Patient safety in hospitals - a Bayesian analysis of unobservable hospital and specialty level risk factors

Micro-Costing Analysis for the Treatment of Atrial Fibrillation: An Economic Evaluation of the First Italian Experience of Same-Day Discharge Protocol for Cryoballoon Atrial Fibrillation Ablation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further due to the aging population, increasing prevalence of risk factors, improving detection methods, and broadening of catheter ablation indications. Along with limited healthcare resources and bed availability, these reasons led to the development of a same-day discharge (SDD) protocol. The aim of this study was to evaluate the health and economic impact of a routine adoption of same-day discharge after cryoballoon AF ablation. Methods: Consecutive patients with symptomatic and drug-refractory AF scheduled for first-time AF ablation were screened, and if deemed suitable, the SDD protocol was proposed and, if accepted, enrolled in the protocol. Results: A total of 324 patients were screened, and 118 were considered eligible for the SDD pathway. Fifty-two patients accepted the SDD pathway and were included in this study. The analysis showed that the variation in resource consumption associated with cryoablation in SDD is equal to EUR 739.85/patient. The analysis showed that the main cost driver for ordinary hospitalization was represented by the hospital stay, which was calculated to be 36% of the total cost. In total, there was a cost reduction of EUR 38.472 thanks to optimized AF patient management from the standard recovery setting to SDD. Conclusions: SDD after cryoballoon ablation of AF is feasible in selected patients with a standardized protocol.

Same-day discharge after percutaneous coronary procedures-Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology

INTRODUCTION

Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. Recent technical advances such as radial access, third generation drug-eluting stents and highly effective antiplatelet therapy have substantially improved the safety profile of coronary procedures. Despite several practice guidelines and a clear patient preference of early hospital discharge, the percentage of coronary procedures performed in an outpatient setting in Austria remains low, mostly due to safety concerns.

METHODS

The aim of this consensus statement is to provide a practical framework for the safe and effective implementation of coronary outpatient clinics in Austria. Based on a structured literature review and an in-depth analysis of available practice guidelines a consensus statement was developed and peer-reviewed within the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology.

RESULTS

Based on the available literature same-day discharge coronary procedures show a favorable safety profile with no increase in the risk of major adverse events compared to an overnight stay. This document provides a detailed consensus in various clinical settings. The most important prerequisite for same-day discharge is, however, adequate selection of suitable patients and a structured peri-interventional and postinterventional management plan.

CONCLUSION

Based on the data analysis this consensus document provides detailed practice guidelines for the safe operation of daycare cathlab programs in Austria.

Same-day discharge after atrial fibrillation ablation

Background

Atrial fibrillation (AF) catheter ablation has become an increasingly effective and safe strategy for the management of AF. With increased safety of catheter ablation, same-day discharge (SDD) is a potential way to minimize health care resource utilization and improve patient experience.

Objective

To evaluate the safety and patient satisfaction of SDD after contemporary AF ablation.

Methods

Consecutive patient undergoing AF ablation at our institution between 1/2020 and 10/2021 were enrolled in registry for clinical, quality, procedural and outcomes data. Patients were considered for SDD per physician discretion and patients' preference based upon clinical evaluation. Adjudicated ninety-day major complications, thirty-day adverse events, and thirty-day re-admissions were collected in a prospective registry for all patients.

Results

A total of 2142 consecutive patients underwent elective AF ablation during the study period. After excluding cases with missing data, 1830 patients were included in the analysis. Of those, 350 (19 %) patients were discharged the same day (SDD group) and 1480 (81 %) stayed overnight. Patients in the SDD group compared to overnight stay group were younger, more likely to be male, White patients, lower CHA2DS2-VASc score and to be on lower rates of warfarin as an anticoagulation strategy. After propensity score matching, SDD was associated with lower rate of major complications and higher patient satisfaction. The majority of life-treating complications occurred interprocedurally or within 6 h of procedure termination.

Conclusion

The present study demonstrated that SDD after contemporary AF ablation is feasible, safe and associated with higher patient satisfaction using a proposed SDD pathway and criteria.

