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Tarantino B, Wood M, Hancock D, Shah K. Does pre-injury anticoagulation make chest tubes any less safe? A nationwide retrospective analysis. Am J Emerg Med 2024; 82:47-51. [PMID: 38788529 DOI: 10.1016/j.ajem.2024.05.008] [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: 11/06/2023] [Revised: 03/26/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Oral anticoagulation is becoming more common with the aging population, which raises concern for the risk of invasive procedures that can cause bleeding, such as chest tube placement (thoracostomy). With the increase in CT imaging, more pneumothoraces and hemothoraces are being identified. The relative risk of thoracostomy in the presence of anticoagulation is not well-established. The objective of this study was to determine whether pre-injury anticoagulation affects the relative risk of tube thoracostomy following significant chest trauma. METHODS This retrospective cohort study used data from the 2019 American College of Surgeons-Trauma Quality Program (ACS-TQP) database using R version 4.2.2. Data from the database was filtered based on inclusion and exclusion criteria. Outcomes were then assessed with the population of interest. Demographics, vitals, comorbidities, and injury parameters were also collected for each patient. This study included all adult patients (≥18 years) presenting with traumatic hemothorax, pneumothorax, or hemopneumothorax. Patients with missing data in demographics, vitals, comorbidities, injury parameters, or outcomes, as well as those with no signs of life upon arrival, were excluded from the study. Patients were stratified into groups based on whether they had pre-injury anticoagulation and whether they had a chest tube placed in the hospital. The primary outcome was mortality, and the secondary outcome was hospital length of stay (LOS). Logistic and standard regressions were used by a statistician to control for age, sex, and Injury Severity Score (ISS). RESULTS Our study population included 72,385 patients (4250 with pre-injury anticoagulation and 68,135 without pre-injury anticoagulation). Pre-injury anticoagulation and thoracostomy were each independently associated with increased mortality and LOS. However, there was a non-significant interaction term between pre-injury anticoagulation and thoracostomy for both outcomes, indicating that their combined effects on mortality and LOS did not differ significantly from the sum of their individual effects. CONCLUSION This study suggests that both pre-injury anticoagulation and thoracostomy are risk factors for mortality and increased LOS in adult patients presenting with hemothorax, pneumothorax, or hemopneumothorax, but they do not interact with each other. We recommend further study of this phenomenon to potentially improve clinical guidelines. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
| | - Myles Wood
- Weill Cornell Medicine, United States of America
| | | | - Kaushal Shah
- Weill Cornell Medicine, United States of America
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Chiumia FK, Chimimba F, Nyirongo HM, Kampira EL, Muula AS, Khuluza F. Adverse Drug Reactions Related with Antibiotic Medicines in Malawi: A Retrospective Analysis of Prevalence and Associated Factors. Drug Healthc Patient Saf 2024; 16:89-101. [PMID: 39070704 PMCID: PMC11283248 DOI: 10.2147/dhps.s468966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
Objective We aimed to assess the occurrence and characteristics of antibiotic-associated adverse drug reactions (ADRs) in Malawi. Methods We retrospectively reviewed 304 patient records from medical wards in three hospitals in Southern Malawi. A global trigger tool was applied for the detection of suspected ADRs, and we used the Naranjo scale, the World Health Organization classification and the Schumock and Thornton scale for causality, seriousness and preventability assessment respectively. ADRs were also further characterized according to anatomical systems. Statistical analysis was done in STATA 14.1. The Chi-square test was used to determine the association between categorical variables and logistic regression analysis was used to measure the strength of the association between various independent variables and the occurrence of ADRs. Results Suspected ADRs were detected in 24% (73/304) of patients, of which 1.4% were definite, 15.1% were probable and 83.6% were possible ADRs. Most of the sADRs were gastrointestinal events (42.5%), followed by: musculoskeletal (26.3%); cardiovascular (16.3%); central nervous system (13.8%; and urinary events (1.3%). About 27% of the sADRs were serious events such as convulsions. The geriatric age group (≥65 years) was more likely to experience sADRs as compared to the younger age group, with an adjusted odds ratio (aOR) of 4.53, 95% CI (2.21-9.28), P<0.001. Patients taking more than one antibiotic medicine had a higher risk of developing sADRs as compared to patients who were administered one type of antibiotic medicine, aOR 2.14, 95% CI (1.18-3.90), p < 0.012. A long hospital stay of >3days was associated with a higher risk of sADRs with aOR of 5.11, 95% CI (2.47-10.55), p < 0.001 than those who stayed ≤ 3 days in the hospital. Conclusion We found a higher prevalence of serious sADRs associated with antibiotic medicines than reported elsewhere. This may, among others, contribute to high patient mortality, poor treatment adherence, antibiotic resistance and increased cost of care.
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Affiliation(s)
- Francis Kachidza Chiumia
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Frider Chimimba
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Happy Magwaza Nyirongo
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Lusungu Kampira
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Sinjani Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Van Wilder A, Bruyneel L, Cox B, Claessens F, De Ridder D, Janssens S, Vanhaecht K. Call for Action to Target Interhospital Variation in Cardiovascular Mortality, Readmissions, and Length-of-Stay: Results of a National Population Analysis. Med Care 2024; 62:489-499. [PMID: 38775668 DOI: 10.1097/mlr.0000000000002012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Excessive interhospital variation threatens healthcare quality. Data on variation in patient outcomes across the whole cardiovascular spectrum are lacking. We aimed to examine interhospital variability for 28 cardiovascular All Patient Refined-Diagnosis-related Groups (APR-DRGs). METHODS We studied 103,299 cardiovascular admissions in 99 (98%) Belgian acute-care hospitals between 2012 and 2018. Using generalized linear mixed models, we estimated hospital-specific and APR-DRG-specific risk-standardized rates for in-hospital mortality, 30-day readmissions, and length-of-stay above the APR-DRG-specific 90th percentile. Interhospital variation was assessed based on estimated variance components and time trends between the 2012-2014 and 2016-2018 periods were examined. RESULTS There was strong evidence of interhospital variation, with statistically significant variation across the 3 outcomes for 5 APR-DRGs after accounting for patient and hospital factors: percutaneous cardiovascular procedures with acute myocardial infarction, heart failure, hypertension, angina pectoris, and arrhythmia. Medical diagnoses, with in particular hypertension, heart failure, angina pectoris, and cardiac arrest, showed strongest variability, with hypertension displaying the largest median odds ratio for mortality (2.51). Overall, hospitals performing at the upper-quartile level should achieve improvements to the median level, and an annual 633 deaths, 322 readmissions, and 1578 extended hospital stays could potentially be avoided. CONCLUSIONS Analysis of interhospital variation highlights important outcome differences that are not explained by known patient or hospital characteristics. Targeting variation is therefore a promising strategy to improve cardiovascular care. Considering their treatment in multidisciplinary teams, policy makers, and managers should prioritize heart failure, hypertension, cardiac arrest, and angina pectoris improvements by targeting guideline implementation outside the cardiology department.
