Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals

The role of nursing care continuity report in predicting length of hospital stay in older people: A retrospective cohort study

BACKGROUND

The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission.

AIM

To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days).

RESEARCH DESIGN AND SETTING

A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR.

RESULTS

A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital-acquired pressure ulcers.

CONCLUSIONS

Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital-acquired ulcers at hospital discharge.

RELEVANCE TO CLINICAL PRACTICE

Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation.

NO PATIENT OR PUBLIC CONTRIBUTION

No direct patient contact was made during the data collection.

Life quality improvement of patients with non-small cell lung cancer undergoing targeted therapy: A case study of continuous care

To investigate the improvement effect of targeted therapy on non-small cell carcinoma patients life quality after the continuous nursing intervention. 104 non-small cell lung cancer patients in our hospital from July 2017 to November 2019 were allocated evenly and randomly into the control group (C) and the study group (S). By using clinical baseline data, quality of life questionnaire core 30 for cancer patients, evaluation of patient compliance behavior, the MOS item short-form health survey (SF-36), self rating depression scale (SDS), self rating anxiety scale (SAS), Overall Survival (OS) progression-free survival and adverse reaction symptoms were evaluated for the life quality of patients. There was comparability between the 2 sets of basic data. There was no significant difference in quality of life questionnaire core 30, SF-36, SAS, or SDS scores before treatment. After 3 months, there was a significant difference in the scores of various scales before treatment. At the same time, there was significant statistical significance before and after treatment in Group S. Their compliance rates were 84.62% and 98.08%. Adverse reactions incidence in Group S was lower. Taking a 2-year follow-up period as an example, significant statistical differences existed in OS and progression-free survival rates between adenocarcinoma and squamous carcinoma. SDS and SAS had high consistency in scoring with QLQ-30 and SF-36 scales. Targeted treatment for non-small cell carcinoma patients significantly improves their life quality and reduces the incidence of adverse reactions after continuous nursing intervention.

Decannulation protocol for short term tracheostomy in pediatric head and neck tumor patients

BACKGROUND

While the majority of pediatric tracheostomies are performed in the setting of chronic and complex medical comorbidities, perioperative tracheostomies following head and neck tumor ablation are generally short-term. Deliberate planning is required for decannulation in this setting and no published protocols currently exist. Our study outlines a management strategy for short-term tracheostomy in pediatric patients following head and neck surgery.

METHODS

A retrospective study of pediatric head and neck tumor patients undergoing tracheostomy was performed at a quaternary children's hospital from February 1, 2016 to December 31, 2018. Charts were reviewed for demographics, surgical operation, relevant tracheostomy-related complications, and time to decannulation.

RESULTS

Eleven patients with a mean age of 10.4 years (st.dev. 6.7, range: 0.5-23) underwent tracheostomy during their primary ablative/reconstructive surgery. Trans-tracheal pressure monitoring helped direct the need for tracheostomy downsizing and readiness for capping trials. All patients were decannulated before hospital discharge after a mean of 12.8 days (st.dev. 2.5, range: 9-18) and were discharged after a mean of 14.8 days (st.dev. 2.5, range: 11-20).

CONCLUSION

Pediatric head and neck surgery patients can be quickly and safely decannulated with an instructive protocol and multidisciplinary care.

Application effect of continuous nursing in patients with advanced esophageal cancer after esophageal stent implantation

OBJECTIVE

To explore the advantages of continuous nursing for patients with advanced esophageal cancer after esophageal stent implantation.

METHODS

A total of 48 patients with advanced esophageal cancer who successfully received esophageal stent implantation in the Department of Oncology, at the First People's Hospital Affiliated with Shanghai Jiao Tong University were divided into the control group (24 cases, receiving routine discharge guidance) and the experimental group (24 cases, receiving continuous nursing through the issuance of a home nursing instruction handbook, dietary transition guidance after discharge, nutrition and food evaluation, and guidance on daily activities, medication, and prevention of complications, etc.). The quality of life (EORTCQLQ-C30), nutritional status (MNA score and the levels of hemoglobin (Hb), serum total protein (TP) and albumin (Alb)), anxious/depressive mental state (HAMA, HAMD), complications and satisfaction were compared between the two groups.

RESULTS

EORTCQLQ-C30, HAMA and HAMD scores of the two groups three months after discharge were lower than those before discharge, and those of the experimental group were lower than those of the control group (all P<0.05). The MNA score and the levels of Hb, TP and Alb in the experimental group three months after discharge had no significant changes compared with those before discharge (all P>0.05), while the MNA score and the levels of Hb, TP and Alb in the control group three months after discharge were lower than those before discharge and those in the experimental group (all P<0.05). The experimental group's nursing satisfaction was higher than that of the control group (P<0.05).

CONCLUSION

The application of continuous nursing in patients with advanced esophageal cancer after esophageal stent implantation can effectively improve the patients' adverse mental state, nutritional status and quality of life.

Barriers to Discharge in Geriatric Long Staying Inpatient and Emergency Department Admissions: A Descriptive Study

Background: This study describes long length of stay during emergency department (ED) visits and hospital admissions, barriers to discharge, and discharge solutions for geriatric patients. Methods: We conducted a retrospective medical record review of a random sample of 150 ED patients and 150 inpatients with long length of stay (LOS) encounters. Cohorts were characterized by demographics, social determinants of health (e.g., health insurance, housing), medical comorbidities at admission, discharge care coordination, and final disposition. Results: In the ED, the primary barrier to discharge was inadequate inpatient bed availability (63%). In the inpatient setting, barriers to discharge were predominantly due to a demonstrated medical requirement for continued hospitalization (55%), followed by difficulty with coordinating discharge to a skilled nursing facility or rehabilitation center (22%). Discussion: Among long LOS ED patients, discharge delays were often the result of unavailable inpatient beds and services. Reducing the LOS for ED patients may require further investigation as to which hospital services are most frequently utilized by geriatric patients and structuring inpatient bed allocation to prevent extended patient boarding in the ED. Reducing long inpatient LOS may require early identification of high-risk patients and strengthening of relationships with community-based services.

