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Liu Z, Yang K, Gu H, Wei M, Feng X, Yu F, Du Y, Li Z, Xia J. Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China. Stroke 2024; 55:1359-1369. [PMID: 38545773 DOI: 10.1161/strokeaha.123.046096] [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: 12/05/2023] [Accepted: 02/29/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry. METHODS Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories. RESULTS Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; P=0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; P<0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; P=0.011). CONCLUSIONS Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.
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Affiliation(s)
- Zeyu Liu
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
| | - Kaixuan Yang
- China National Clinical Research Center for Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
| | - Minping Wei
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
| | - Xianjing Feng
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
| | - Fang Yu
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
| | - Yang Du
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
- National Center for Healthcare Quality Management in Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
- Vascular Neurology, Department of Neurology (Z. Li), Beijing Tiantan Hospital, Capital Medical University, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China
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Bilgin H, Sili U, Pazar N, Kucuker I, Kepenekli E, Yanar MA, Memisoglu A, Ozek E, Adhikari NK, Pinto R, Korten V. Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study. Am J Infect Control 2023; 51:1028-1033. [PMID: 36603809 DOI: 10.1016/j.ajic.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). METHODS AND MATERIALS This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. RESULTS We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). CONCLUSION In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
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Affiliation(s)
- Huseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazli Pazar
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Isil Kucuker
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Eda Kepenekli
- Department of Pediatric Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meral Agirman Yanar
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Asli Memisoglu
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Eren Ozek
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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