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Affiliation(s)
- Astrid Van Wilder
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Luk Bruyneel
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Bianca Cox
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Fien Claessens
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Dirk De Ridder
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
- Department of Quality, University Hospitals Leuven, Belgium
- Department of Urology, University Hospitals Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Belgium
| | - Kris Vanhaecht
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
- Department of Urology, University Hospitals Leuven, Belgium
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Aalders MB, van der List JP, Keijser LCM, Benner JL. Anxiety and depression prior to total knee arthroplasty are associated with worse pain and subjective function: A prospective comparative study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38943459 DOI: 10.1002/ksa.12336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE The aim of this study was to investigate the influence of preoperative anxiety and depression on subjective function, pain and revision rates following total knee arthroplasty (TKA). METHODS A prospective comparative study was conducted, including 349 patients undergoing TKA surgery between January 2019 and April 2021. Patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively, and a set of Patient-Reported Outcome Measures (PROMs) preoperatively and at 6, 12 and 24 months postoperatively. Patients were categorized into anxiety and depression groups based on HADS scores. PROMs included the Knee injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), Oxford Knee Score (OKS) and NRS-Pain. Differences in PROM scores between the anxiety/depression group and, respectively, nonanxiety/nondepression group were assessed, as well as differences in minimal clinical important difference (MCID) and attainment of Patient Acceptable Symptom State (PASS). Lastly, revision rates were compared. RESULTS Anxiety and depression groups exhibited inferior subjective function preoperatively and postoperatively compared to nonanxiety and nondepression groups (all p < 0.05), experienced more pain preoperatively (p < 0.001) and also postoperatively for depression patients (all p < 0.05). Significantly fewer patients with anxiety and depression reached the PASS for KOOS-PS, OKS and NRS-Pain (all p < 0.05). There were no differences in the proportion of patients reaching the MCID for all PROMs (all p > 0.060), and revision rates did not differ between groups (both p > 0.96). CONCLUSION Preoperative anxiety and depression negatively influence subjective function and pain preoperatively and up to 2-year follow-up in patients undergoing TKA. Revision rates did not differ between groups, and there were no relevant differences in clinical improvement of subjective function and pain. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Margot B Aalders
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Lucien C M Keijser
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Joyce L Benner
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
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Haouatti F, Belhadj IK, Goumidi A, Yafour N, Toumi H. The cost of multiple myeloma and its complications: A single-center study from Oran, Algeria. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:654-662. [PMID: 38340806 DOI: 10.1016/j.pharma.2024.02.001] [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: 11/05/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The expenses of multiple myeloma (MM) represent a real economic and societal burden for patients and health authorities. However, very little is known about the situation in Algeria. Therefore, the aim of this study is to evaluate the costs generated by the management of MM and its complications in Algerian patients. MATERIALS AND METHODS An observational retrospective study conducted on patients diagnosed with MM, from January 1st, 2019 to April 31st, 2023, at the Establishment Hospitalier Universitaire November 1st, Oran. A bottom-up costing methodology was used to assess the phase-specific cost and the complication burden. RESULTS In total, 249 qualified for the study. For autologous stem cell transplantation (ASCT) eligible patients, the mean per patient cost of treating myeloma was estimated at: induction regimen ($4072); ASCT ($2899); consolidation ($1538); and maintenance ($355.76). The mean drug cost for ASCT-ineligible patients was $1421. The use of generic bortezomib and generic melphalan has led to a reduction in expenses of $1,075,181 ($5,024 per patient; 55.35%) and $10,864 ($487 per patient; 15.07%), respectively. Another cost-saving adaptation was ASCT using non-cryopreserved (NC) stem cells. The cost of managing MM complications was $177,782 per year. CONCLUSION A number of adjustments have been implemented to the management of MM over time to improve clinical efficacy and reduce costs in Algeria. However, this may have come with a startlingly high cost of complications.
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Affiliation(s)
- Fairouz Haouatti
- Department of Pharmacovigilance, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria.
| | - Ikram K Belhadj
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Ahlem Goumidi
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Nabil Yafour
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Houari Toumi
- Department of Pharmacovigilance, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
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de Moura Pedro RA, Besen BAMP, Mendes PV, Gomes ACM, de Carvalho MT, Malbouisson LMS, Park M, Taniguchi LU. Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review. J Crit Care 2024; 80:154510. [PMID: 38150833 DOI: 10.1016/j.jcrc.2023.154510] [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: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data. METHODS This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE. RESULTS Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%). CONCLUSIONS In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.
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Affiliation(s)
| | | | - Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Marcelo Park
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, Alshlowi S. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual 2024; 13:e002484. [PMID: 38423585 PMCID: PMC10910643 DOI: 10.1136/bmjoq-2023-002484] [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: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. METHODS Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the 'demand and supply approach' of the Institute of Healthcare Improvement, were adapted to examine and modify factors influencing hospital patient flow. RESULTS This study (conducted from the last quarter of 2019 through September 2022) resulted in a remarkable improvement in patient flow, as evident from the reduction in average hospital length of stay (from 11.5 to 4.4 days) and average emergency department boarding time (from 11.9 to 1.2 hours) and the improvement of bed turnover rate (from 0.57 to 0.93), (p<0.001, p=0.017, p=0.038, respectively), with net cost savings of 123 130 192 million Saudi Riyals (US$32 821 239). CONCLUSION Implementing a well-structured case management programme can enhance care coordination, streamlilne transitions, boost patient outcomes, and increase revenues within hospital settings.
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Affiliation(s)
- Sultanah Al Harbi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Baker Aljohani
- Medical Administration, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lamiaa Elmasry
- Quality Improvement and Patient Safety Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Frenk Lee Baldovino
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Kamille Bianca Raviz
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lama Altowairqi
- Admission Office Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Seetah Alshlowi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
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Giese A, Khanam R, Nghiem S, Staines A, Rosemann T, Boes S, Havranek MM. Assessing the excess costs of the in-hospital adverse events covered by the AHRQ's Patient Safety Indicators in Switzerland. PLoS One 2024; 19:e0285285. [PMID: 38315675 PMCID: PMC10843032 DOI: 10.1371/journal.pone.0285285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/19/2023] [Indexed: 02/07/2024] Open
Abstract
There currently exists no comprehensive and up-to date overview on the financial impact of the different adverse events covered by the Patient Safety Indicators (PSIs) from the Agency for Healthcare Research and Quality. We conducted a retrospective case-control study using propensity score matching on a national administrative data set of 1 million inpatients in Switzerland to compare excess costs associated with 16 different adverse events both individually and on a nationally aggregated level. After matching 8,986 cases with adverse events across the investigated PSIs to 26,931 controls, we used regression analyses to determine the excess costs associated with the adverse events and to control for other cost-related influences. The average excess costs associated with the PSI-related adverse events ranged from CHF 1,211 (PSI 18, obstetric trauma with instrument) to CHF 137,967 (PSI 10, postoperative acute kidney injuries) with an average of CHF 27,409 across all PSIs. In addition, adverse events were associated with 7.8-day longer stays, 2.5 times more early readmissions (within 18 days), and 4.1 times higher mortality rates on average. At a national level, the PSIs were associated with CHF 347 million higher inpatient costs in 2019, which corresponds to about 2.2% of the annual inpatient costs in Switzerland. By comparing the excess costs of different PSIs on a nationally aggregated level, we offer a financial perspective on the implications of in-hospital adverse events and provide recommendations for policymakers regarding specific investments in patient safety to reduce costs and suffering.
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Affiliation(s)
- Alice Giese
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Rasheda Khanam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Son Nghiem
- College of Health & Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony Staines
- IFROSS Institute, University of Lyon III, Lyon, France
- Hospital Federation of Vaud, Prilly, Vaud, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Stefan Boes
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Michael M. Havranek
- Competence Center for Health Data Science, Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Denis A, Montreuil J, Bouklouch Y, Reindl R, Berry GK, Harvey EJ, Bernstein M. Hospital episode-of-care costs for hip fractures: an activity-based costing analysis. OTA Int 2023; 6:e295. [PMID: 38053755 PMCID: PMC10695580 DOI: 10.1097/oi9.0000000000000295] [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: 08/02/2022] [Accepted: 10/14/2023] [Indexed: 12/07/2023]
Abstract
Background Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC. Material and Methods This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019. Clinical and demographic data were extracted through the institution's centralized data warehouse. Data acquisition also included direct and indirect costs per episode of care, adverse events, and precise temporal data. Results The median total EOCC was $13,113 (interquartile range 6658), excluding physician fees. Out of the total cost, 75% was attributed to direct costs, which represented a median expenditure of $9941. The median indirect cost of the EOCC was $3322. Based on the multivariate analysis, patients not operated within the 48 hours guidelines had an increased length of stay by 5.7 days (P = 0.003), representing an increase in EOCC of close to 5000$. Higher American Society of Anesthesiology (ASA) scores were associated with elevated EOCC. Conclusion The cost of managing a patient with geriatric hip fracture from arrival in the emergency department to discharge from surgical ward represented $13,113. Main factors influencing the EOCC included adherence to the 48-hour benchmark surgical delay and ASA score. High-quality costing data are vital in assessing health care spending, conducting cost effectiveness analyses, and ultimately in guiding policy decisions. Level of Evidence Level III (3), retrospective cohort study.
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Affiliation(s)
- Antoine Denis
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Yasser Bouklouch
- McGill University Health Center—Research Institute, Montreal, QC, Canada
| | - Rudolf Reindl
- McGill Division of Orthopaedic Surgery, Montreal, QC, Canada
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Grosman-Rimon L, Li DHY, Collins BE, Wegier P. Can we improve healthcare with centralized management systems, supported by information technology, predictive analytics, and real-time data?: A review. Medicine (Baltimore) 2023; 102:e35769. [PMID: 37960822 PMCID: PMC10637563 DOI: 10.1097/md.0000000000035769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023] Open
Abstract
This narrative review discusses the effects of implementing command centers, centralized management systems, supported by information technology, predictive analytics, and real-time data, as well as small-scale centralized operating systems, on patient outcomes, operation, care delivery, and resource utilization. Implementations of command centers and small-scale centralized operating systems have led to improvement in 3 areas: integration of both multiple services into the day-to-day operation, communication and coordination, and employment of prediction and early warning system. Additional studies are required to understand the full impact of command centers on the healthcare system.
