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Choi Y, Lee DH, Oh J. Epidemiology and clinical characteristics of trauma in older patients transferred from long-term care hospitals to emergency departments: A nationwide retrospective study in South Korea. Arch Gerontol Geriatr 2023; 115:105212. [PMID: 37774489 DOI: 10.1016/j.archger.2023.105212] [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: 07/24/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND South Korea's aging population had leg to an increased number of long-term care hospitals (LTCHs), and increased transfer of older patients to emergency departments (EDs). This study investigated the epidemiological and injury profiles of LTCH patients aged ≥65 who were transferred from LTCHs to EDs due to trauma. METHOD This retrospective study conducted between January 2014 and December 2019 in South Korea utilized data from the National Emergency Department Information System. The requirement for informed consent was waived by the IRB due to the retrospective nature of the study. Patient information was anonymized prior to analysis. RESULTS Of the 1,472,006 trauma cases aged ≥65, 14,469 came from LTCHs. Outcomes varied: 44.1% were discharged, 40.6% were admitted to general wards (GW), 5.9% to intensive care units (ICU), 2.4% to other hospitals, and 6.5% returned to LTCHs. ED length of stay (LOS) was longest in the death (410.28 ± 559.73 min) and GW admission (390.12 ± 621.71 min) groups. Falls were the main cause of injury (50.1%), and the most common fracture was femoral (71.6%). Femoral and shoulder/upper extremity fractures increased hospitalization risk only, whereas self-harm increased both hospitalization and mortality risk. CONCLUSION Visits to the ED by older patients from LTCH for trauma were avoidable in 50.6% of cases. Additionally, these patients had longer ED LOS and higher hospitalization rates than non-LTCH patients. Falls were the predominant mode of presentation, femoral fracture was the most common fracture among patients from LTCH.
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Affiliation(s)
- Yunhyung Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Anyangcheonro 1071, YangChoengu, Seoul 07985, Korea; Chung-Ang University Gwangmyeong Hospital, Deokan-ro 110, Gwangmyeong-si, 14353 Gyeonggi-do, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Anyangcheonro 1071, YangChoengu, Seoul 07985, Korea; Ewha Womans University Mokdong Hospital, Anyangcheonro 1071, Yangchoengu, Seoul 07985, Republic of Korea.
| | - Jongseok Oh
- Postdoctoral researcher, Graduate School of Public Administration, Seoul National University, Room 208, Bld 16, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea.
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Chen KC, Wen SH. Impact of interhospital transfer on emergency department timeliness of care and in-hospital outcomes of adult non-trauma patients. Heliyon 2023; 9:e13393. [PMID: 36814609 PMCID: PMC9939607 DOI: 10.1016/j.heliyon.2023.e13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Background Patients who present to the emergency department (ED) from interhospital transfer (IHT) and non-IHT are known to have differences in various clinical outcomes including mortality. The ED timeliness of care is an effective indicator of the quality of ED care and operational efficiency. The impact of IHT on ED timeliness of care remains unclear. We evaluated the association between IHT and ED timeliness of care or in-hospital outcomes in adult non-trauma patients. Methods Data of consecutive hospital admission of adult non-trauma patients who visited the ED of a medical center from January 2018 to Jun 2020 were retrospectively analyzed. The patients were divided into IHT and non-IHT cohorts. Various data were recorded. The ED length of stay (LOS) was measured as the outcome of ED timeliness of care, while hospital LOS and in-hospital death were measured as the in-hospital outcomes. Multiple regression analyses were performed using unmatched and propensity-matched cohorts. In the later analyses, both groups were propensity matched for sex, age, and other covariates that showed significant differences between two groups to achieve a 1:4 balanced cohort. Results Data on 1856 IHT patients and 16295 non-IHT patients were analyzed. IHT was associated with a shorter ED LOS, longer hospital LOS, and higher odds of in-hospital death compared with non-IHT in unmatched and propensity-matched analyses. The shorter ED LOS was due to the slightly longer interval of arrival to ED physicians (∼1 min) and considerably shorter intervals of ED physicians to decision (∼120 min) and decision to departure (∼105 min). Risk stratification revealed that IHT was associated with a shorter ED LOS in patients with all levels (1-5) of Taiwan Triage and Acuity Scale (TTAS) and associated with longer hospital LOS and higher odds of in-hospital death in patients with TTAS level ≥3. Conclusions IHT was associated with a shorter ED LOS, longer hospital LOS, and higher odds of in-hospital death in adult non-trauma patients compared with non-IHT. The expedited ED timeliness of care in the IHT cohort was due to considerably shorter intervals of both ED physicians to decision and decision to disposition.
