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Connolly J, Peisah C. Waiting for guardianship in a public hospital geriatric inpatient unit: a mixed methods observational case series. Intern Med J 2023; 53:1339-1346. [PMID: 36031739 DOI: 10.1111/imj.15916] [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: 02/27/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients. AIMS This study aims to examine processes around Guardianship applications in a public hospital Geriatric inpatient setting including times to, reasons for and outcomes of referral; and to explore the content of the medical records in relation to criteria for application. METHOD This was a mixed methods observational case series using descriptive data supplemented by qualitative case-note analysis of inpatients referred for guardianship (with/without FM) from 2018 to 2020 in a New South Wales Geriatric Medicine inpatient unit. Medical records were examined for evidence of operationalised criteria for guardianship, aligned with disability, capacity and need/risk common to most Australian jurisdictions. RESULTS Of 45 patients with guardianship applications, 98% were granted guardians and 33 of 37 (89%) FM applications. Multiple risks underpinned applications, most commonly frequent falls (49%) and medication mismanagement (49%). Although only 29% were in receipt of services preadmission, 98% were discharged to residential care. Average hospital LOS was 70 days (interquartile range, 35), contributed to by delays between admission and decision to apply for guardianship/FM (median, 28 inpatient days) and uncertainties around or lack of documented capacity assessments. CONCLUSION This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.
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Affiliation(s)
- Joanna Connolly
- Rehabilitation and Aged Care Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carmelle Peisah
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Capacity Australia, Sydney, New South Wales, Australia
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2
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Heltø ALK, Rosager EV, Aasbrenn M, Maule CF, Petersen J, Nielsen FE, Suetta C, Gregersen R. Predicting Short-Term Mortality in Older Patients Discharged from Acute Hospitalizations Lasting Less Than 24 Hours. Clin Epidemiol 2023; 15:707-719. [PMID: 37324726 PMCID: PMC10264096 DOI: 10.2147/clep.s405485] [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: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Over coming decades, a rise in the number of short, acute hospitalizations of older people is to be expected. To help physicians identify high-risk patients prior to discharge, we aimed to develop a model capable of predicting the risk of 30-day mortality for older patients discharged from short, acute hospitalizations and to examine how model performance changed with an increasing amount of information. Methods This registry-based study included acute hospitalizations in Denmark for 2016-2018 lasting ≤24 hours where patients were permanent residents, ≥65 years old, and discharged alive. Utilizing many different predictor variables, we developed random forest models with an increasing amount of information, compared their performance, and examined important variables. Results We included 107,132 patients with a median age of 75 years. Of these, 3.3% (n=3575) died within 30 days of discharge. Model performance improved especially with the addition of laboratory results and information on prior acute admissions (AUROC 0.835), and again with comorbidities and number of prescription drugs (AUROC 0.860). Model performance did not improve with the addition of sociodemographic variables (AUROC 0.861), apart from age and sex. Important variables included age, dementia, number of prescription drugs, C-reactive protein, and eGFR. Conclusion The best model accurately estimated the risk of short-term mortality for older patients following short, acute hospitalizations. Trained on a large and heterogeneous dataset, the model is applicable to most acute clinical settings and could be a useful tool for physicians prior to discharge.