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Affiliation(s)
| | - Donny H Y Li
- Research Institute, Humber River Health, Toronto, Ontario, Canada
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Pete Wegier
- Research Institute, Humber River Health, Toronto, Ontario, Canada
- University of Toronto, Institute of Health Policy, Management and Evaluation, Ontario, Canada
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11
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Choi EY, Kim J, Lee W, Jang SG, Pyo J, Ock M. Comprehensive Measurement of the Burden of Disease due to Adverse Events: A New Analysis of the Cross-Sectional Patient Safety Incident Inquiry. J Korean Med Sci 2023; 38:e337. [PMID: 37935164 PMCID: PMC10627726 DOI: 10.3346/jkms.2023.38.e337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/19/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND A methodology for comprehensively and reasonably measuring the burden of disease due to adverse events has yet to be clearly established. In this study, a new and systematic method for measuring the burden of disease due to adverse events was tested by utilizing the results of a medical record review, which is commonly used as a gold standard. METHODS Using the characteristics of preventable adverse events identified in the 2019 Patient Safety Incidents Inquiry (PSII), conducted to monitor the level of patient safety in Korea accurately, the resulting disability-adjusted life years (DALYs) and economic costs were estimated. DALYs were calculated as the sum of the years lived with a disability for patients who suffered permanent disability, or more, due to preventable adverse events, and the years of life lost due to premature mortality was calculated for patients who died due to preventable adverse events. The economic cost was calculated using the main diagnostic codes of patients who suffered preventable adverse events, identified as prolonged hospitalization in PSII, and the average medical cost by disease category and age group. RESULTS Estimates of DALYs due to preventable adverse events were 1,114.4 DALYs per 100,000 population for the minimum standard and 1,658.5 DALYs per 100,000 population for the maximum standard. Compared to the 2015 Korea Burden of Disease results, the ranking of DALYs due to preventable adverse events was sixth for the minimum standard and third for the maximum standard. The annual medical cost of adverse events in 2016 was estimated to be approximately Korean Republic Won (KRW) 870 billion (700 million US dollars). Medical expenses due to preventable adverse events were calculated to be approximately KRW 150 billion (120 million US dollars) as a minimum standard and approximately KRW 300 billion (240 million US dollars) as a maximum standard. CONCLUSION If this more standard method of systematically calculating the disease burden due to adverse events is used, it will be possible to compare the size of the patient safety problem with that of other diseases. The results of this study indicate that we still need to pay more attention to the issue of patient safety.
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Affiliation(s)
- Eun Young Choi
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Juyoung Kim
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Seung Gyeong Jang
- Department of Nursing, College of Nursing, Inje University, Gimhae, Korea
| | - Jeehee Pyo
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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12
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Cardelli LS, Delbaere Q, Massin F, Granier M, Casella G, Barbato G, Dupasquier V, Macia JC, Leclercq F, Pasquie JL, Roubille F. Wearable Cardioverter Defibrillator Shortens the Lengths of Stay in Patients with Left Ventricular Dysfunction after Myocardial Infarction: A Single-Centre Real-World Experience. J Clin Med 2023; 12:4884. [PMID: 37568286 PMCID: PMC10419391 DOI: 10.3390/jcm12154884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The wearable cardioverter defibrillator (WCD) has been proven to be effective in preventing sudden cardiac death (SCD) in patients soon after acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤35%. The aim of this study was to assess whether a WCD may shorten the length of an initial hospital stay (total length, days in the intensive care unit (ICU) and in the acute cardiac care unit (ACCU)) among these patients. This was a single-centre, retrospective observational study of patients referred for the management of SCD risk post-AMI and LVEF ≤35%, in a tertiary care hospital. The clinical characteristics and length of index hospitalization of the group of patients discharged, with or without WCD, were compared. A propensity score analysis was performed, then weighted regression models were conducted. A total of 101 patients in the WCD group and 29 in the control group were enrolled in the analysis. In the weighted regression models, WCD significantly reduced the days spent in ACCU (p < 0.001). WCD patients had significantly fewer days spent in ACCU (5.5 ± 2.6 vs. 8.4 ± 12.8 days, p < 0.001) and shorter hospitalizations (10.2 ± 5.7 vs. 13.4 ± 17.6 days, p = 0.005), compared with the control group. It was concluded that the WCD appears to reduce the total length of hospitalization and lengths of stay in ACCU for patients post-AMI and with left ventricular dysfunction.
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Affiliation(s)
| | - Quentin Delbaere
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Massin
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Mathieu Granier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Gaetano Barbato
- Cardiology Department, Ospedale Maggiore, 40100 Bologna, Italy
| | - Valentin Dupasquier
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Christophe Macia
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Florence Leclercq
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - Jean-Luc Pasquie
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
| | - François Roubille
- Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France (F.R.)
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13
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Polancich S, Miltner R, Montgomery A, Dick T, Poe T, Brown D, Patrician PA. Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes. J Healthc Manag 2023; 68:174-186. [PMID: 37159016 DOI: 10.1097/jhm-d-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.
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Affiliation(s)
- Shea Polancich
- University of Alabama at Birmingham School of Nursing and University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | | | - Tracey Dick
- University of Alabama at Birmingham School of Nursing
| | - Terri Poe
- University of Alabama at Birmingham Hospital
| | - Daran Brown
- University of Alabama at Birmingham Hospital
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Vroman H, Mosch D, Eijkenaar F, Naujokat E, Mohr B, Medic G, Swijnenburg M, Tesselaar E, Franken M. Continuous vital sign monitoring in patients after elective abdominal surgery: a retrospective study on clinical outcomes and costs. J Comp Eff Res 2023; 12:e220176. [PMID: 36645412 PMCID: PMC10288965 DOI: 10.2217/cer-2022-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/10/2022] [Indexed: 01/17/2023] Open
Abstract
Aim: To assess changes in outcomes and costs upon implementation of continuous vital sign monitoring in postsurgical patients. Materials & methods: Retrospective analysis of clinical outcomes and in-hospital costs compared with a control period. Results: During the intervention period patients were less frequently admitted to the intensive care unit (ICU) (p = 0.004), had shorter length of stay (p < 0.001) and lower costs (p < 0.001). The intervention was associated with a lower odds of ICU admission (odds ratio: 0.422; p = 0.007) and ICU related costs (odds ratio: -662.4; p = 0.083). Conclusion: Continuous vital sign monitoring may have contributed to fewer ICU admissions and lower ICU costs in postsurgical patients.
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Affiliation(s)
- Heleen Vroman
- Department of Science, Bravis Hospital, Roosendaal, The Netherlands
| | - Diederik Mosch
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Elke Naujokat
- Philips Medizin Systeme Boeblingen GmbH, Hewlett-Packard-Str. 2,71034 Boeblingen, Germany
| | - Belinda Mohr
- Philips, 222 Jacobs Street, Cambridge, MA 02141, USA
| | - Goran Medic
- Philips Healthcare, High Tech Campus 52, 5656 AG Eindhoven, The Netherlands
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Eric Tesselaar
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
- Department of Medical & Health Sciences, Medical Radiation Physics, Linköping University, Sweden
| | - Martijn Franken
- Department of Medical Physics, Bravis Hospital, Roosendaal, The Netherlands
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15
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Takamatsu A, Honda H. Post-sign-off events in infectious disease consultation and the incidence of nonadherence to infectious disease recommendations in the post-sign-off period: A retrospective cohort study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e38. [PMID: 36960090 PMCID: PMC10028937 DOI: 10.1017/ash.2023.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 03/05/2023]
Abstract
Objective Infectious diseases (ID) consultation has contributed to improving outcomes in hospitalized patients. However, the timing of signing off on ID consultation varies, depending on the consulting ID physician. We studied the descriptive epidemiology of treatment-related adverse events (ADEs) occurring after the ID physician has signed off on consultation and the epidemiology and predictors of nonadherence to ID recommendations in the post-sign-off period. Methods This retrospective cohort study was conducted at a Japanese tertiary-care center. All patients who received ID consultation between January and December 2019 and treatment recommendations for a confirmed or suspected infectious disease were included. The incidence of any treatment-related ADE after signing off, nonadherence to the final ID recommendations, and factors associated with nonadherence to the ID recommendations were identified. Results In total, 367 patients receiving ID consultation were included. The incidence of post-sign-off events during index hospitalization was 59 (16.1%) of 367, with antimicrobial-associated ADEs accounting for 26 events (44.1%) and HAIs accounting for 13 events (22.0%). After excluding patients who discontinued treatment, nonadherence to ID recommendations was identified in 55 (15.7%) of 351 patients. Newly acquired HAIs during the index hospitalization after signing off on ID consultation was an independent risk factor for nonadherence to ID recommendations (adjusted odds ratio, 3.78; 95% confidence interval, 1.14-12.52). Conclusions Post-sign-off events were common and led to nonadherence to ID recommendations during the post-sign-off period. Because this nonadherence occurs for various reasons, patients may require continued attention after signing off to ensure their safety.
