not EMR problem list, reported AMI the most common explanation was true AMI with missing EMR problem list diagnoses (60%). Less common reasons for discordance in this category include: (1) administrative coding error (20%), (2) computer algorithm error (8%), (3) patient death before EMR problem list created (4%), (4) EMR problem list not used (4%) and (5) AMI diagnosis was removed from EMR problem list (4%). Where EMR problem list, but not administrative claims data, reported AMI the most common explanation was no AMI with historical diagnosis of AMI from a previous admission (60%). Less common reasons for discordance in this category include: (1) AMI present but not the principal diagnosis (32%), (2) administrative coding error (4%) and (3) erroneous EMR problem list entry (4%). Conclusion: Compared to administrative and chart review diagnoses, we found that using the EMR problem list to identify patient admissions with a principal diagnosis of AMI will overlook a subset of patients primarily due to inadequate clinical documentation. Additionally, the EMR problem list does not discriminate the admission principal diagnosis from the secondary diagnoses.

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted &lt; 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

scholarly journals Reducing potentially avoidable tasks in a hyperacute stroke unit

2021 ◽  
Vol 10 (3) ◽  
pp. e001482
Author(s):  
Derya Tireli ◽  
Michael Broksgaard Jensen
Keyword(s):  
Stroke Unit ◽  
Junior Doctor ◽  
Night Shift ◽  
Healthcare Providers ◽  
Junior Doctors ◽  
Patient Admissions ◽  
Work Routines ◽  
Routine Tasks ◽  
Very High ◽  
Night Shifts

The workflow in a stroke unit can be very high, and this is especially noticeable during evening and night shifts, where staffing is reduced but the patient’s need for frequent and intensive care is not. The specialised and standardised settings in a stroke regime are constant and demanding for healthcare providers who, therefore, must work efficiently. Patient admissions, acute situations and routine tasks are major contributors to the burden of work during evening and night shifts for junior doctors on call. Thus, it is important to reduce the number of potentially avoidable tasks done by these junior doctors during night shifts so they have more time to perform tasks of high priority. The aim of this project was to reduce the potentially avoidable tasks occurring at night for the on-call junior doctor to only one per shift. We investigated the types of tasks that frequently occur for the on-call junior doctor during the night shift and improved our daily morning and evening rounds to reduce the number of tasks during the night shift. Using the plan–do–study–act method, we made improvements through education, knowledge sharing, checklists and feedback, and we reduced the number of potentially avoidable tasks for on-call junior doctors from a median of 11 to a median of 3 per week, demonstrating that the workload for the on-call junior doctor during the night shift can be reduced through a systematic approach to improving the work routines of doctors and nurses.

Lymphedema as a Meteoropathic Disease Based on a Retrospective Study in a Single Institute: a Preliminary Report

2022 ◽  
Author(s):  
Motomu Suzuki ◽  
Koukichi Koukichi ◽  
Taro Mikami ◽  
Yuichiro Yabuki ◽  
Saori Asano ◽  
...  
Keyword(s):  
Atmospheric Pressure ◽  
Preliminary Report ◽  
Lymphatic System ◽  
Meteorological Data ◽  
Climatic Conditions ◽  
Japan Meteorological Agency ◽  
Patient Admissions ◽  
Abdominal Aortic ◽  
Higher Temperature ◽  
Clinical Records

Abstract Since cellulitis is one of the most important factors for the prognosis of lymphedema, the prevention and prediction of cellulitis are considered to be critical in controlling lymphedema. We hypothesized that patients with lymphedema might show meteoropathy, as abdominal aortic aneurysm ruptures are considered to be influenced by climatic conditions, and the lymphatic system is one of the circulation systems. Thus, we aimed to determine if the onset of cellulitis in limbs affected by lymphedema is related to climatic conditions. We reviewed the clinical records of patients with lymphedema admitted for cellulitis at our institute between January 2007 and December 2017. We identified 40 patients, 25 of whom lived in the same area. We examined the association between the number of patient admissions according to season and meteorological data obtained from the Japan Meteorological Agency database. Thirteen of 25 patients were admitted in summer, whereas only one patient was admitted in winter. Both higher temperature and lower atmospheric pressure around the day of admission were associated with the occurrence of cellulitis. Lymphedema may be regarded as a meteoropathic disease, as climatic conditions were shown to be associated with cellulitis in limbs affected by lymphedema.