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Affiliation(s)
- Amalia Lærke Kjær Heltø
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Vangsgaard Rosager
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Aasbrenn
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Cathrine Fox Maule
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Janne Petersen
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Rasmus Gregersen
- Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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van den Ende E, Schouten B, Pladet L, Merten H, van Galen L, Marinova M, Schinkel M, Boerman AW, Nannan Panday R, Rustemeijer C, Dulaimy M, Bell D, Nanayakkara PW. Leaving the hospital on time: hospital bed utilization and reasons for discharge delay in the Netherlands. Int J Qual Health Care 2023; 35:mzad022. [PMID: 37148301 PMCID: PMC10411855 DOI: 10.1093/intqhc/mzad022] [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: 06/27/2022] [Revised: 12/19/2022] [Accepted: 05/03/2023] [Indexed: 05/08/2023] Open
Abstract
Inappropriate bed occupancy due to delayed hospital discharge affects both physical and psychological well-being in patients and can disrupt patient flow. The Dutch healthcare system is facing ongoing pressure, especially during the current coronavirus disease pandemic, intensifying the need for optimal use of hospital beds. The aim of this study was to quantify inappropriate patient stays and describe the underlying reasons for the delays in discharge. The Day of Care Survey (DoCS) is a validated tool used to gain information about appropriate and inappropriate bed occupancy in hospitals. Between February 2019 and January 2021, the DoCS was performed five times in three different hospitals within the region of Amsterdam, the Netherlands. All inpatients were screened, using standardized criteria, for their need for in-hospital care at the time of survey and reasons for discharge delay. A total of 782 inpatients were surveyed. Of these patients, 94 (12%) were planned for definite discharge that day. Of all other patients, 145 (21%, ranging from 14% to 35%) were without the need for acute in-hospital care. In 74% (107/145) of patients, the reason for discharge delay was due to issues outside the hospital; most frequently due to a shortage of available places in care homes (26%, 37/145). The most frequent reason for discharge delay inside the hospital was patients awaiting a decision or review by the treating physician (14%, 20/145). Patients who did not meet the criteria for hospital stay were, in general, older [median 75, interquartile range (IQR) 65-84 years, and 67, IQR 55-75 years, respectively, P < .001] and had spent more days in hospital (7, IQR 5-14 days, and 3, IQR 1-8 days respectively, P < .001). Approximately one in five admitted patients occupying hospital beds did not meet the criteria for acute in-hospital stay or care at the time of the survey. Most delays were related to issues outside the immediate control of the hospital. Improvement programmes working with stakeholders focusing on the transfer from hospital to outside areas of care need to be further developed and may offer potential for the greatest gain. The DoCS can be a tool to periodically monitor changes and improvements in patient flow.
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Affiliation(s)
- Eva van den Ende
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Bo Schouten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 111, Amsterdam 1081 HV, The Netherlands
| | - Lara Pladet
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 111, Amsterdam 1081 HV, The Netherlands
| | - Louise van Galen
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Milka Marinova
- Imperial College London, Lift Bank D, Chelsea and Westminster Hospital, NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
| | - Michiel Schinkel
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Location Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Anneroos W Boerman
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
- Department of Clinical Chemistry, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - Rishi Nannan Panday
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
| | - Cees Rustemeijer
- Department of Internal Medicine, Amstelland Hospital, Laan van de Helende Meesters 8, Amstelveen 1186 AM, The Netherlands
| | - Muhammad Dulaimy
- Department of Internal Medicine, Zaans Medical Center, Koningin Julianaplein 58, Zaandam 1502 DV, The Netherlands
| | - Derek Bell
- Imperial College London, Lift Bank D, Chelsea and Westminster Hospital, NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom
| | - Prabath Wb Nanayakkara
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
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Caballer-Tarazona V, Zúñiga-Lagares A, Reyes-Santias F. Analysis of hospital costs by morbidity group for patients with severe mental illness. Ann Med 2022; 54:858-866. [PMID: 35318876 PMCID: PMC8956305 DOI: 10.1080/07853890.2022.2048884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The goal of this study is to analyse hospital costs and length of stay of patients admitted to psychiatric units in hospitals in a European region of the Mediterranean Arc. The aim is to identify the effects of comorbidities and other variables in order to create an explanatory cost model. METHODS In order to carry out the study, the Ministry of Health was asked to provide data on access to the mental health facilities of all hospitals in the region. Among other questions, this database identifies the most important diagnostic variables related to admission, like comorbidities, age and gender. The method used, based on the Manning-Mullahy algorithm, was linear regression. The results were measured by the statistical significance of the independent variables to determine which of them were valid to explain the cost of hospitalization. RESULTS Psychiatric inpatients can be divided into three main groups (psychotic, organic and neurotic), which have statistically significant differences in costs. The independent variables that were statistically significant (p <.05) and their respective beta and confidence intervals were: psychotic group (19,833.0 ± 317.3), organic group (9,878.4 ± 276.6), neurotic group (11,060.1 ± 287.6), circulatory system diseases (19,170 ± 517.6), injuries and poisoning (21,101.6 ± 738.7), substance abuse (20,580.6 ± 514, 6) and readmission (19,150.9 ± 555.4). CONCLUSIONS Unlike most health services, access to psychiatric facilities does not correlate with comorbidities due to the specific nature of this specialization. Patients admitted to psychosis had higher costs and a higher number of average staysKEY MESSAGESThe highest average hospital expenditure occurred in patients admitted for psychotic disorders.Due to the particularities of psychiatry units and unlike other medical specialties, the number of comorbidities did not influence the number of hospital stays or hospital expenditure.Apart from the main diagnostic group, the variables that were useful to explain hospital expenditure were the presence of poisoning and injuries as comorbidity, diseases of circulatory system as comorbidity, history of substance abuse and readmission.