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Affiliation(s)
- Akane Takamatsu
- Department of Microbiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Author for correspondence: Hitoshi Honda, MD, Department of Infectious Diseases, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi470-1192, Japan. E-mail: . Or Akane Takamatsu, MD, Department of Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. E-mail:
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
- Author for correspondence: Hitoshi Honda, MD, Department of Infectious Diseases, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi470-1192, Japan. E-mail: . Or Akane Takamatsu, MD, Department of Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. E-mail:
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16
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Lehmann L, Appelbaum S, Ostermann T, Weber B, Hofmann SC. Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004 to 2018. J Dtsch Dermatol Ges 2022; 20:1603-1611. [PMID: 36464811 DOI: 10.1111/ddg.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Assessment of complaints addressed to the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association helps to identify quality assurance problems in dermatology. METHODS 333 dermatological reports (years 2004-2018) were allocated to three five-year intervals in order to show changes of total number of reports and with regard to indications, types of care, defined diagnosis categories, and therapeutic interventions. Statistical analysis was mainly descriptive (SPSS 27). Representative cases are explained in more detail. RESULTS The number of dermatological reports fell from 119 in the first to 92 reports in the last five-year interval, along with a decline in treatment error rates (43 % and 29 %) despite an increasing number of procedures across disciplines. 104 reports dealt with (supposed) diagnostic errors, 156 with physical or pharmacological therapies, and 73 reports with surgery. The latter had a low treatment error rate (29 %). CONCLUSIONS In comparison to the number of dermatological treatments in Germany, patient allegations are raised only rarely indicating greater patient satisfaction and/or a lower risk potential in dermatology. Incorrect dosages or device settings, diagnostic errors, and deficits in obtaining informed consent are relevant sources of error as underlined by the presented case reports.
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Affiliation(s)
- Lion Lehmann
- Institute of General Medicine, University Hospital Cologne, Cologne, Germany.,Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Sebastian Appelbaum
- Department of Psychology and Psychotherapy, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Beate Weber
- Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association, Düsseldorf, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology und Dermatosurgery, University of Witten/Herdecke, Helios University Hospital Wuppertal, Wuppertal, Germany
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17
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Lehmann L, Appelbaum S, Ostermann T, Weber B, Hofmann SC. Analyse von Behandlungsfehlervorwürfen gegen Dermatologen im Zeitraum 2004 bis 2018 anhand von Gutachten der Ärztekammer Nordrhein. J Dtsch Dermatol Ges 2022; 20:1603-1612. [PMID: 36508375 DOI: 10.1111/ddg.14899_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Lion Lehmann
- Institut für Allgemeinmedizin, Universitätsklinikum Köln.,Fakultät für Gesundheit, Universität Witten/Herdecke
| | - Sebastian Appelbaum
- Department für Psychologie und Psychotherapie, Fakultät für Gesundheit, Universität Witten/Herdecke
| | - Thomas Ostermann
- Department für Psychologie und Psychotherapie, Fakultät für Gesundheit, Universität Witten/Herdecke
| | - Beate Weber
- Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein, Düsseldorf
| | - Silke C Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke, Helios Universitätsklinikum Wuppertal
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Prediction models for the prediction of unplanned hospital admissions in community-dwelling older adults: A systematic review. PLoS One 2022; 17:e0275116. [PMID: 36149932 PMCID: PMC9506609 DOI: 10.1371/journal.pone.0275116] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 09/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Identification of community-dwelling older adults at risk of unplanned hospitalizations is of importance to facilitate preventive interventions. Our objective was to review and appraise the methodological quality and predictive performance of prediction models for predicting unplanned hospitalizations in community-dwelling older adults Methods and findings We searched MEDLINE, EMBASE and CINAHL from August 2013 to January 2021. Additionally, we checked references of the identified articles for the inclusion of relevant publications and added studies from two previous reviews that fulfilled the eligibility criteria. We included prospective and retrospective studies with any follow-up period that recruited adults aged 65 and over and developed a prediction model predicting unplanned hospitalizations. We included models with at least one (internal or external) validation cohort. The models had to be intended to be used in a primary care setting. Two authors independently assessed studies for inclusion and undertook data extraction following recommendations of the CHARMS checklist, while quality assessment was performed using the PROBAST tool. A total of 19 studies met the inclusion criteria. Prediction horizon ranged from 4.5 months to 4 years. Most frequently included variables were specific medical diagnoses (n = 11), previous hospital admission (n = 11), age (n = 11), and sex or gender (n = 8). Predictive performance in terms of area under the curve ranged from 0.61 to 0.78. Models developed to predict potentially preventable hospitalizations tended to have better predictive performance than models predicting hospitalizations in general. Overall, risk of bias was high, predominantly in the analysis domain. Conclusions Models developed to predict preventable hospitalizations tended to have better predictive performance than models to predict all-cause hospitalizations. There is however substantial room for improvement on the reporting and analysis of studies. We recommend better adherence to the TRIPOD guidelines.
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Khalili M, Sharifi H, Mesgarpour B, Kheirandish M, Olsson S, Javidnikou N, Haghdoost AA. Evaluation of Pharmacovigilance System in Iran. Int J Health Policy Manag 2022; 11:990-1000. [PMID: 33590736 PMCID: PMC9808195 DOI: 10.34172/ijhpm.2020.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evaluating a pharmacovigilance system helps identify its deficiencies and could facilitate measures to remedy and improve the quantity and quality of adverse drug reaction (ADR) reports and other opportunities for pharmacovigilance systems strengthening. This study aimed to evaluate the status of pharmacovigilance in Iran using the World Health Organization (WHO) pharmacovigilance indicators with the prospect of identifying the gaps and areas for improvement. METHODS This study was conducted in 2 parts. The first part included a secondary analysis of the national data obtained from the Iranian National Pharmacovigilance Center (PVC) using a structured data collection form based on WHO core pharmacovigilance indicators. In the second part, a 3-month prospective study was carried out to investigate 2 outcome indicators, ie, length of stay and costs of medicine-related hospitalization in all patients of 2 main referral hospitals in the southeast and north of Iran. RESULTS Iran has a PVC with national policy, trained staff, and a statutory budget. In 2017, the number of ADR reports was 15.0 per 100 000 population, and 262 signals were detected during the preceding 5 years. The average length of stay and costs of medicine-related hospitalization were 5 days and US$817.2 in Afzalipour hospital and 6.6 days and US$306.7 in Razi hospital, respectively. The status of pharmacovigilance in the Iranian public health programs (PHPs) is unknown, and most of the indicators could not be assessed. CONCLUSION A robust pharmacovigilance system is a pivotal part of the overall medicines regulatory system. The Iranian pharmacovigilance system has relatively the proper structural condition. Though the underreporting of ADRs, especially medicine-related deaths, is an important issue, and some indicators' status was unclear. The Iranian pharmacovigilance program requires a higher prioritization, particularly in the PHPs, a greater allocation of resources, and cross-sectoral cooperation to bolster and achieve the pharmacovigilance objectives.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development, Tehran, Iran
| | - Mehrnaz Kheirandish
- Department for Assessment and Control of Prescribing and Use of Medicines and Health Products, Food and Drug Administration, Tehran, Iran
| | - Sten Olsson
- International Society of Pharmacovigilance, London, UK
- Pharmacovigilance Consulting, Uppsala, Sweden
| | | | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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20
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Dudding KM, Bordelon C, Sanders AN, Shorten A, Wood T, Watts P. Improving Quality in Neonatal Care Through Competency-Based Simulation. Neonatal Netw 2022; 41:159-167. [PMID: 35644362 DOI: 10.1891/nn-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 440,000 patients die each year due to preventable errors. Although human error is inevitable, we can mitigate this risk by enhancing skills and clinical competencies by improving the quality of neonatal care through competency-based simulation. Clinical skills are learned activities necessary to function within an environment. Skills gained during pre-licensure nursing education, on-site clinical training, and experience as a clinical care provider, collectively demonstrate a clinician's overall competence to function within a clinical setting. Simulation is a method of supporting nurses to establish, maintain, and remediate competency-based skills for safe and effective healthcare. Evidence suggests that simulation improve clinical skills and maintain patient safety. With this knowledge, many professional organizations have adopted and set standards for the use of simulation, as an educational methodology, to improve clinician skills and competence providing only the highest quality care to neonates within the Neonatal Intensive Care Unit.