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Affiliation(s)
- Kun-Chuan Chen
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Hualien City, Taiwan,Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan
| | - Shu-Hui Wen
- Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan,Department of Public Health, College of Medicine, Tzu Chi University, Hualien City, Taiwan,Corresponding author. Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan.
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VanSpronsen AD, Zychla L, Turley E, Villatoro V, Yuan Y, Ohinmaa A. Causes of Inappropriate Laboratory Test Ordering from the Perspective of Medical Laboratory Technical Professionals: Implications for Research and Education. Lab Med 2023; 54:e18-e23. [PMID: 35801961 DOI: 10.1093/labmed/lmac076] [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: 01/11/2023] Open
Abstract
OBJECTIVE Inappropriate laboratory test ordering is a significant and persistent problem. Many causes have been identified and studied. Medical laboratory professionals (MLPs) are technical staff within clinical laboratories who are uniquely positioned to comment on why inappropriate ordering occurs. We aimed to characterize existing MLP perceptions in this domain to reveal new or underemphasized interventional targets. METHODS We developed and disseminated a self-administered survey to MLPs in Canada, including open-ended responses to questions about the causes of inappropriate laboratory test ordering. RESULTS Four primary themes were identified from qualitative analysis: ordering-provider factors, communication factors, existing test-ordering processes, and patient factors. Although these factors can largely be found in previous literature, some are under-studied. CONCLUSION MLP insights into nonphysician triage ordering and poor result communication provide targets for further investigation. A heavy focus on individual clinician factors suggests that current understandings and interprofessional skills in the MLP population can be improved.
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Affiliation(s)
- Amanda D VanSpronsen
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Zychla
- Research, Canadian Association for Medical Radiation Technologists, Ottawa, Ontario, Canada
| | - Elona Turley
- Coagulation Medicine, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Valentin Villatoro
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Ambasta A, Ma IWY, Omodon O, Williamson T. Association between physician continuity of care and patient outcomes in clinical teaching units: a cohort analysis. CMAJ Open 2023; 11:E40-E44. [PMID: 36649981 PMCID: PMC9851623 DOI: 10.9778/cmajo.20220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hospital-based clinical teaching units (CTUs) are supervised by rotating attending physicians. Physician hand-offs in other contexts have been associated with worse patient outcomes, presumably through communication gaps. We aimed to determine the association between attending physician hand-offs on CTUs and patient outcomes including escalation of care, readmission and mortality. METHODS We conducted a retrospective, multicentre cohort study using data from 3 tertiary care hospitals in Calgary between Jan. 1, 2015, and Dec. 31, 2017. We included hospital admissions in the top 10 case-mix groups. Our exposure variable was the number of attending physicians seen by a patient. Outcome measures were admission to intensive care unit (ICU); inpatient 7- and 30-day mortality; and 7- and 30-day readmission rate. We used multivariable regression statistical models adjusted for patient age, sex, length of stay, Charlson Comorbidity Index, case-mix groups, senior resident presence, team handovers and team transfers. RESULTS Our cohort included 4324 unique patients. There were no significant differences in the incidence rate ratios (IRRs) of admission to ICU, inpatient 7- and 30-day mortality, and 7- and 30-day readmission rates among 1 or 2 physicians. However, we noted a significant increase in 30-day readmission rate (IRR 1.37, 95% confidence interval 1.05-1.78) in patients who had 3 or more attending physicians compared with those who had 1 attending physician. INTERPRETATION We found that 2 or more physician hand-offs on CTUs had a modestly greater association with patient readmission at 30 days. More research is needed to explore this finding and to evaluate associated patient and resource outcomes with physician hand-offs.
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Affiliation(s)
- Anshula Ambasta
- Department of Anesthesia, Pharmacology and Therapeutics (Ambasta), Therapeutics Initiative, University of British Columbia, Vancouver, BC; Department of Medicine (Ambasta, Ma), Cumming School of Medicine, University of Calgary; Ward of the 21st Century (Ma, Omodon), University of Calgary and Calgary Zone of Alberta Health Services; Department of Community Health Sciences (Williamson), Centre for Health Informatics, University of Calgary, Calgary, Alta.