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Lupiáñez-Pérez I, Gómez-González AJ, Morilla-Herrera JC, Marfil-Gómez R, León-Campos Á, Caro-Bautista J, Villa-Estrada F, Aranda-Gallardo M, Moya-Suárez AB, Morales-Asencio JM. A protocol for a randomized trial measuring flowmetry in risk areas for pressure ulcer: Hyperoxygenated fatty acids vs olive oil. J Tissue Viability 2022; 31:501-505. [DOI: 10.1016/j.jtv.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
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Nicolaus S, Crelier B, Donzé JD, Aubert CE. Definition of patient complexity in adults: A narrative review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221081288. [PMID: 35586038 PMCID: PMC9106317 DOI: 10.1177/26335565221081288] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
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Affiliation(s)
- Stefanie Nicolaus
- Department of General Internal Medicine, Biel Hospital, Biel, Switzerland
| | - Baptiste Crelier
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
| | - Jacques D Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Aasbrenn M, Christiansen CF, Esen BÖ, Suetta C, Nielsen FE. Mortality of older acutely admitted medical patients after early discharge from emergency departments: a nationwide cohort study. BMC Geriatr 2021; 21:410. [PMID: 34215192 PMCID: PMC8252197 DOI: 10.1186/s12877-021-02355-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background The mortality of older patients after early discharge from hospitals is sparsely described. Information on factors associated with mortality can help identify high-risk patients who may benefit from preventive interventions. The aim of this study was to examine whether demographic factors, comorbidity and admission diagnoses are predictors of 30-day mortality among acutely admitted older patients discharged within 24 h after admission. Methods All medical patients aged ≥65 years admitted acutely to Danish hospitals between 1 January 2013 and 30 June 2014 surviving a hospital stay of ≤24 h were included. Demographic factors, comorbidity, discharge diagnoses and mortality within 30 days were described using data from the Danish National Patient Registry and the Civil Registration System. Cox regression was used to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for all-cause mortality. Results A total of 93,295 patients (49.4% men) with a median age of 75 years (interquartile range: 69–82 years), were included. Out of these, 2775 patients (3.0%; 95% CI 2.9–3.1%) died within 30 days after discharge. The 30-day mortality was increased in patients with age 76–85 years (aHR 1.59; 1.45–1.75) and 86+ years (aHR 3.35; 3.04–3.70), male gender (aHR 1.22; 1.11–1.33), a Charlson Comorbidity Index of 1–2 (aHR 2.15; 1.92–2.40) and 3+ (aHR 4.07; 3.65–4.54), and unmarried status (aHR 1.17; 1.08–1.27). Discharge diagnoses associated with 30-day mortality were heart failure (aHR 1.52; 1.17–1.95), respiratory failure (aHR 3.18; 2.46–4.11), dehydration (aHR 2.87; 2.51–3.29), constipation (aHR 1.31; 1.02–1.67), anemia (aHR 1.45; 1.27–1.66), pneumonia (aHR 2.24; 1.94–2.59), urinary tract infection (aHR 1.33; 1.14–1.55), dyspnea (aHR 1.57; 1.32–1.87) and suspicion of malignancy (aHR 2.06; 1.64–2.59). Conclusions Three percent had died within 30 days. High age, male gender, the comorbidity burden, unmarried status and several primary discharge diagnoses were identified as independent prognostic factors of 30-day all-cause mortality.