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Haahr‐Raunkjaer C, Mølgaard J, Elvekjaer M, Rasmussen SM, Achiam MP, Jorgensen LN, Søgaard MI, Grønbæk KK, Oxbøll A, Sørensen HBD, Meyhoff CS, Aasvang EK. Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients. Acta Anaesthesiol Scand 2022; 66:552-562. [PMID: 35170026 PMCID: PMC9310747 DOI: 10.1111/aas.14048] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022]
Abstract
Background Patients undergoing major surgery are at risk of complications, so‐called serious adverse events (SAE). Continuous monitoring may detect deteriorating patients by recording abnormal vital signs. We aimed to assess the association between abnormal vital signs inspired by Early Warning Score thresholds and subsequent SAEs in patients undergoing major abdominal surgery. Methods Prospective observational cohort study continuously monitoring heart rate, respiratory rate, peripheral oxygen saturation, and blood pressure for up to 96 h in 500 postoperative patients admitted to the general ward. Exposure variables were vital sign abnormalities, primary outcome was any serious adverse event occurring within 30 postoperative days. The primary analysis investigated the association between exposure variables per 24 h and subsequent serious adverse events. Results Serious adverse events occurred in 37% of patients, with 38% occurring during monitoring. Among patients with SAE during monitoring, the median duration of vital sign abnormalities was 272 min (IQR 110–447), compared to 259 min (IQR 153–394) in patients with SAE after monitoring and 261 min (IQR 132–468) in the patients without any SAE (p = .62 for all three group comparisons). Episodes of heart rate ≥110 bpm occurred in 16%, 7.1%, and 3.9% of patients in the time before SAE during monitoring, after monitoring, and without SAE, respectively (p < .002). Patients with SAE after monitoring experienced more episodes of hypotension ≤90 mm Hg/24 h (p = .001). Conclusion Overall duration of vital sign abnormalities at current thresholds were not significantly associated with subsequent serious adverse events, but more patients with tachycardia and hypotension had subsequent serious adverse events. Trial registration Clinicaltrials.gov, identifier NCT03491137.
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Affiliation(s)
- Camilla Haahr‐Raunkjaer
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Jesper Mølgaard
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Søren M. Rasmussen
- Biomedical Engineering Department of Health Technology Technical University of Denmark Lyngby Denmark
| | - Michael P. Achiam
- Department of Surgical Gastroenterology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lars N. Jorgensen
- Digestive Disease Centre, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Mette I.V. Søgaard
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Katja K. Grønbæk
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Anne‐Britt Oxbøll
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Helge B. D. Sørensen
- Biomedical Engineering Department of Health Technology Technical University of Denmark Lyngby Denmark
| | - Christian S. Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Centre for Translational Research Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Eske K. Aasvang
- Department of Anaesthesiology Centre for Cancer and Organ Diseases Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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22
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Cantor N, Durr KM, McNeill K, Thompson LH, Fernando SM, Tanuseputro P, Kyeremanteng K. Increased Mortality and Costs Associated with Adverse Events in Intensive Care Unit Patients. J Intensive Care Med 2022; 37:1075-1081. [PMID: 35238691 DOI: 10.1177/08850666221084908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Adverse events (AEs) are defined as unintended complications occurring to patients as a result of medical care. AEs are especially prevalent in the intensive care unit (ICU) setting and may lead to negative patient outcomes. Although many studies have examined the impact of AEs on patient outcomes, few have investigated their associated costs. Methods: The study population consisted of 17 173 adult patients (≥18 years of age) who were admitted to the ICU at The Ottawa Hospital (TOH) between 2011 and 2016. AEs were categorized using an established International Classification of Diseases 10th revision (ICD-10) patient safety indicators (PSI) system for AE detection. Logistic regression was performed to determine the association between AEs and in-hospital outcomes, including mortality. In addition, we constructed a generalized linear model to assess the independent association between AEs and total hospital costs. Results: Patients who experienced an AE had longer total hospital and ICU lengths of stay, required more invasive ICU interventions, had more complex discharge plans, and experienced higher rates of in-hospital mortality compared to those who did not experience an AE. Average total hospital costs and ICU-specific costs were higher among patients who experienced an AE ($72 718; $46 715) relative to their counterparts ($20 543; $16 217), but the per day cost was comparable in both groups. After controlling for age, sex, patient comorbidities, and illness severity, AEs were significantly associated with an increased odds of mortality (OR = 1.13, 95% CIs = 1.04, 1.22) and total average costs (Cost Ratio = 1.04, 95% CIs = 1.06, 1.08). The most impactful AE subtypes from a cost- and patient-perspective were hospital-acquired infections (HAI) and cardiac-related AEs. Conclusion: Incidence of AEs among ICU patients is associated with higher patient mortality and elevated costs. Specific causes of these AEs should be investigated, with further protocols and interventions developed to reduce their occurrence.
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Affiliation(s)
- Nathan Cantor
- 10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kevin M Durr
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Kylie McNeill
- Department of Medicine, 6363University of Ottawa, Ottawa, Canada
| | | | - Shannon M Fernando
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Canada.,Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,152971Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, 10055Ottawa Hospital Research Institute, 6363University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Montfort Hospital, Ottawa, Ontario, Canada
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23
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A systematic review and network meta-analysis comparing energy devices used in colorectal surgery. Tech Coloproctol 2022; 26:413-423. [DOI: 10.1007/s10151-022-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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24
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Wang K, Hussain W, Birge JR, Schreiber MD, Adelman D. A High-Fidelity Model to Predict Length-of-Stay in the Neonatal Intensive Care Unit (NICU). INFORMS JOURNAL ON COMPUTING 2022; 34:183-195. [PMID: 35814619 PMCID: PMC9262254 DOI: 10.1287/ijoc.2021.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Having an interpretable dynamic length-of-stay (LOS) model can help hospital administrators and clinicians make better decisions and improve the quality of care. The widespread implementation of electronic medical record (EMR) systems has enabled hospitals to collect massive amounts of health data. However, how to integrate this deluge of data into healthcare operations remains unclear. We propose a framework grounded in established clinical knowledge to model patients' lengths-of-stay. In particular, we impose expert knowledge when grouping raw clinical data into medically meaningful variables, which summarize patients' health trajectories. We use dynamic predictive models to output patients' remaining lengths-of-stay (RLOS), future discharges, and census probability distributions based on their health trajectories up to the current stay. Evaluated with large-scale EMR data, the dynamic model significantly improves predictive power over the performance of any model in previous literature and remains medically interpretable.
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Affiliation(s)
- Kanix Wang
- Booth School of Business, The University of Chicago, Chicago, Illinois 60637
| | - Walid Hussain
- Section of Neonatology, Department of Pediatrics, The University of Chicago, Chicago, Illinois 60637
| | - John R Birge
- Booth School of Business, The University of Chicago, Chicago, Illinois 60637
| | - Michael D Schreiber
- Section of Neonatology, Department of Pediatrics, The University of Chicago, Chicago, Illinois 60637
| | - Daniel Adelman
- Booth School of Business, The University of Chicago, Chicago, Illinois60637
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25
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Voskanyan YE. [Adverse events associated with medical care, or the dark side of health care in foreign countries: a systematic review]. Khirurgiia (Mosk) 2022:79-98. [PMID: 36223155 DOI: 10.17116/hirurgia202210179] [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] [Indexed: 06/16/2023]
Abstract
A systematic review is devoted to epidemiology of adverse events in short-stay hospitals in foreign countries. It is found that dualism is an important feature of medical care, since treatment results can be not only useful, but also harmful (adverse events) associated with medical care per se. Adverse events are diagnosed in 10.68% of patients. Moreover, complications occur at previous stages of treatment in 20.91% of cases. Incidence of adverse events is 2 times higher in surgical departments and intensive care units compared to therapeutic departments. Among all adverse events, 42.83% are associated with open surgery, 16.17% with drug therapy, and 14.10% with manipulations or minimally invasive interventions. Preventable adverse events caused by human factor account for 48.24%. In other cases, adverse events are the result of side effects of medical technologies, exposure to physical environment and unsafe patient behavior. Infection associated with medical care (28.15%) prevails among other adverse events. In 51.45% of cases, adverse events are characterized by mild harm and do not prolong hospital-stay. Moderate harm requiring additional in-hospital treatment develops in 31.80% of cases. In 11.89% of cases, adverse events are life-threatening complications and/or cause disability. Moderate-to-severe harm increases hospital-stay by 8.7 days. Incidence of adverse events followed by unfavorable outcomes is 5.25%. Overall mortality and mortality from adverse events are 6.67% and 0.55%, respectively. Deaths associated with adverse events account for one in five deaths in a hospital and one in ten deaths in population of developed countries.
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Affiliation(s)
- Yu E Voskanyan
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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26
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Luiz RB, Estevam LO, Raponi MBG, Felix MMDS, Barbosa MH. Efficacy of educational strategies in patient involvement for safety in care: a systematic review. Rev Gaucha Enferm 2022; 43:e20210198. [DOI: 10.1590/1983-1447.2022.20210198.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT Objective To evaluate the effectiveness of educational strategies in the involvement of hospitalized adult patient for safety in care. Method Systematic review carried out by searching for experimental and quasi-experimental studies, published from January/2010 to December/2021, in PubMed®, Cochrane Library CENTRAL, Scopus, Web of Science, LILACS, CINAHL and EMBASE. Results Twelve studies were included to involve the patient in safe care practices, five (41.7%) experimental and seven (58.3%) quasi-experimental. Different educational strategies were adopted in the articles included: verbal guidance, books, leaflets and folders (n=4; 33.3%); videos, e-books and electronic applications (n=5; 41.7%); poster, leaflets and video (n=3; 25%). Four experimental studies had a high risk of bias (80%) and all quasi-experimental studies had a low risk of bias (100%). Conclusion The use of educational strategies proved to be effective in involving the patient in safe care practices. Considering the heterogeneity between studies, it is recommended carrying out future research.