| | - Irene W Y Ma
- Department of Anesthesia, Pharmacology and Therapeutics (Ambasta), Therapeutics Initiative, University of British Columbia, Vancouver, BC; Department of Medicine (Ambasta, Ma), Cumming School of Medicine, University of Calgary; Ward of the 21st Century (Ma, Omodon), University of Calgary and Calgary Zone of Alberta Health Services; Department of Community Health Sciences (Williamson), Centre for Health Informatics, University of Calgary, Calgary, Alta
| | - Onyebuchi Omodon
- Department of Anesthesia, Pharmacology and Therapeutics (Ambasta), Therapeutics Initiative, University of British Columbia, Vancouver, BC; Department of Medicine (Ambasta, Ma), Cumming School of Medicine, University of Calgary; Ward of the 21st Century (Ma, Omodon), University of Calgary and Calgary Zone of Alberta Health Services; Department of Community Health Sciences (Williamson), Centre for Health Informatics, University of Calgary, Calgary, Alta
| | - Tyler Williamson
- Department of Anesthesia, Pharmacology and Therapeutics (Ambasta), Therapeutics Initiative, University of British Columbia, Vancouver, BC; Department of Medicine (Ambasta, Ma), Cumming School of Medicine, University of Calgary; Ward of the 21st Century (Ma, Omodon), University of Calgary and Calgary Zone of Alberta Health Services; Department of Community Health Sciences (Williamson), Centre for Health Informatics, University of Calgary, Calgary, Alta
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van Steenbergen GJ, Cremers P, Dekker L, van Veghel D. The next phase in the implementation of value-based healthcare: Adding patient-relevant cost drivers to existing outcome measure sets. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2073004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Paul Cremers
- Netherlands Heart Network (NHN), Eindhoven, Netherlands
| | - Lukas Dekker
- Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Dennis van Veghel
- Catharina Heart Centre, Catharina Hospital, Eindhoven, Netherlands
- Netherlands Heart Registration (NHR), Eindhoven, Netherlands
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Tam K, Williamson T, Ma IWY, Ambasta A. Association Between Health System Factors and Utilization of Routine Laboratory Tests in Clinical Teaching Units: a Cohort Analysis. J Gen Intern Med 2022; 37:1444-1449. [PMID: 34355347 PMCID: PMC9085997 DOI: 10.1007/s11606-021-07063-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have looked at health system factors associated with laboratory test use. OBJECTIVE To determine the association between health system factors and routine laboratory test use in medical inpatients. DESIGN We conducted a retrospective cohort study on adult patients admitted to clinical teaching units over a 3-year period (January 2015 to December 2017) at three tertiary care hospitals in Calgary, Alberta. PARTICIPANTS Patients were assigned to a Case Mix Group+ (CMG+) category based on their clinical characteristics, and patients in the top 10 CMG+ groups were included in the cohort. EXPOSURES The examined health system factors were (1) number of primary attending physicians seen by a patient, (2) number of attending medical teams seen by a patient, (3) structure of the medical team, and (4) day of the week. MAIN MEASURES The primary outcome was the total number of routine laboratory tests ordered on a patient during their admission. Statistical models were adjusted for age, sex, length of stay, Charlson comorbidity index, and CMG+ group. RESULTS The final cohort consisting of 36,667 patient-days in hospital (mean (SD) age 62.5 (18.4) years) represented 5071 unique hospitalizations and 4324 unique patients. Routine laboratory test use was increased when patients saw multiple attending physicians; with an adjusted incidence rate ratio (IRR) of 1.46 (95% CI, 1.37-1.55) for two attending physicians, and 2.50 (95% CI, 2.23-2.79) for three or more attending physicians compared to a single attending physician. The number of routine laboratory tests was slightly lower on weekends (IRR 0.98, 95% CI, 0.96-0.99) and on teams without a senior resident as part of their team structure (IRR 0.89, 95% CI 0.830.96). CONCLUSIONS The associations observed in this study suggest that breaks in continuity of care, including increased frequency in patient transfer of care, may impact the utilization of routine laboratory tests.
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Affiliation(s)
- Keith Tam
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Irene W Y Ma
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada.,Ward of the 21st Century, University of Calgary, Alberta, Canada
| | - Anshula Ambasta
- Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada. .,Ward of the 21st Century, University of Calgary, Alberta, Canada.
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Lieng MK, Marcin JP, Sigal IS, Haynes SC, Dayal P, Tancredi DJ, Gausche-Hill M, Mouzoon JL, Romano PS, Rosenthal JL. Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals. J Rural Health 2022; 38:293-302. [PMID: 33734494 PMCID: PMC8489899 DOI: 10.1111/jrh.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California. METHODS Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross-sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient-level confounders. FINDINGS A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33-0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the "policies, procedures, and protocols" section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31-0.91). CONCLUSIONS Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.