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Affiliation(s)
- Martin Aasbrenn
- CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark. .,Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | | | - Buket Öztürk Esen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Suetta
- CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark.,Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospitals, Herlev, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Gaspar S, Botelho Guedes F, Vitoriano Budri AM, Ferreira C, Gaspar de Matos M. Hospital-acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scand J Caring Sci 2021; 36:978-987. [PMID: 34105825 DOI: 10.1111/scs.12995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/01/2021] [Accepted: 04/18/2021] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to understand the perceptions of 11 Portuguese nurses' stakeholders regarding pressure ulcers prevention practice and reality in the hospital setting. METHODS Convenience sampling was used to recruit nursing stakeholders for a heterogeneous focus group. A semi-structured interview was conducted with 11 nursing stakeholders involved in pressure ulcers prevention and/or patient safety. MaxQda 2020 qualitative analysis software was used in the content analysis and data processing. Informed consent was obtained, and anonymity was guaranteed. RESULTS Four themes were approached in the interview: (1) Pressure ulcer risk assessment; (2) Nurses and doctors pressure ulcers monitoring; (3) Pressure ulcer risk profiles; and (4) Effective interventions to improve patient safety. The categorisation of the four themes was created aposteriori based on the 'Awareness/Knowledge/Competence, Opportunity, and Motivation - Behaviour Change Wheel' (adapted COM-B system). Interest, responsibility, autonomy, leadership and prioritisation for decision-making were some categories linked to motivation. Braden scale operationalisation, education given during undergraduate degree continued professional health education, missing care, reliability of the records and patients' clinical characteristics emerged as categories associated with awareness/knowledge/competence. Understaffing/nursing hours, health policies, electronic health records systems and clinical language used, access to appropriate equipment and resources, teamwork and clinical support specialist on tissue viability/wound care were some categories related to opportunity. CONCLUSIONS Pressure ulcer prevention is complex and requires a focussed attitude, robust evidenced-based knowledge and enhanced skills in risk assessment, communication and team collaboration. The highlighted categories could be further analysed at an organisational level to develop tailored strategies that could contribute to successful evidence-based practice implementation. RELEVANCE TO CLINICAL PRACTICE The findings provide directions for behavioural change in the hospital context related to pressure ulcers prevention through awareness/knowledge/competence, motivation and opportunity to improve care delivered.
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Affiliation(s)
- Susana Gaspar
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Fábio Botelho Guedes
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Aglécia Moda Vitoriano Budri
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, University of Medicine and Health Sciencies, Dublin, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeon in Ireland, Dublin, Ireland
| | - Carlos Ferreira
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Institute of Education, University of Lisbon, UIDEF, Lisbon, Portugal
| | - Margarida Gaspar de Matos
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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9
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Pavol MA, Boehme AK, Yuzefpolskaya M, Maurer MS, Casida J, Festa JR, Ibeh C, Willey JZ. Cognition predicts days-alive-out-of-hospital after LVAD implantation. Int J Artif Organs 2021; 44:952-955. [PMID: 34011184 DOI: 10.1177/03913988211018484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cognition influences hospitalization rates for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We used cognition to predict days-alive-out-of-hospital (DAOH) in patients after LVAD surgery. METHODS We retrospectively identified 59 HF patients with cognitive assessment prior to LVAD. Cognitive tests of attention, memory, language, and visual motor speed were averaged into one score. DAOH was converted to a percentage based on total days from LVAD surgery to either heart transplant or 900 days post-LVAD. Variables significantly associated with DAOH in univariate analyses were included in a linear regression model to predict DAOH. RESULTS A linear regression model including LVAD type (continuous or pulsatile flow) and cognition significantly predicted DAOH (F(2,54) = 6.44, p = 0.003, R2 = .19). Inspection of each variable revealed that cognition was a significant predictor in the model (β = .11, SE = .04, p = 0.007) but LVAD type was not (p = 0.08). CONCLUSIONS Cognitive performance assessed prior to LVAD implantation predicted how much time patients spent out of the hospital following surgery. Further studies are warranted to identify the impact of pre-LVAD cognition on post-LVAD hospitalization.
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Affiliation(s)
- Marykay A Pavol
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesus Casida
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chinwe Ibeh
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Z Willey
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
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Adamuz J, González-Samartino M, Jiménez-Martínez E, Tapia-Pérez M, López-Jiménez MM, Rodríguez-Fernández H, Castro-Navarro T, Zuriguel-Pérez E, Carratala J, Juvé-Udina ME. Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study. BMJ Open 2021; 11:e041726. [PMID: 33597132 PMCID: PMC7893207 DOI: 10.1136/bmjopen-2020-041726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19. METHODS A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes. RESULTS Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01). CONCLUSION The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.
