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Attree C, Fennessy S, Jeffrey G, Kontorinis N, Naylor N, Hazeldine S. Prior hospital attendances in deceased Australian patients with alcohol-related liver disease: a multicentre project. Intern Med J 2024; 54:1003-1009. [PMID: 38314610 DOI: 10.1111/imj.16339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 01/14/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND AND AIMS To establish the hospital visit history of patients who die with alcohol-related liver disease (ArLD). To determine if patients with ArLD present to hospital early or in the terminal phase of their disease. METHODS Retrospective cohort study of patients with a history of ArLD who died as an inpatient at three tertiary Western Australian hospitals from February 2015 to February 2017. Hospital records were reviewed to identify the number and cause of emergency department (ED), inpatient and outpatient attendances in all Western Australian public hospitals in the 10 years prior to death. RESULTS One hundred fifty-nine patients (23% female) had a total of 753 ED, 3535 outpatient appointments, 1602 hospital admissions and 10 755 admission days. Twelve months prior to death, 82% of patients had a public hospital contact and 74% an admission. Patients who had their first hospital contact within 12 months prior to death were significantly more likely to have a liver-related cause of death (P < 0.01). Aboriginal and Torres Strait Islander patients (15% of cohort) died at a significantly younger age (M = 49.2, SD = 10.5 years) than non-Aboriginal and Torres Strait Islander patients (M = 59.9, SD = 10.2 years, P < 0.01). Despite having more ED attendances and hospital admissions, Aboriginal and Torres Strait Islander patients had significantly less (P = 0.04) outpatient appointments (Mdn = 5.5, interquartile range [IQR] = 1-18 vs Mdn = 11, IQR = 3-33). CONCLUSIONS Most patients with ArLD have multiple early attendances, which present an opportunity for early interventions. There are missed opportunities for Aboriginal and Torres Strait Islander patients for outpatient hospital engagement.
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Affiliation(s)
- Chloe Attree
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sean Fennessy
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gary Jeffrey
- Department of Hepatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Nickolas Kontorinis
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nola Naylor
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Simon Hazeldine
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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T P M, T S D, Ramesh AC, K N V, Mahadevaiah T. Evaluation of the Overall Accuracy of the Combined Early Warning Scoring Systems in the Prediction of In-Hospital Mortality. Cureus 2022; 14:e24486. [PMID: 35651391 PMCID: PMC9135612 DOI: 10.7759/cureus.24486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Deterioration of clinical condition of in-hospital patients further leads to intensive care unit (ICU) transfer or death which can be reduced by the use of prediction tools. The early warning scoring (EWS) system is a prediction tool used in monitoring medical patients in hospitals, hospital staying length, and inpatient mortality. The present study evaluated four different EWS systems for the prediction of patient survival. Method The present prospective observational study has analyzed 217 patients visiting the emergency department from November 2016 to November 2018, followed by demographic and clinical data collection. Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS), Leed's Early Warning Score (LEWS), and patient-at-risk scores (PARS) were assigned based upon body temperature, consciousness level, heart rate, blood pressure, respiratory rate, mobility, etc. Data was analyzed with the help of R 4.0.4 (R Foundation, Vienna, Austria) and Microsoft Excel (Microsoft, Redmond, Washington). Results Out of these 217 patients, 205 got shifted to a ward, and 12 died, amongst which the majority belonged to the 31-40 age group. Among patients admitted to ICU had a MEWS greater than 3, TEWS within the range 0 to 2 and 3 to 5, LEWS greater than 7, and PARS greater than 5 on the initial days of admission. The patients who died and those who were shifted to the ward showed significant differences in EWS. A significant association was observed between all the EWS and patient outcomes (p<0.001). Conclusion MEWS, TEWS, LEWS, and PARS were effective in the prediction of inpatient mortality as well as admission to the ICU. With the increase in the EWS, there was an increase in the duration of ICU stay and a decrease in chances of survival.