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Luiz RB, Estevam LO, Raponi MBG, Felix MMDS, Barbosa MH. Eficácia de estratégias educativas no envolvimento do paciente para a segurança no cuidado: revisão sistemática. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210198.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RESUMO Objetivo Avaliar a eficácia de estratégias educativas no envolvimento do paciente adulto hospitalizado para a segurança no cuidado. Método Revisão sistemática realizada por meio da busca de estudos experimentais e quase-experimentais, publicados de janeiro/2010 a dezembro/2021, no PubMed®, Cochrane Library CENTRAL, Scopus, Web of Science, LILACS, CINAHL e EMBASE. Resultados Foram incluídos doze estudos para envolver o paciente nas práticas seguras do cuidado, cinco (41,7%) experimentais e sete (58,3%) quase experimentais. Diferentes estratégias educativas foram adotadas nos artigos incluídos: orientações verbais, livretos, folhetos e folders (n=4; 33,3%); vídeos, e-book e aplicativos eletrônicos (n=5; 41,7%); pôster, folhetos e vídeo (n=3; 25%). Quatro estudos experimentais apresentaram alto risco de viés (80%) e todos quase-experimentais baixo risco de viés (100%). Conclusão O uso de estratégias educativas se demonstrou eficaz no envolvimento do paciente em práticas seguras do cuidado. Recomenda-se a condução de futuras pesquisas ao se considerar a heterogeneidade entre os estudos.
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Klein DO, Rennenberg RJ, Koopmans RP, Prins MH. A Systematic Review of Methods for Medical Record Analysis to Detect Adverse Events in Hospitalized Patients. J Patient Saf 2021; 17:e1234-e1240. [PMID: 32168280 PMCID: PMC8612912 DOI: 10.1097/pts.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods. METHODS We searched Embase, PubMed, and Cochrane databases for studies (2000-2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately. RESULTS Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average €4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE. CONCLUSIONS Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.
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Affiliation(s)
- Dorthe O. Klein
- From the Departments of Clinical Epidemiology and Medical Technology Assessment (KEMTA)
| | | | | | - Martin H. Prins
- Department of Epidemiology, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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29
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Li H, Tao H, Li G. Predictors and reasons for inappropriate hospitalization days for surgical patients in a tertiary hospital in Wuhan, China: a retrospective study. BMC Health Serv Res 2021; 21:900. [PMID: 34470637 PMCID: PMC8408966 DOI: 10.1186/s12913-021-06845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization. METHODS A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs. RESULTS The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60-69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor's conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs. CONCLUSIONS Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.
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Affiliation(s)
- Hao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Hongbing Tao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
| | - Gang Li
- Department of Outpatient Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China
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Baldock TE, Brown LR, McLean RC. The junior doctor changeover effect: does it exist in general surgery? Ann R Coll Surg Engl 2021; 104:57-66. [PMID: 34432533 DOI: 10.1308/rcsann.2021.0088] [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] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence of this 'changeover effect'. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover. METHODS Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North of England between 2005 and 2016. This included patient characteristics, diagnoses, comorbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the 'changeover week'; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3-ST8), it is the first Wednesday in October. Another week, four weeks prior, was chosen as a historical comparator. RESULTS In total, 61,714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariable adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October, respectively, showed no significant difference for measured outcomes. CONCLUSIONS This retrospective cohort study provides contemporary evidence that the 'changeover effect' does not exist in acute general surgical admissions in the UK.
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Affiliation(s)
| | - L R Brown
- South East Scotland Deanery, NHS Education for Scotland, UK
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Economic Burden of Stroke Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147552. [PMID: 34299999 PMCID: PMC8307880 DOI: 10.3390/ijerph18147552] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/01/2023]
Abstract
Globally, one of the main causes of non-communicable disease as a cause of death every year is stroke. The objective of this study was to analyze the burden in consequence of stroke. This research used a systematic review method. Furthermore, a search for articles was carried out in June–July 2020. Four databases were used to search articles from 2015 to 2020. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were prospective cost studies, retrospective cost studies, database analysis, mathematical models, surveys, and COI studies that assess burden of stroke in primary and referral healthcare (hospital-based). The results showed that from four databases, 9270 articles were obtained, and 13 articles were qualified. A total of 9270 articles had the identified search keywords, but only 13 articles met the set criteria for inclusion. The criteria for inclusion were stroke patients, the economic burden of stroke disease based on cost of illness method, which is approximately equal to USD 1809.51–325,108.84 (direct costs 86.2%, and indirect costs 13.8%). Those that used the health expenditure method did not present the total cost; instead, only either direct or indirect cost of health expenditure were reported. For most hospital admissions due to stroke, LOS (length of stay) was the dominant cost. The high economic burden to manage stroke justifies the promotion and preventive efforts by the policymakers and motivates the practice of healthy lifestyles by the people.
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Zanetti ACB, Dias BM, Bernardes A, Capucho HC, Balsanelli AP, de Moura AA, Soato R, Gabriel CS. Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital. PLoS One 2021; 16:e0249531. [PMID: 33857137 PMCID: PMC8049336 DOI: 10.1371/journal.pone.0249531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. Methods A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. Results A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29–0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient’s hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04–1.39). Conclusions Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.
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Affiliation(s)
- Ariane Cristina Barboza Zanetti
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Bruna Moreno Dias
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Andrea Bernardes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Helaine Carneiro Capucho
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Alexandre Pazetto Balsanelli
- Department of Administration of Health and Nursing Services, Paulista School of Nursing, Federal University of São Paulo – UNIFESP, São Paulo – SP, Brazil
| | - André Almeida de Moura
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Soato
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Carmen Silvia Gabriel
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Ghosh AK, Unruh MA, Soroka O, Shapiro M. Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis. Health Serv Res Manag Epidemiol 2021; 8:23333928211035581. [PMID: 34377740 PMCID: PMC8330458 DOI: 10.1177/23333928211035581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission. OBJECTIVE To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). METHOD Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. RESULTS For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA). CONCLUSION Further research to understand the ACA's policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Mark A. Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Orysya Soroka
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
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Kim S, Shin HG, Jo AEJ, Min A, Ock M, Hwang JI, Jeong Y, Park MS, Lee JB, Chang TIK, Song E, Kim H, Lee SI. Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea. Int J Qual Health Care 2020; 32:495-501. [PMID: 32696047 DOI: 10.1093/intqhc/mzaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. DESIGN A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. SETTING Inpatient units of six hospitals. PARTICIPANTS Medical records of 2 596 patients randomly selected were reviewed in the first stage review. INTERVENTION(S) N/A. MAIN OUTCOME MEASURE(S) Adverse events. RESULTS A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. CONCLUSIONS Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.
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Affiliation(s)
- Sukyeong Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - A E Jeong Jo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-In Hwang
- Department of Nursing Management, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Youngjin Jeong
- Department of Family Medicine, Veterans Health Service (VHS) Medical center, Seoul, Republic of Korea
| | - Moon Sung Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong Bouk Lee
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Tae I K Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Eunhyang Song
- Department of Neurology, Seoul Metropolitan Seobuk Hospital, Seoul, South Korea
| | - Heungseon Kim
- Department of Quality Improvement, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Sang-Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Measuring adverse events following hip arthroplasty surgery using administrative data without relying on ICD-codes. PLoS One 2020; 15:e0242008. [PMID: 33152055 PMCID: PMC7644076 DOI: 10.1371/journal.pone.0242008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/26/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction Measure and monitor adverse events (AEs) following hip arthroplasty is challenging. The aim of this study was to create a model for measuring AEs after hip arthroplasty using administrative data, such as length of stay and readmissions, with equal or better precision than an ICD-code based model. Materials and methods This study included 1 998 patients operated with an acute or elective hip arthroplasty in a national multi-centre study. We collected AEs within 90 days following surgery with retrospective record review. Additional data came from the Swedish Hip Arthroplasty Register, the Swedish National Patient Register and the Swedish National Board of Health and Welfare. We made a 2:1 split of the data into a training and a holdout set. We used the training set to train different machine learning models to predict if a patient had sustained an AE or not. After training and cross-validation we tested the best performing model on the holdout-set. We compared the results with an established ICD-code based measure for AEs. Results The best performing model was a logistic regression model with four natural age splines. The variables included in the model were as follows: length of stay at the orthopaedic department, discharge to acute care, age, number of readmissions and ED visits. The sensitivity and specificity for the new model was 23 and 90% for AE within 30 days, compared with 5 and 94% for the ICD-code based model. For AEs within 90 days the sensitivity and specificity were 31% and 89% compared with 16% and 92% for the ICD-code based model. Conclusion We conclude that a prediction model for AEs following hip arthroplasty surgery, relying on administrative data without ICD-codes is more accurate than a model based on ICD-codes.