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Affiliation(s)
- Jordi Adamuz
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Department of Infectious Diseases, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marta Tapia-Pérez
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - María-Magdalena López-Jiménez
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
| | - Hugo Rodríguez-Fernández
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - Trinidad Castro-Navarro
- Nursing Knowledge Management and Information Systems Department, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Esperanza Zuriguel-Pérez
- Nursing Research Deparment, Vall d'Hebron University Hospital (VHIR), Barcelona, Catalunya, Spain
| | - Jordi Carratala
- Department of Infectious Diseases, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
- Faculty of Medicine, Deparment of Clinical Sciences, University of Barcelona, Barcelona, Spain
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11
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Fuertes-Guiró F, Viteri Velasco E. The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis. J Med Econ 2020; 23:819-830. [PMID: 32372679 DOI: 10.1080/13696998.2020.1764965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: We used a systematic review and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients. The opportunity cost of frailty in geriatric surgery is estimated using the results.Methodology: Two literature reviews were carried out between 2000 and 2019: (1) studies comparing total hospital costs of frail and non-frail surgical patients; (2) studies evaluating the length of hospital stay and cost for surgical geriatric patients. We performed a meta-analysis of the items selected in the first review. We subsequently calculated the opportunity cost of frail patients, based on the design of a cost/time variable.Results: Twelve articles in the first review were selected (272,717 non-frail and 16,461 frail). Fourteen articles were selected from the second review. Frail patients had higher hospital costs than non-frail patients (22,282.541 € and 16,388.844, p < .001) and a longer hospital stay (10.16 days and 8.4 (p < .001)). The estimated opportunity cost in frail patients is 1,019.56 € (cost/time unit factor of 579.30 €/day).Conclusions: Frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources.
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Affiliation(s)
- Fernando Fuertes-Guiró
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Eduardo Viteri Velasco
- Quirón Salud University Hospital, Universitat Internacional de Catalunya, Barcelona, Spain
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12
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Adamuz J, Juvé-Udina ME, González-Samartino M, Jiménez-Martínez E, Tapia-Pérez M, López-Jiménez MM, Romero-Garcia M, Delgado-Hito P. Care complexity individual factors associated with adverse events and in-hospital mortality. PLoS One 2020; 15:e0236370. [PMID: 32702709 PMCID: PMC7377913 DOI: 10.1371/journal.pone.0236370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients’ electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78–0.83). Conclusions Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes.
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Affiliation(s)
- Jordi Adamuz
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Maria-Eulàlia Juvé-Udina
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| | - Maribel González-Samartino
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Infectious Disease Department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Tapia-Pérez
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - María-Magdalena López-Jiménez
- Nursing knowledge management and information systems department, Bellvitge University Hospital, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Romero-Garcia
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Delgado-Hito
- School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Bellvitge Institute of Biomedical Research (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
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13
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Lindhardt CL, Beck SH, Ryg J. Nursing care for older patients with pressure ulcers: A qualitative study. Nurs Open 2020; 7:1020-1025. [PMID: 32587720 PMCID: PMC7308692 DOI: 10.1002/nop2.474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/26/2020] [Accepted: 02/16/2020] [Indexed: 11/17/2022] Open
Abstract
Aim To explore the experience and perception of pressure ulcers in a group of nurses caring for older patients. Design A qualitative study based on interviews with (N = 6) nurses working with older patients. Method A qualitative approach was applied using thematic analysis influenced by Braun and Clarke. Results The findings comprised one main theme "Prevention of pressure ulcers is important" and four sub-themes "Nursing resources on the ward," "Basic nursing skills-lift the duvet," "Introduction of new nurses on the ward-bedside teaching" and "Missing articulation of pressure ulcers." Bedside teaching and experienced nurses may create a culture on the ward where basic nursing skills and observations are articulated.