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Affiliation(s)
- Mishal T P
- Emergency Medicine, Mathikere Sampige (MS) Ramaiah Medical College, Bengaluru, IND
| | - Deepak T S
- Emergency Medicine, Mathikere Sampige (MS) Ramaiah Medical College, Bengaluru, IND
| | - Aruna C Ramesh
- Emergency Medicine, Mathikere Sampige (MS) Ramaiah Medical College, Bengaluru, IND
| | - Vikas K N
- Anesthesiology, Mathikere Sampige (MS) Ramaiah Medical College, Bengaluru, IND
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Gusmano MK, Rodwin VG, Weisz D, Cottenet J, Quantin C. Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data. Palliat Med 2021; 35:1682-1690. [PMID: 34032175 DOI: 10.1177/02692163211019299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. AIM Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. DESIGN Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database. RESULTS 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84-2.43) and aOR = 2.59 (2.12-3.17), respectively). The odds of admission for hospital palliative care were about 25% lower (p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. CONCLUSION The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life.
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Affiliation(s)
- Michael K Gusmano
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Victor G Rodwin
- Wagner School of Public Service, New York University, New York, NY, USA
| | - Daniel Weisz
- R.N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
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Moon F, Mooney C, McDermott F, Miller A, Poon P. Bereaved families' experiences of end-of-life decision making for general medicine patients. BMJ Support Palliat Care 2021:bmjspcare-2020-002743. [PMID: 33722814 DOI: 10.1136/bmjspcare-2020-002743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Family involvement in decision making for hospitalised patients is associated with improved end-of-life care. Yet, these discussions can be challenging for physicians and families and associated with distress, confusion and conflict. There is a need to understand how best to support families involved in decisions regarding the transition from active to palliative treatment in hospital settings. AIM To explore bereaved families' experiences of end-of-life decision making for general medicine patients. DESIGN A qualitative exploratory study framed by social constructionism using semistructured interviews and thematic analysis. SETTING AND PARTICIPANTS The general medicine units of one large public hospital in Melbourne, Australia. We recruited 28 bereaved family members of patients who had received end-of-life care. FINDINGS Patients and families depended on physicians to explain clinical complexity and treatment beneficence; however, trust in medical judgement was mediated by participant's own interpretations of clinical progress. Families sought to be respected as advocates and experienced distress if physicians disregarded their perspectives and insight concerning patient preferences. Ideally, families supported patients to express their preferences to physicians. Otherwise, families contextualised treatment decisions through their knowledge of patient's values and quality of life. Families often felt burdened by or excluded from medical decision making and experienced distress and confusion regarding their rights to request or refuse treatment. CONCLUSION Our study highlights how families contribute to decision making to ensure end-of-life care treatments reflect patient preferences. Physicians can ease families' distress around treatment withdrawal by providing a meaningful explanation of complex clinical issues, clarifying decision-making roles and acknowledge families' desire to protect and advocate for their loved one.
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Affiliation(s)
- Felicity Moon
- Department of Social Work, Monash Health, Clayton, Victoria, Australia
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Christine Mooney
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Alistair Miller
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Peter Poon
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
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End-of-life care and intensive care unit clinician involvement in a private acute care hospital: A retrospective descriptive medical record audit. Aust Crit Care 2020; 34:452-459. [PMID: 33358274 DOI: 10.1016/j.aucc.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION More Australians die in the hospital than in any other setting. This study aimed to (i) evaluate the quality of end-of-life (EOL) care in the hospital against an Australian National Standard, (ii) describe the characteristics of intensive care unit (ICU) clinician involvement in EOL care, and (iii) explore the demographic and clinical factors associated with quality of EOL care. METHOD A retrospective descriptive medical record audit was conducted on 297 adult inpatients who died in 2017 in a private acute care hospital in Melbourne, Australia. Data collected related to 20 'Processes of Care', considered to contribute to the quality of EOL care. The decedent sample was separated into three cohorts as per ICU clinician involvement. RESULTS The median age of the sample was 81 (25th-75th percentile = 72-88) years. The median tally for EOL care quality was 16 (25th-75th percentile = 13-17) of 20 care processes. ICU clinicians were involved in 65.7% (n = 195) of cases; however, contact with the ICU outreach team or an ICU admission during the final inpatient stay was negatively associated with quality of EOL care (coefficient = -1.51 and -2.07, respectively). Longer length of stay was positively associated with EOL care (coefficient = .05). Specialist palliative care was involved in 53% of cases, but this was less likely for those admitted to the ICU (p < .001). Evidence of social support, bereavement follow-up, and religious support were low across all cohorts. CONCLUSION Statistically significant differences in the quality of EOL care and a negative association between ICU involvement and EOL care quality suggest opportunities for ICU outreach clinicians to facilitate discussion of care goals and the appropriateness of ICU admission. Advocating for inclusion of specialist palliative care and nonclinical support personnel in EOL care has merit. Future research is necessary to investigate the relationship between ICU intervention and EOL care quality.