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Affiliation(s)
- Monica K. Lieng
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - James P. Marcin
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Ilana S. Sigal
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Sarah C. Haynes
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Parul Dayal
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Marianne Gausche-Hill
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Jamie L. Mouzoon
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Patrick S. Romano
- Department of Pediatrics, University of California Davis, Sacramento, California
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8
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Redundant laboratory testing on referral from general practice to the outpatient clinic: a post-hoc analysis. BJGP Open 2021; 6:BJGPO.2021.0134. [PMID: 34620597 PMCID: PMC8958751 DOI: 10.3399/bjgpo.2021.0134] [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: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022] Open
Abstract
Background Inappropriately repeated laboratory testing is a commonly occurring problem. However, this has not been studied extensively in the outpatient clinic after referral by GPs. Aim The aim of this study was to investigate how often laboratory tests ordered by the GP were repeated on referral to the outpatient clinic, and how many of the normal test results remained normal on repetition. Design & setting This is a post-hoc analysis of a study on laboratory testing strategies in patients newly referred to the outpatient clinic between April 2015 and April 2017. Method All patients who had a referral letter including laboratory test results ordered by the GP were included. These results were compared with the laboratory test results ordered in the outpatient clinic. Results Data were available for 295 patients, 191 of which had post-visit testing done. In this group, 56% of tests ordered by the GP were repeated. Tests with abnormal results were repeated more frequently than tests with normal results (65% versus 53%; P<0.001). A longer test interval was associated with slightly smaller odds of tests being repeated (odds ratio [OR] 0.97, 95% confidence interval [CI] = 0.95 to 0.99; P = 0.003). Of the tests with normal test results that were repeated, 90% remained normal. This was independent of testing interval or testing strategy. Conclusion Laboratory tests ordered by the GP are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.
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Education and Visual Reminders Fail to Reduce Overuse and Waste in Interhospital Transfers to a Pediatric Intensive Care Unit. Pediatr Qual Saf 2021; 6:e464. [PMID: 34476316 PMCID: PMC8389902 DOI: 10.1097/pq9.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: As healthcare costs continue to rise, initiatives to reduce costs while maintaining high-quality care become a priority. Nonclinically indicated studies add to this cost, especially during interfacility transfers when studies are often repeated. Also, unnecessary evaluations add to nonmonetary costs such as pain, radiation exposure, and iatrogenic anemia. This study aimed to establish the frequency of redundant testing on interfacility transfers to the pediatric intensive care unit (PICU) and then implement an education-based quality improvement strategy for waste reduction. Methods: In the preintervention period (September 2018–February 2019), we collected data on patients transferred to the PICU from any outside facility. Investigators evaluated studies repeated within 6 hours and deemed them redundant or indicated. We then determined a rate of patients with redundant studies as the first aim. This result prompted an educational intervention focused on testing stewardship. Investigators then collected data in the postintervention period (July–December 2019) and compared the rate of redundant studies. Results: Study efforts identified 150 patients in the preintervention period and 131 in the postintervention period, establishing a 21%–25% frequency of redundant testing. Education and visual reminders failed to reduce this testing. Conclusion: This study established a baseline rate of redundant testing on transferred patients to the PICU. An educational intervention alone did not produce significant change.
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10
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Lapić I, Rogić D. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study. Diagnosis (Berl) 2021; 8:121-124. [PMID: 32549124 DOI: 10.1515/dx-2020-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
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11
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Brooten JK, Buckenheimer AS, Hallmark JK, Grey CR, Cline DM, Breznau CJ, McQueen TS, Harris ZJ, Welsh D, Williamson JD, Gabbard JL. Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions. West J Emerg Med 2020; 21:935-942. [PMID: 32726267 PMCID: PMC7390558 DOI: 10.5811/westjem.2020.5.46067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. Methods This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. Results We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. Conclusion The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area.
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Affiliation(s)
- Justin K Brooten
- Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina
| | - Alyssa S Buckenheimer
- Wake Forest School of Medicine, Department of Internal Medicine, Section on General Internal Medicine, Winston-Salem, North Carolina
| | - Joy K Hallmark
- University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina
| | - Carl R Grey
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina
| | - David M Cline
- Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Candace J Breznau
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina
| | - Tyler S McQueen
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina
| | - Zvi J Harris
- Wake Forest Graduate School of Arts and Science, Department of Biomedical Science, Winston-Salem, North Carolina
| | - David Welsh
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina
| | - Jennifer L Gabbard
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina
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