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.

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.

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).

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.

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

Abstract 179: Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement is Not Associated With Increased Early or Late Readmission Risk

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Maneesh Sud ◽  
Feng Qui ◽  
Peter C Austin ◽  
Dennis T Ko ◽  
David Wood ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Transcatheter Aortic Valve ◽  
Readmission Risk

Background: Elderly patients undergoing transcatheter aortic valve replacement (TAVR) are at risk of hospital readmission post-procedure. It is not known if the index hospital length of stay, and specifically early discharge after TAVR is associated with an increased risk of readmission. We hypothesized a non-linear relationship whereby both short and long lengths of stay were associated with increased readmission risk. Methods: We performed a retrospective multi-center cohort analysis of patients undergoing elective transfemoral TAVR and surviving to discharge between Jan 2007 and March 2014. The exposure variable was hospital length of stay measured from the procedure date to the date of discharge and modeled as a continuous variable in a multivariable cause-specific Cox regression. Main outcome measures were 30-day and 1-year all-cause readmissions. Results: The study population consisted of 709 patients with a median length of stay of 6 days (interquartile range: 4-8 days). At 30-days and 1-year, 13.5% (n=96) and 44.0% (n=312) of patients were readmitted, respectively. Although length of stay was not associated with 30-day all-cause readmissions (p=0.92), there existed a significant association with 1-year readmission (p=0.01) after adjustment for baseline clinical variables. The association between length of stay and 1-year readmission was linear (p=0.55 for non-linearity) with no evidence supporting an increased readmission risk for shorter length of stays. Conclusions: Among elderly survivors of elective transfemoral TAVR, a short length of stay was not associated with an increased readmission risk within 30 days or 1 year. The 1-year readmission risk increased with longer length of stay.

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

EP.FRI.992 Milking the COW: A pilot study of seven-day consultant working

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Caterina Clements ◽  
Robert Mitchell ◽  
Kumaran Ratnasingham
Keyword(s):  
Length Of Stay ◽  
General Surgery ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Efficient Treatment ◽  
Time Period ◽  
Before And After ◽  
Theatre Utilisation ◽  
Funding Gap

Abstract Aims The Five Year Forward View, predicts a funding gap of nearly £30 billion per year by 2020/21, with continued disparity in resources and healthcare demand. Further, the view describes ever widening gaps in three main domains of healthcare; prevention, quality and efficiency. Those domains raised are echoed in the efficient operative working of a general surgical service with an aged, co-morbid population and inefficient theatre utilisation with increasing case cancellation due to lack of bed space.  In 2012, the Academy of Medical Royal Colleges recommended patients have the same standard of care seven days a week, with consultant review ‘at least once every twenty-four hours’. In general surgery, will a seven-day consultant led working model with a ‘consultant of the week’ (COW) enable more rapid and appropriate decisions to be made for patients enabling their efficient treatment and reducing length of stay. Method A retrospective analysis of hospital length of stay and mortality before and after the implementation of a consultant led weekday and weekend service in general surgery was carried out looking at data in October 2017 and 2018. Results The introduction of enhanced seven-day working is associated with reductions of one fifth in length of stay but no difference in mortality. Conclusions Whilst statistically significant associations with the COW and reduced length of stay have been made, the clinical significance of one fifth of a day may be negligible. Continued data collection over a longer time period, prospectively will increase the power of the study. 

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