The importance of human factors in therapeutic dietary errors of a hospital: A mixed-methods study

An accurate therapeutic diet can help people improve their medical condition. Any discrepancy in this regard could jeopardize a patient’s clinical condition. This study was aimed to determine prevalence of dietary errors among in-patients at an international private hospital’s food department, and to explore causes of error to suggest strategies to reduce such errors in the future. Thus, a sequential explanatory mixed-methods study was carried out. For the quantitative part, secondary data were collected on a daily basis over one-month. For qualitative data, errors arising during the meal flow process were traced to the source on the same day of error followed by qualitative interviews with person responsible. Quantitative data were analyzed in SPSS v.25 as percentages. Qualitative data were analyzed by deductive-inductive thematic analysis. Out of a total of 7041 diets, we found that only 17 had errors. Of these, almost two-thirds were critical. Majority of these errors took place during diet card preparation (52.94%), by dietitians (70.59%), during weekdays (82.35%), breakfasts (47.06%), and in the cardiac care ward (47.06%). The causes identified through interviews were lack of backup or accessory food staff, and employee’s personal and domestic issues. It was concluded that even though the prevalence of dietary errors was low in this study, critical errors formed majority of these errors. Adopting organizational behavior strategies in the hospital may not only reduce dietary errors, but improve patients’ well-being, and employee satisfaction in a long run.

Hospital-acquired complications: the relative importance of hospital- and patient-related factors

OBJECTIVE

To quantify the prevalence of hospital-acquired complications; to determine the relative influence of patient- and hospital-related factors on complication rates.

DESIGN, PARTICIPANTS

Retrospective analysis of administrative data (Integrated South Australian Activity Collection; Victorian Admitted Episodes Dataset) for multiple-day acute care episodes for adults in public hospitals.

SETTING

Thirty-eight major public hospitals in South Australia and Victoria, 2015-2018.

MAIN OUTCOME MEASURES

Hospital-acquired complication rates, overall and by complication class, by hospital and hospital type (tertiary referral, major metropolitan service, major regional service); variance in rates (intra-class correlation coefficient, ICC) at the patient, hospital, and hospital type levels as surrogate measures of their influence on rates.

RESULTS

Of 1 558 978 public hospital episodes (10 029 918 bed-days), 151 486 included a total of 214 286 hospital-acquired complications (9.72 [95% CI, 9.67-9.77] events per 100 episodes; 2.14 [95% CI, 2.13-2.15] events per 100 bed-days). Complication rates were highest in tertiary referral hospitals (12.7 [95% CI, 12.6-12.8] events per 100 episodes) and for episodes including intensive care components (37.1 [95% CI, 36.7-37.4] events per 100 episodes). For all complication classes, inter-hospital variation was determined more by patient factors (overall ICC, 0.55; 95% CI, 0.53-0.57) than by hospital factors (ICC, 0.04; 95% CI, 0.02-0.07) or hospital type (ICC, 0.01; 95% CI, 0.001-0.03).

CONCLUSIONS

Hospital-acquired complications were recorded for 9.7% of hospital episodes, but patient-related factors played a greater role in determining their prevalence than the treating hospital.

The possibilities of day surgery system development within the health policy in Slovakia

BACKGROUND

In the day surgery system are intertwined elements of state health policy, health care payers' interests, employers of health care system, as well as the interests and wishes of patients. A problem in the health policy is to find a way to regulate ambulatory and short-term surgical procedures, which are hardly distinguishable, and still fulfil the requirements of transparent financing, quality and security. The objective of this paper is to highlight the reasons for the long-term stagnation in Slovakia day surgery and the possibilities of eliminating the structural drivers causing this negative phenomenon.

METHODS

Due to the nature of the analyzed data and desired outcomes, we selected application of correspondence analysis. Results of correspondence analysis provide valuable information necessary for the projection of specialization of one day surgery clinics for that type of procedure, as well as for the support of the new clinics creation (also with the potential state support), the pricing policy, systemic reduction of beds what is connected with reduction of underutilized departments in hospitals, in order to optimize management processes in the healthcare system.

RESULTS

Contribution reveals negative aspects which causing a low level of day surgery in Slovakia. Moreover, it reveals the approaches of the different subjects of day surgery. Presented options for setting optimal strategy supporting its development are based on the results of the analysis. Correspondence analysis provided valuable information of present structure of the day surgery system. The determined similarity of the regions and association of specialized fields indicate specific settings of the day surgery system and its components that are inevitable to analyze in the subsequent analytical process.

CONCLUSIONS

Results of the analysis are very important in order to set up the system measures in the process of its further development, which should be part of the strategic plan of each health system. On conceptual and methodological issues related with reporting of day surgery performances are highlighting international organizations such as the OECD,WHO.

JEL CLASSIFICATION

I13, I18, H51.