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Affiliation(s)
- Christina Louise Lindhardt
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
- Department of Clinical InstituteUniversity of Southern DenmarkOdenseDenmark
- University College AbsalonSorøDenmark
| | - Sanne Have Beck
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
| | - Jesper Ryg
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
- Department of Clinical InstituteUniversity of Southern DenmarkOdenseDenmark
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14
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Klinge M, Aasbrenn M, Öztürk B, Christiansen CF, Suetta C, Pressel E, Nielsen FE. Readmission of older acutely admitted medical patients after short-term admissions in Denmark: a nationwide cohort study. BMC Geriatr 2020; 20:203. [PMID: 32527311 PMCID: PMC7291666 DOI: 10.1186/s12877-020-01599-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Knowledge of unplanned readmission rates and prognostic factors for readmission among older people after early discharge from emergency departments is sparse. The aims of this study were to examine the unplanned readmission rate among older patients after short-term admission, and to examine risk factors for readmission including demographic factors, comorbidity and admission diagnoses. Methods This cohort study included all medical patients aged ≥65 years acutely admitted to Danish hospitals between 1 January 2013 and 30 June 2014 and surviving a hospital stay of ≤24 h. Data on readmission within 30 days, comorbidity, demographic factors, discharge diagnoses and mortality were obtained from the Danish National Registry of Patients and the Danish Civil Registration System. We examined risk factors for readmission using a multivariable Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for readmission. Results A total of 93,306 patients with a median age of 75 years were acutely admitted and discharged within 24 h, and 18,958 (20.3%; 95% CI 20.1 - 20.6%) were readmitted with a median time to readmission of 8 days (IQR 3 - 16 days). The majority were readmitted with a new diagnosis. Male sex (aHR 1.15; 1.11 - 1.18) and a Charlson Comorbidity Index ≥3 (aHR 2.28; 2.20 - 2.37) were associated with an increased risk of readmission. Discharge diagnoses associated with increased risk of readmission were heart failure (aHR 1.26; 1.12 - 1.41), chronic obstructive pulmonary disease (aHR 1.33; 1.25 - 1.43), dehydration (aHR 1.28; 1.17 - 1.39), constipation (aHR 1.26; 1.14 - 1.39), anemia (aHR 1.45; 1.38 - 1.54), pneumonia (aHR 1.15; 1.06 - 1.25), urinary tract infection (aHR 1.15; 1.07 - 1.24), suspicion of malignancy (aHR 1.51; 1.37 - 1.66), fever (aHR 1.52; 1.33 - 1.73) and abdominal pain (aHR 1.12; 1.05 - 1.19). Conclusions One fifth of acutely admitted medical patients aged ≥65 were readmitted within 30 days after early discharge. Male gender, the burden of comorbidity and several primary discharge diagnoses were risk factors for readmission.
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Affiliation(s)
- M Klinge
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - M Aasbrenn
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C Suetta
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospitals, Copenhagen, Denmark.,CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - E Pressel
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - F E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. .,Department of Emergency Medicine, Slagelse Hospital, Bispebjerg and Frederiksberge, Denmark. .,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
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15
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Pobrotyn P, Susło R, Witczak IT, Rypicz Ł, Drobnik J. An analysis of the costs of treating aged patients in a large clinical hospital in Poland under the pressure of recent demographic trends. Arch Med Sci 2020; 16:666-671. [PMID: 32399116 PMCID: PMC7212232 DOI: 10.5114/aoms.2018.81132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing. MATERIAL AND METHODS Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wrocław, Poland in the years 2012-2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65-74, 75-84 and 85 years and older). RESULTS The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland. CONCLUSIONS The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients' hospital treatment.
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Affiliation(s)
- Piotr Pobrotyn
- Management, University Clinical Hospital, Wroclaw, Poland
| | - Robert Susło
- Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela T. Witczak
- Economics and Quality in Health Care Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Rypicz
- Economics and Quality in Health Care Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Jarosław Drobnik
- Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
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16
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Kısacık ÖG, Sönmez M. Pressure ulcers prevention: Turkish nursing students' knowledge and attitudes and influencing factors. J Tissue Viability 2019; 29:24-31. [PMID: 31759832 DOI: 10.1016/j.jtv.2019.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/23/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Öznur Gürlek Kısacık
- Faculty of Health Science, Nursing Department, Afyonkarahisar University of Health Science, 03200, Afyonkarahisar, Turkey.
| | - Münevver Sönmez
- Faculty of Health Science, Nursing Department, Bülent Ecevit University of Health Science, 67000, Zonguldak, Turkey
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17
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Kim S, Lee SC, Skinner CS, Brown CJ, Balentine CJ. A Surgeon's Guide to Treating Older Patients with Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2019; 15:1-7. [PMID: 31728133 PMCID: PMC6855304 DOI: 10.1007/s11888-019-00424-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Review strategies to improve outcomes of colorectal cancer treatment in older patients. RECENT FINDINGS Older colorectal patients face many barriers to recovery during their initial inpatient stay following surgery and after leaving the hospital. In addition to the risk of inpatient morbidity and mortality, older patients are more likely to require post-acute care services, to face nutritional deficits, and to experience complications of chemoradiation. SUMMARY In order to improve outcomes for older patients with colorectal cancer, it is important for surgeons to recognize their unique needs and to develop plans to address them. The involvement of a multidisciplinary team with geriatric experience can guide planning for surgery, the immediate postoperative recovery, and long-term survivorship.
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Affiliation(s)
- Sooyeon Kim
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Simon C. Lee
- Department of Clinical Sciences, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Celette S. Skinner
- Department of Clinical Sciences, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cynthia J. Brown
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Care Center, Birmingham, AL; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Courtney J. Balentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- VA North Texas Health Care System, Dallas, TX
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