hospital characteristic
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Author(s):  
Erik M von Meyenfeldt ◽  
Fieke Hoeijmakers ◽  
Geertruid M H Marres ◽  
Eric R E van Thiel ◽  
Elske Marra ◽  
...  

Abstract OBJECTIVES Good perioperative care is aimed at rapid recovery, without complications or readmissions. Length of stay (LOS) is influenced not only by perioperative care routines but also by patient factors, tumour factors, treatment characteristics and complications. The present study examines variation in LOS between hospitals after minimally invasive lung resections for both complicated and uncomplicated patients to assess whether LOS is a hospital characteristic influenced by local perioperative routines or other factors. METHODS Dutch Lung Cancer Audit (surgery) data were used. Median LOS was calculated on hospital level, stratified by the severity of complications. Lowest quartile (short) LOS per hospital, corrected for case-mix factors by multivariable logistic regression, was presented in funnel plots. We correlated short LOS in complicated versus uncomplicated patients to assess whether short LOS clustered in the same hospitals regardless of complications. RESULTS Data from 6055 patients in 42 hospitals were included. Median LOS in uncomplicated patients varied from 3 to 8 days between hospitals and increased most markedly for patients with major complications. Considerable between-hospital variation persisted after case-mix correction, but more in uncomplicated than complicated patients. Short LOS in uncomplicated and complicated patients were significantly correlated (r = 0.53, P < 0.001). CONCLUSIONS LOS after minimally invasive anatomical lung resections varied between hospitals particularly in uncomplicated patients. The significant correlation between short LOS in uncomplicated and complicated patients suggests that LOS is a hospital characteristic potentially influenced by local processes. Standardizing and optimizing perioperative care could help limit practice variation with improved LOS and complication rates.


Psychiatry ◽  
2018 ◽  
Vol 80 ◽  
pp. 24-31
Author(s):  
Vyacheslav V. Ryakhovskiy ◽  
◽  
Vladimir G. Rotshtein ◽  
Elena S. Shipilova ◽  
◽  
...  

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tiffany Chang ◽  
Judith Lichtman ◽  
Larry Goldstein ◽  
Mary George

Background: ICD-9-CM codes recorded in administrative databases are often used to identify patients with specific clinical conditions. We determined if there are variations in the accuracy of stroke and transient ischemic attack (TIA) ICD-9-CM codes based on hospital characteristics and stroke severity. Methods: We used the records of patients discharged from hospitals in the Paul Coverdell National Acute Stroke Program in 2013. Diagnosis categories included ischemic stroke, TIA, subarachnoid hemorrhage, and intracerebral hemorrhage. We compared the agreement between the principal ICD-9-CM code and attending physician’s clinical diagnosis. The effects of hospital characteristics and stroke severity (National Institutes of Health Stroke Scale score, NIHSS) on percent agreement were assessed. Results: Among 67,442 patient records with hospital characteristic data, agreement between ICD-9-CM codes and the clinical diagnosis for ischemic stroke was higher for hospitals with stroke units, stroke teams, larger numbers of beds, and locations in metropolitan areas (P<0.05) (Table). For 55,373 records with a documented NIHSS at admission, agreement was lower for mild ischemic strokes (NIHSS 0-7) compared with more severe strokes (P<0.001); disagreements were commonly due to the patient having a carotid endarterectomy (potentially reflecting continuity of care for a stroke event) or TIA rather than a stroke. Conclusion: Systematic variations in the accuracy of ICD-9-CM codes by hospital characteristics and stroke severity may affect case identification in epidemiologic studies and have implications for hospital-level quality metrics.


2015 ◽  
Vol 144 (5) ◽  
pp. 1065-1074 ◽  
Author(s):  
M. SANAGOU ◽  
K. LEDER ◽  
A. C. CHENG ◽  
D. PILCHER ◽  
C. M. REID ◽  
...  

SUMMARYTo identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001–2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P < 0·001). Other hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare.


2012 ◽  
Vol 33 (7) ◽  
pp. 711-717 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
M. Todd Greene ◽  
Edward H. Kennedy ◽  
Thana Khawcharoenporn ◽  
Sarah Krein ◽  
...  

Objective.To evaluate hospital characteristics and practices used by Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP), the 3 most common types of healthcare-associated infection (HAI) in Thailand.Design.Survey.Setting.Thai hospitals with an intensive care unit and 250 or more hospital bedsMethods.Between January 1, 2010, and October 31, 2010, research nurses collected data from all eligible hospitals. The survey assessed hospital characteristics and practices to prevent CAUTI, CLABSI, and VAP. Ordinal logistic regression was used to assess relationships between hospital characteristics and use of prevention practices.Results.A total of 204 (80%) of 256 hospitals responded. Most hospitals (93%) reported regularly using alcohol-based hand rub. The most frequently reported prevention practice by infection was as follows: for CAUTI, condom catheters in men (47%); for CLABSI, avoiding routine central venous catheter changes (85%); and for VAP, semirecumbent positioning (84%). Hospitals with peripherally inserted central catheter insertion teams were more likely to regularly use elements of the CLABSI prevention bundle. Greater safety scores were associated with regular use of several VAP prevention practices. The only hospital characteristic associated with increased use of at least 1 prevention practice for each infection was membership in an HAI collaborative.Conclusions.While reported adherence to hand hygiene was high, many of the prevention practices for CAUTI, CLABSI, and VAP were used infrequently in Thailand. Policies and interventions emphasizing specific infection prevention practices, establishing a strong institutional safety culture, and participating in collaboratives to prevent HAI may be beneficial.


1995 ◽  
Vol 16 (3) ◽  
pp. 135-140 ◽  
Author(s):  
Scott K. Fridkin ◽  
Lilia Manangan ◽  
Elizabeth Bolyard ◽  
William R. Jarvis ◽  

AbstractObjective:To assess the efficacy of current Myco-bacterium tuberculosis control measures.Design:Voluntary questionnaire to members of the Society for Healthcare Epidemiology of America.Results:Healthcare worker (HCW) tuberculin skin-test (TST) conversion rates were significantly higher in larger hospitals ( ≥ 437 beds) (0.9% versus 0.6%; P < 0.05), or in hospitals reporting ≥ 6 TB patients in 1992 (1.2% versus 0.6%; P < 0.05). Among larger hospitals or those hospitals surveyed reporting ≥ 6 TB patients, those without at least three of the four criteria suggested in the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines for acid-fast bacilli (AFB) isolation (specifically, a single-patient room; negative pressure; and air exhausted directly outside) had significantly higher annual TST conversion rates than those with these criteria (1.8% versus 0.6%; P < 0.05). Respiratory therapist or bronchoscopist TST conversion rates were significantly lower in hospitals compliant with the exhaust criteria (1.2% versus 2.8%; P < 0.05). Regardless of hospital characteristic, HCW TST conversion rates did not differ between hospitals in which HCWs used surgical masks or used disposable particulate respirators.Conclusion:Among larger hospitals or hospitals reporting ≥ 6 TB patients per year, failure to comply with the 1990 CDC TB recommendations for AFB isolation room guidelines was associated with higher HCW TST conversion rates. These data suggest that complete implementation of the 1990 CDC TB guidelines would decrease HCWs’ risk of nosocomial transmission of TB in larger hospitals or those reporting more TB patients. However, in nonoutbreak situations, disposable particulate respirators or submicron surgical masks may not offer significantly greater protection to HCWs than surgical masks.


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