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Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement. Surg Endosc 2020; 35:6344-6357. [PMID: 33104919 PMCID: PMC8523439 DOI: 10.1007/s00464-020-08103-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. METHODS All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into 'short admissions' and 'long admissions'. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. RESULTS A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of 'short admissions' per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher 'short admission' rates and 4 hospitals had significantly lower 'short admission' rates. Overall, 6.2% [hospital variation (0.0-13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). CONCLUSIONS Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.
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In-Hospital Patient Safety Events, Healthcare Costs and Utilization: An Analysis from the Incident Reporting System in an Academic Medical Center. Healthcare (Basel) 2020; 8:healthcare8040388. [PMID: 33036424 PMCID: PMC7711548 DOI: 10.3390/healthcare8040388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
The possible association of patient safety events (PSEs) with the costs and utilization remains a concern. In this retrospective analysis, we investigated adult hospitalizations at a medical center between 2010 and 2015 with or without reported PSEs. Administrative and claims data were analyzed to compare the costs and length of stay (LOS) between cases with and without PSEs of the three most common categories during the first 14 days of hospitalization. Two models, including linear regression and propensity score-matched comparison, were performed for each reference day group of hospitalizations. Of 14,181 PSEs from 424,635 hospitalizations, 69.8% were near miss or no-harm events. Costs and LOS were similar between fall cases and controls in all of the 14 reference days. In contrast, for cases of tube and line events and controls, there were consistent differences in costs and LOS in the majority of the reference days (86% and 57%, respectively). Consistent differences were less frequently seen for medication events and control events (36% and 43%, respectively). Our study approach of comparing cases with PSEs and those without any PSE showed significant differences in costs and LOS for tube and line events, and medication events. No difference in cost or LOS was found regarding fall events. Further studies exploring adjustments for event risks and harm-oriented analysis are warranted.
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Zeffiro V, Sanson G, Welton J, Maurici M, Malatesta A, Carboni L, Vellone E, Alvaro R, D'Agostino F. Predictive factors of a prolonged length of stay in a community Nursing-Led unit: A retrospective cohort study. J Clin Nurs 2020; 29:4685-4696. [PMID: 32956527 DOI: 10.1111/jocn.15509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/08/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold. BACKGROUND Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services. DESIGN Retrospective cohort study. METHODS Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines. RESULTS The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold. CONCLUSIONS The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients. RELEVANCE TO CLINICAL PRACTICE The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing-Led unit for each individual patient.
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Affiliation(s)
- Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - John Welton
- College of Nursing Education, University of Colorado, Aurora, CO, USA
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabio D'Agostino
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Tessier L, Guilcher SJT, Bai YQ, Ng R, Wodchis WP. The impact of hospital harm on length of stay, costs of care and length of person-centred episodes of care: a retrospective cohort study. CMAJ 2020; 191:E879-E885. [PMID: 31405834 DOI: 10.1503/cmaj.181621] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is a lack of data in Canada on the longitudinal effects of adverse events that occur in hospital, specifically in the period after discharge. Our objective was to quantify the impact of adverse events on hospital length of stay, length of person-centred episodes of care (PCEs) and costs of PCEs, as well as their impact on the total health system. METHODS We conducted a population-based, retrospective cohort study using linked health administrative databases. We included adults in Ontario who had an acute hospital admission between Apr. 1, 2015, and Mar. 31, 2016. We grouped hospital admissions into 1 of 9 episode types and used the Canadian Institute for Health Information methodology for hospital harm to measure adverse events. We specified generalized linear models to estimate the impact of hospital harm on the following: incremental length of index acute hospital admission, incremental length of the PCE, and incremental costs of the PCE. RESULTS Out of 610 979 hospital admissions, 36 004 (5.9%) involved an occurrence of harm. The impact of harm on the incremental length of hospital stay ranged from 0.4 to 24.2 days (p < 0.001); the incremental length of the PCE ranged from 0.3 to 30.2 days (p < 0.001); and the incremental costs of the PCE ranged from $800 to $51 067 (p < 0.001). Total hospital days attributable to hospital harm amounted to 407 696, and the total attributable cost to the Ontario health system amounted to $1 088 330 376. INTERPRETATION We found that experiencing harm in hospital significantly affects both in-hospital and post-discharge use of health services and costs of care, and constitutes an enormous expense to Ontario's publicly funded health system.
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Affiliation(s)
- Lauren Tessier
- Institute of Health Policy, Management and Evaluation (Tessier, Guilcher, Bai, Ng, Wodchis), University of Toronto; Health System Performance Research Network (Tessier); Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES (Bai, Ng), Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont.
| | - Sara J T Guilcher
- Institute of Health Policy, Management and Evaluation (Tessier, Guilcher, Bai, Ng, Wodchis), University of Toronto; Health System Performance Research Network (Tessier); Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES (Bai, Ng), Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation (Tessier, Guilcher, Bai, Ng, Wodchis), University of Toronto; Health System Performance Research Network (Tessier); Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES (Bai, Ng), Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Ryan Ng
- Institute of Health Policy, Management and Evaluation (Tessier, Guilcher, Bai, Ng, Wodchis), University of Toronto; Health System Performance Research Network (Tessier); Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES (Bai, Ng), Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation (Tessier, Guilcher, Bai, Ng, Wodchis), University of Toronto; Health System Performance Research Network (Tessier); Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES (Bai, Ng), Toronto, Ont.; Institute for Better Health (Wodchis), Trillium Health Partners, Mississauga, Ont
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Otchi EH, Esena RK, Srofenyoh EK, Marfo K, Agbeno EK, Asah-Opoku K, Ken-Amoah S, Ameh EO, Beyuo T, Oduro F. Types and prevalence of adverse events among obstetric clients hospitalized in a secondary healthcare facility in Ghana. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519881524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The main objective of this study was to determine the types and prevalence of adverse events among obstetric clients hospitalized in a secondary health facility in Ghana. Design A retrospective study that reviewed medical records of obstetric clients on admission at the Obstetrics Unit of a secondary healthcare facility in Ghana. Setting Clinical environment. The study site is the third largest health facility in Ghana that provides maternity services and serves as the major referral facility for Greater Accra Region, the capital of Ghana. About 41% (4676) of its total antenatal cases (11,406) in 2015 were referrals from other facilities in Ghana. The medical records were reviewed retrospectively from 1 January to 31 December 2015. A four-stage review process was used: the first and second stages (by nurse/midwife reviewers) involved the identification and exclusion of records that had a length of stay less than 24 h and inadequate documentation; and were unlikely to include an adverse event. The third stage by obstetrician gynaecologist reviewers included a full review of all the positive trigger folders to determine the types, causes and degree of preventability of the adverse events. The fourth stage involved an independent obstetrician gynaecologist review of all records that had discrepancies. Details of the review process are presented in the figure. Participants Obstetric clients (i.e. pregnant women at any stage of gestation or less than 5 days after delivery who were attended to at the hospital). About a third (1402, 49.3%) met the inclusion criteria and were reviewed. Main outcome measures The main outcome measure for this study was the prevalence of adverse events among hospitalized obstetric clients. Results The prevalence of adverse events was 12% (168) out of 1402 records reviewed. The mean maternal age of the clients was 30.0 ± 5.8 years. Among these, the greatest proportion of adverse events was related to surgical interventions (66.3%) and the smallest were related to patient care (0.7%). Conclusions This study has provided the first documented prevalence (12.0%) and types of adverse events among hospitalized obstetric clients in a secondary health facility in Ghana. It provides a preliminary baseline for the burden of adverse events among the obstetric population in Ghana.
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Affiliation(s)
- Elom-Hilary Otchi
- Africa Institute of Healthcare Quality Safety & Accreditation (AfIHQSA), Accra, Ghana
- Department of Health Policy, Planning & Management, University of Ghana School of Public Health, Accra, Ghana
| | - Reuben K Esena
- Department of Health Policy, Planning & Management, University of Ghana School of Public Health, Accra, Ghana
| | | | | | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Titus Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E, Bower P, Campbell S, Haneef R, Avery AJ, Ashcroft DM. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ 2019; 366:l4185. [PMID: 31315828 PMCID: PMC6939648 DOI: 10.1136/bmj.l4185] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. REVIEW METHODS Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated. RESULTS Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). CONCLUSIONS Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.