The impact of atrial fibrillation on hospitalization outcomes for patients with chronic lymphocytic leukemia: A large database analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19508-e19508
Author(s):  
Mohammad Ammad Ud Din ◽  
Samarthkumar Thakkar ◽  
Harsh P. Patel ◽  
Syed Ather Hussain ◽  
Aneeqa Zafar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Chronic Lymphocytic Leukemia ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Lymphocytic Leukemia ◽  
Total Cost ◽  
Patient Admissions ◽  
All Cause Mortality

e19508 Background: With the increased use of novel agents like Bruton tyrosine kinase inhibitors (BTKi) for the treatment of chronic lymphocytic leukemia (CLL), the incidence of atrial fibrillation (AF) is on the rise in these patients. However, the excess burden added by AF to the morbidity and mortality of CLL patients is unclear. Methods: Using the appropriate ICD-9 and ICD-10 codes, the National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2008 to 2019. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors like age, sex, income, and the relevant co-morbidities to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while secondary outcomes included stroke, acute heart failure (AHF), and total cost of hospital stay. Results: The mean age of the cohorts was 82 years. Females made up 44% of both groups. The AF group had similar prevalence of systemic hypertension (62.38% vs 62.10%; p= 0.73), diabetes mellitus (5.09% vs 5.43%; p= 0.35), congestive heart failure (5.57% vs 5.36%; p= 0.58), valvular heart disease (1.17% vs 1.44%; p= 0.14), and pulmonary hypertension (0.21% vs 0.14%; p= 0.31) compared to the group without AF. PSM revealed CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; p= <0.0001), AHF (7.50% vs 3.85%; p= <0.001), and stroke (3.09% vs 1.65%; p= <0.0001). Admission in the AF group also had a higher median total cost of hospital stay ($9097 vs $7646). A logistic regression model was done to adjust for confounders which revealed similar results for the AF group with increased adjusted odd’s ratio (aOR) of ACM (aOR:1.39, 95% confidence interval (CI): 1.19-1.61; p= <0.001), AHF (aOR: 2.16, 95% CI: 1.85-2.52; p= <0.001), and stroke (aOR:1.94, 95% CI: 1.54-2.44; P= <0.001) (Table). Conclusions: Our data suggest that hospitalized CLL patients with AF are at a significantly increased risk of all-cause mortality, AHF, and stroke. Several limitations like the inability to establish the temporal relationship between CLL and AF and the lack of data regarding medications of individual patients are important to keep in mind while interpreting the results.[Table: see text]

Common Organisms Responsible for Healthcare-associated Infection (HCAI)

2019 ◽  
Author(s):  
George Jacob ◽  
Martina N. Cummins
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Local Policy ◽  
Healthcare Associated Infection ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Patient Admissions ◽  
Before And After ◽  
Control And Prevention ◽  
Infectious Waste

MRSA are S. aureus which become methicillin resistant by the acquisition of the mec A gene which is on a mobile chromosomal determinant called staphylococcal cassette chromosome mec (SCC mec). The mec A gene encodes for a penicillin- binding protein (PBP2a) which has a low affinity for isoxazolyl-penicillins (MICs to oxacillin/ meticillin ≥ 4μg/ ml) and is resistant to all classes of beta-lactam antibiotics. Current Department of Health (DOH) guidance (2014) recommends that mandatory MRSA screening be streamlined to include only: ● All patient admissions to high- risk units; ● Healthcare workers; and ● All patients previously identified as colonized or infected with MRSA. The guidance also advises Trusts to follow local risk assessment policies to identify other potential high- risk units or units with a history of high endemicity of MRSA; and The guidance also recommends regular auditing of compliance with MRSA screening policy. The 2006 guideline for the control and prevention of MRSA in healthcare facilities recommends the following four measures. ● Isolation MRSA- positive patients should be nursed in a single room or if none is available, cohorting into a bay after risk assessment. Patient movement, and the number of staff and visitors looking after the patient, should be minimized. ● Hand hygiene and use of personal protective equipment (PPE) All staff and visitors should decontaminate their hands with soap and water/or an alcohol rub before and after contact with the patient or their immediate surroundings. Single-use disposable gloves and aprons/non- permeable gowns should be used by staff and visitors if there is a risk of contamination with body fluids. ● Disposal of waste and laundry All waste from colonized/ infected patients should be placed in the infectious waste stream. All linen and bedding from patients colonized/infected with MRSA should be considered as contaminated and processed as infected linen. ● Cleaning and decontamination The patient’s room should be cleaned/disinfected daily with an appropriate detergent/disinfectant as per local policy. On discharge of the patient, the room needs to be terminally cleaned before it is reused. All patient equipment should either be single-patient use or be cleaned, disinfected, and sterilized.

scholarly journals 1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S479-S479
Author(s):  
Jamie Campbell ◽  
Christopher Polk ◽  
Danya Roshdy ◽  
Michael Leonard
Keyword(s):  
Hospice Care ◽  
Intervention Group ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Short Term ◽  
Patient Admissions ◽  
Short Term Mortality ◽  
Living With Hiv ◽  
The Impact

Abstract Background Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes. Methods We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care. Results We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1. Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge. Conclusion Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up. Disclosures All authors: No reported disclosures.

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