Factors Associated with Hospital Discharge Difficulties for Pediatric Patients in Japan - Using the Delphi Technique

PURPOSE

This study aimed to identify factors associated with discharge difficulties for pediatric patients in Japan in order to develop pediatric discharge screening tools.

DESIGN AND METHODS

This study employed the Delphi method by setting consensus level to 80%. A total of 131 acute hospitals were randomly selected by computer from among 261 hospitals. Five nurses with experience in discharge planning for children from each hospital were recruited for this study resulting in 655 participants enrolled.

RESULTS

We received 160 responses from participants who expressed consent to participate in the first edition questionnaire, and 112 responses with the second questionnaire. The study identified three factor categories associated with discharge difficulties: patient factors (22 items), family factors (32), and societal factors (12). Among these, 4 patient factors including "Unstable child with congenital disease", 15 family factors including "Abuse or possibility of abuse", "Carer with difficulties in bringing up the child due to a tendency towards depression", and "Carer with a poor opinion of home care", and 5 societal factors including "No alternative pediatric hospitals for transfers" reached consensus showing them to be considered important for the participants.

IMPLICATIONS

The findings suggest that the factors associated with discharge difficulties for Japanese pediatric patients may be useful when used for the screening, in providing discharge planning at an early stage. These factors would provide useful ideas when developing discharge screening tools that will enable nurses to provide discharge planning for pediatric patients at the early stages of hospitalization.

Patterns of Functional Impairment over Time Amongst Older Men-the Manitoba Follow-up Study

Background

To determine the incidence and prevalence patterns of activity of daily living (ADL) impairments in ageing men.

Methods

3,983 men were enrolled in the Manitoba Follow-up Study (MFUS) cohort study in 1948. From 1996 onwards, functional status was measured. We classified basic (BADL) and instrumental (IADL) into mutually exclusive categories as a time dependant factor after the second survey wave as: First survey response; no limitation; incident (first episode of disability); persistent (limitation which was seen on all questionnaires after the incident episode); resilient (noted in previous surveys but not present); and recurrent (noted in present survey, and limitations noted as present and absent in previous surveys).

Results

There were 1,745 participants in 1996 at a mean age of 76 years. Incident BADL limitations increased substantially with age: from 1% at age 75 to 15% at age 95. Similarly, persistent limitations increased with age: from 0.4% at age 75 to 18% at age 95. However, BADL function was fluid, with many individuals grouped within the resilient and recurrent patterns. Similar age effects and variability were noted in IADLs.

Conclusion

New and persistent disabilities are highly associated with age. However, there is considerable change in functional status over time.

Statistical models for analyzing count data: predictors of length of stay among HIV patients in Portugal using a multilevel model

BACKGROUND

This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal.

OBJECTIVE

To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal.

METHOD

Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay.

RESULTS

The median length of stay in our study was 11 days (interquartile range: 6-22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study.

CONCLUSIONS

This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.

Factors associated with length of stay and death in tube-fed patients: A cross-sectional multicentre study

OBJECTIVES

To analyse the factors associated with length of stay (LOS) and death in nasogastric/nasoenteric tube (NG/NET)-fed patients.

DESIGN

A cross-sectional multicentre study.

METHOD

Data collection took place from October 2017-April 2019, and the sample consisted of 365 participants from seven Brazilian hospitals. Demographic, clinical and therapeutic data were collected from the patients' medical records. Data analysis was performed using bivariate and multivariate tests, considering a significance level of p<.05.

RESULTS

Most patients were male, older adults, with high risk of death and highly dependent on nursing care. The LOS was associated with age, patient care complexity and length of NG/NET use. Death was associated with patient age. In the multivariate analysis, patients highly dependent on nursing care, and intensive and semi-intensive care had a greater chance of dying when compared with patients receiving minimal care. Screening for factors affecting LOS and death is important to plan effective nursing care.

Length of hospital stay among oldest-old patients in acute geriatric ward

PURPOSE

To examine risk factors for prolonged hospital length of stay (LOS) in the oldest-old inpatients aged ≥ 90.

METHODS

This retrospective cross-sectional study was performed in acute Geriatrics Department at Kaplan Medical Center. The target population was the oldest-old inpatients aged ≥ 90 hospitalized with acute illness. In total 1536 admissions of 987 patients admitted between January 2007 and December 2010 from the emergency room were included in the study. We retrieved from the electronic hospital records the following data: demographics, admission diagnosis, comorbidities, laboratory tests, drugs, functional and cognitive status, Charlson Comorbidity Index (CCI) score and age-adjusted CCI score.

RESULTS

The risk factors for a prolonged LOS were tube-feeding, consumption of ≥ 5 drugs, non-independent functional status, diagnosis of urinary tract infection (UTI), pneumonia and malignancy on admission, and comorbidities of congestive heart failure (CHF) and hypoalbuminemia. Multiple linear regression analysis found that UTI, hypoalbuminemia, elevated troponin, pneumonia, number of drugs, malignancy, CHF and number of comorbidities explain a higher risk for a longer LOS.

CONCLUSION

Hospital LOS in the oldest-old patients in acute geriatric ward was associated with admission diagnosis and comorbidities. Awareness of the risk factors for a longer LOS might contribute to reducing hospitalization stay and its related negative consequences. Accurate prediction of prolonged LOS in this age group of patients may be more challenging and require variables that were not included in our study. Future research is warranted.