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Affiliation(s)
- Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Kanza Khan
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Aseel Abuzour
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Denham Phipps
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Peter Bower
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Razaan Haneef
- Lancashire Teaching Hospitals NHS Foundation Trust, Manchester, UK
| | - Anthony J Avery
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
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Rafter N, Finn R, Burns K, Condell S, Conroy RM, Hickey A, O'Connor P, Vaughan D, Walsh G, Williams DJ. Identifying hospital-acquired infections using retrospective record review from the Irish National Adverse Events Study (INAES) and European point prevalence survey case definitions. J Hosp Infect 2018; 101:313-319. [PMID: 30590090 DOI: 10.1016/j.jhin.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Point prevalence surveys (PPSs) collect data on hospital-acquired infections (HAIs) at one point in time but do not provide information on incidence over the entire admission or impact on patients or healthcare resources. Retrospective record review examines the entire admission to determine adverse event prevalence, incidence, preventability, physical impairment and additional length of stay. AIM To establish whether European HAI surveillance definitions can be applied to the Irish National Adverse Events Study (INAES) retrospective record review data to determine HAI burden. METHODS In the INAES, 1574 admissions were reviewed using a two-stage methodology and 247 adverse events were found. These were examined against European HAI case definitions to determine whether the event was an HAI. Results were compared with the 2011/12 European PPS data for Ireland. FINDINGS The prevalence of HAI adverse events in INAES was 4.4% (95% confidence interval (CI) 3.1-6.1%) with an incidence of 3.8 (95% CI 2.5-5.2) HAI adverse events per 100 admissions. The PPS HAI prevalence for Ireland was 5.2%. HAI types and micro-organisms were similar in INAES and the PPS. Approximately three-quarters of INAES HAI adverse events were preventable, 7% caused permanent impairment and 7% contributed to death. A mean of 10 additional bed days were attributed to HAI adverse events, equivalent to €9400 per event. CONCLUSION Retrospective record review is an accurate source of information on HAI incidence, preventability and impact that complements PPS prevalence rates. HAI adverse events result in higher costs to the healthcare system than other adverse events.
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Affiliation(s)
- N Rafter
- Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - R Finn
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - K Burns
- Department of Clinical Microbiology, RCSI and Beaumont Hospital, Health Protection Surveillance Centre, Dublin, Ireland
| | - S Condell
- Clinical Effectiveness Unit, National Patient Safety Office, Department of Health, Dublin, Ireland
| | - R M Conroy
- Division of Population Health Sciences, RCSI, Ireland
| | - A Hickey
- Department of Psychology, Division of Population Health Sciences, RCSI, Ireland
| | - P O'Connor
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - D Vaughan
- Department of Quality and Safety, Children's Hospital Group, Dublin, Ireland
| | - G Walsh
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - D J Williams
- Department of Geriatric & Stroke Medicine, RCSI and Beaumont Hospital, Dublin, Ireland
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Manoukian S, Stewart S, Dancer S, Graves N, Mason H, McFarland A, Robertson C, Reilly J. Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology. J Hosp Infect 2018; 100:222-235. [PMID: 29902486 DOI: 10.1016/j.jhin.2018.06.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Healthcare-associated infection (HCAI) affects millions of patients worldwide. HCAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HCAI is essential to ensure that we invest in cost-effective infection prevention and control (IPC) measures. AIM To identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HCAI; to highlight and discuss potential biases of all statistical approaches. METHODS A systematic review from 1997 to April 2017 was conducted in PubMed, CINAHL, ProQuest and EconLit databases. Studies were quality-assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorized as time-fixed or time-varying, with the former exhibiting time-dependent bias. Two examples of meta-analysis were used to illustrate how estimates of excess LOS differ between different studies. FINDINGS Ninety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HCAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms, and susceptibilities. CONCLUSION Methodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK.
| | - S Stewart
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK
| | - N Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - A McFarland
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Reilly
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Sousa P, Uva AS, Serranheira F, Uva MS, Nunes C. Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retrospective cohort study. Int J Qual Health Care 2018; 30:132-137. [PMID: 29309608 PMCID: PMC5890867 DOI: 10.1093/intqhc/mzx190] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/18/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To analyse the variation in the rate of adverse events (AEs) between acute hospitals and explore the extent to which some patients and hospital characteristics influence the differences in the rates of AEs. Design Retrospective cohort study. Chi-square test for independence and binary logistic regression models were used to identify the potential association of some patients and hospital characteristics with AEs. Setting Nine acute Portuguese public hospital centres. Participants A random sample of 4250 charts, representative of around 180 000 hospital admissions in 2013, was analysed. Intervention To measure adverse events based on chart review. Main Outcome Measure Rate of AEs. Results Main results: (i) AE incidence was 12.5%; (ii) 66.4% of all AEs were related to Hospital-Acquired Infection and surgical procedures; (iii) patient characteristics such as sex (female 11%; male 14.4%), age (≥65 y 16.4%; <65 y 8.5%), admission coded as elective vs. urgent (8.6% vs. 14.6%) and medical vs. surgical Diagnosis Related Group code (13.4% vs. 11.7%), all with p < 0.001, were associated with a greater occurrence of AEs. (iv) hospital characteristics such as use of reporting system (13.2% vs. 7.1%), being accredited (13.7% vs. non-accredited 11.2%), university status (15.9% vs. non-university 10.9%) and hospital size (small 12.9%; medium 9.3%; large 14.3%), all with p < 0.001, seem to be associated with a higher rate of AEs. Conclusions We identified some patient and hospital characteristics that might influence the rate of AEs. Based on these results, more adequate solutions to improve patient safety can be defined.
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Affiliation(s)
- Paulo Sousa
- National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540 Lisboa, Portugal.,CISP-Centro de Investigação em Saúde Pública, ENSP- Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540, Lisboa, Portugal
| | - António Sousa Uva
- National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540 Lisboa, Portugal.,CISP-Centro de Investigação em Saúde Pública, ENSP- Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540, Lisboa, Portugal
| | - Florentino Serranheira
- National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540 Lisboa, Portugal.,CISP-Centro de Investigação em Saúde Pública, ENSP- Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540, Lisboa, Portugal
| | - Mafalda Sousa Uva
- National Institute of Health, Doutor Ricardo Jorge, Avenida Padre Cruz, 1600-540, Lisboa, Portugal
| | - Carla Nunes
- National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540 Lisboa, Portugal.,CISP-Centro de Investigação em Saúde Pública, ENSP- Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-540, Lisboa, Portugal
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Haas R, O’Brien L, Bowles KA, Haines T. Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study. Clin Rehabil 2018; 32:1493-1508. [DOI: 10.1177/0269215518779647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Romi Haas
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Terry Haines
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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Hong Y, Mansour S, Alotaibi G, Wu C, McMurtry MS. Effect of anticoagulants on admission rates and length of hospital stay for acute venous thromboembolism: A systematic review of randomized control trials. Crit Rev Oncol Hematol 2018; 125:12-18. [PMID: 29650271 DOI: 10.1016/j.critrevonc.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 02/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is a paucity of data available on hospitalization and length of stay (LOS) for different anticoagulant therapies. We sought to compare and summarize admission rates and LOS, and describe the frequency of reporting these two outcomes in randomized control trials (RCTs) comparing different anticoagulant therapies for venous thromboembolism (VTE). METHODS A literature search was conducted from inception to August 15, 2016 on RCTs of anticoagulant therapy for patients with VTE. Study selection, data extraction and risk of bias analysis were done by two reviewers independently. Meta-analyses were conducted for admission rates and LOS. RESULTS A total of 4064 articles were identified. There were 74 articles of 70 studies included in the analysis. Hospitalization rates and LOS were reported in 13 (18.6%) and 12 (17.1%) of the 70 included studies, respectively. Low-molecular-weight heparin (LMWH)-treated patients were 33.0% less likely to be admitted to hospitals compared to unfractionated heparin (UFH) (RR = 0.67, 95% CI [0.58, 0.78]). The mean difference in LOS between LMWH and UFH was 2.54 days in favor of LMWH (95% CI [-4.94, -0.14]). Compared to parenteral therapy, using rivaroxaban was associated with a lower admission rate for a difference of 1.4-5.1% in VTE, 2.5% in DVT and 0.2% in PE. The LOS of patients receiving rivaroxaban was significant shorter than the LOS in parenteral therapy group for a difference of 1-5 days in VTE, 3 days in DVT and 1 day in PE. CONCLUSION Admission rates were lower and LOS was shorter using LMWH compared to UFH and oral therapy compared to parenteral therapy for acute VTE treatment in RCTs, based on limited eligible RCTs. These crucial clinically relevant outcomes are underreported in the existing VTE clinical trials.
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Affiliation(s)
- Yongzhe Hong
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Sola Mansour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ghazi Alotaibi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cynthia Wu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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