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Lee YS, Choi JW, Park YH, Chung C, Park DI, Lee JE, Lee HS, Moon JY. Evaluation of the efficacy of the National Early Warning Score in predicting in-hospital mortality via the risk stratification. J Crit Care 2018; 47:222-226. [PMID: 30036835 DOI: 10.1016/j.jcrc.2018.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the efficacy of the National Early Warning Score (NEWS) in predicting in-hospital mortality. MATERIALS AND METHODS This was a retrospective observational study and the electronic medical records of the patients were reviewed based on NEWS at the time of admission. RESULTS The performance of NEWS was effective in predicting hospital mortality (area under the curve: 0.765; 95% confidence interval: 0.659-0.846). Based on the Kaplan Meier survival curves, the survival time of patients who are at high risk according to NEWS was significantly shorter than that of patients who are at low risk (p < 0.001). Results of the multivariate Cox proportional hazards regression analysis showed that the hazard ratios of patients who are at medium and high risk based on NEWS were 2.6 and 4.7, respectively (p < 0.001). In addition, our study showed that the combination model that used other factors, such as age and diagnosis, was more effective than NEWS alone in predicting hospital mortality (NEWS: 0.765; combination model: 0.861; p < 0.005). CONCLUSIONS NEWS is a simple and useful bedside tool for predicting in-hospital mortality. In addition, the rapid response team must consider other clinical factors as well as screening tools to improve clinical outcomes.
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Affiliation(s)
- Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Jae Woo Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Republic of Korea
| | - Yeon Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Dong Il Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Moon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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Screening for sepsis in general hospitalized patients: a systematic review. J Hosp Infect 2017; 96:305-315. [PMID: 28506711 DOI: 10.1016/j.jhin.2017.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/07/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sepsis is a condition widely observed outside critical care areas. AIM To examine the application of sepsis screening tools for early recognition of sepsis in general hospitalized patients to: (i) identify the accuracy of these tools; (ii) determine the outcomes associated with their implementation; and (iii) describe the implementation process. METHODS A systematic review method was used. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and Embase databases were systematically searched for primary articles, published from January 1990 to June 2016, that investigated screening tools or alert mechanisms for early identification of sepsis in adult general hospitalized patients. The review protocol was registered with PROSPERO (CRD42016042261). FINDINGS More than 8000 citations were screened for eligibility after duplicates had been removed. Six articles met the inclusion criteria testing two types of sepsis screening tools. Electronic tools can capture, recognize abnormal variables, and activate an alert in real time. However, accuracy of these tools was inconsistent across studies with only one demonstrating high specificity and sensitivity. Paper-based, nurse-led screening tools appear to be more sensitive in the identification of septic patients but were only studied in small samples and particular populations. The process of care measures appears to be enhanced; however, demonstrating improved outcomes is more challenging. Implementation details are rarely reported. Heterogeneity of studies prevented meta-analysis. CONCLUSION Clinicians, researchers and health decision-makers should consider these findings and limitations when implementing screening tools, research or policy on sepsis recognition in general hospitalized patients.
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Mills A, Walker A, Levinson M, Hutchinson AM, Stephenson G, Gellie A, Heriot G, Newnham H, Robertson M. Resuscitation orders in acute hospitals: A point prevalence study. Australas J Ageing 2016; 36:32-37. [DOI: 10.1111/ajag.12354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Amber Mills
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - Anne Walker
- The Alfred Hospital; Melbourne Victoria Australia
| | - Michele Levinson
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - Alison M Hutchinson
- Centre for Nursing Research; Deakin University and Monash Health Partnership; Melbourne Victoria Australia
| | - Gemma Stephenson
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - Anthea Gellie
- Cabrini-Monash University Department of Medicine; Cabrini Institute; Melbourne Victoria Australia
| | - George Heriot
- Royal Melbourne Hospital; Melbourne Victoria Australia
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