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Wah W, Berecki-Gisolf J, Walker-Bone K. In-hospital complications of work-related musculoskeletal injuries. Injury 2024; 55:111211. [PMID: 37984014 DOI: 10.1016/j.injury.2023.111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND, OBJECTIVES Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries. METHODS This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications. RESULTS In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events. CONCLUSION This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia.
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia; Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, 21 Alliance Ln, Clayton, Melbourne, Victoria 3168, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia
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2
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Gonnah AR, Abdelwahab M, Taylor R, Labib A, Masoud O, Debski M, Abdelaziz HK, Roberts DH. Health-related quality of life following TAVI or cardiac surgery in patients at intermediate and low risk: a systematic review and meta-analysis. Clin Med (Lond) 2023; 23:594-605. [PMID: 38065591 PMCID: PMC11046617 DOI: 10.7861/clinmed.2023-0258] [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] [Indexed: 12/18/2023]
Abstract
Recent randomised trials have shown that clinical outcomes with transcatheter aortic valve implantation (TAVI) are non-inferior to surgical aortic valve replacement (SAVR) in patients with symptomatic aortic stenosis at intermediate to low risk. Health-related quality of life (HrQoL) outcomes in these patient groups remain uncertain. A systematic search of the literature was conducted that included nine trials and 11,295 patients. Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart-failure-specific measure and EuroQol-5D (EQ-5D) (a generic health status tool) changes were the primary outcomes. New York Heart Association (NYHA) classification was the secondary outcome. Improvement in KCCQ scores was greater with TAVI (mean difference (MD)=13.56, 95% confidence interval (CI) 11.67-15.46, p<0.001) at 1 month, as was the improvement in EQ-5D (MD=0.07, 95% CI 0.05-0.08, p<0.001). There was no difference in KCCQ (MD=1.05, 95% CI -0.11 to 2.21, p=0.08) or EQ-5D (MD=-0.01, 95% CI -0.03 to 0.01), p=0.37) at 12 months. NYHA functional class 3/4 was lower in patients undergoing TAVI at 1 month (MD=0.51, 95% CI 0.34-0.78, p=0.002), but there was no difference at 12 months (MD=1.10; 95% CI 0.87-1.38, p=0.43). Overall, TAVI offers early benefit in HRQoL outcomes compared with SAVR, but they are equivalent at 12 months.
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Affiliation(s)
| | | | - Rebecca Taylor
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Aser Labib
- Southport and Ormskirk NHS Foundation Trust, Southport, UK
| | - Omar Masoud
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Maciej Debski
- University of East Anglia, Norwich, UK and research fellow, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - David Hesketh Roberts
- Lancashire Cardiac Centre, Blackpool, UK, and honorary senior lecturer, University of Liverpool, Merseyside Liverpool
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3
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Duah-Owusu White M, Vassallo M, Kelly F, Nyman S. Two factors that can increase the length of hospital stay of patients with dementia. Rev Esp Geriatr Gerontol 2022; 57:298-302. [PMID: 36411104 DOI: 10.1016/j.regg.2022.10.004] [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: 02/22/2022] [Revised: 09/02/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Patients with dementia are at greater risk of a long hospital stay and this is associated with adverse outcomes. The aim of this service evaluation was to identify variables most predictive of increased length of hospital stay amongst patients with dementia. METHODS/DESIGN We conducted a retrospective analysis on a cross-sectional hospital dataset for the period January-December 2016. Excluding length of stay less than 24h and readmissions, the sample comprised of 1133 patients who had a dementia diagnosis on record. RESULTS The highest incidence rate ratio for length of stay in the dementia sample was: (a) discharge to a care home (IRR: 2.443, 95% CI 1.778-3.357), (b) falls without harm (IRR: 2.486, 95% CI 2.029-3.045). CONCLUSIONS Based on this dataset, we conclude that improvements made to falls prevention strategies in hospitals and discharge planning procedures can help to reduce the length of stay for patients with dementia.
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Affiliation(s)
| | - Michael Vassallo
- University Hospitals Dorset NHS Foundation Trust, United Kingdom
| | | | - Samuel Nyman
- Bournemouth University Clinical Research Unit, Bournemouth University, Bournemouth, Dorset, United Kingdom
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. Benchmarking hospital safety and identifying determinants of hospital-acquired complication: the case of Queensland cardiac linkage longitudinal cohort. Infect Prev Pract 2022; 4:100198. [PMID: 35005603 PMCID: PMC8717596 DOI: 10.1016/j.infpip.2021.100198] [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: 07/06/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospital-acquired complications (HACs) are costly and associated with adverse health outcomes, although they can be avoided. Administrative linkage health data have become more accessible and can be used to monitor and reduce HAC. AIMS This study aims to use linkage administrative data to benchmark the safety performance of hospitals and estimate the feasible magnitude that HAC can be reduced. We also identify risk factors associated with HACs, and estimate the effects of HACs on adverse health outcomes and hospital costs. METHODS This is a retrospective linkage cohort study. The cohort includes 371,040 inpatient multiple-day admissions of 83,025 cardiovascular disease patients admitted to public hospitals in 2010 with follow-ups until 2015.Data envelopment analysis was applied to benchmark the patient safety performance of hospitals. Logistic regression was used to examine the odds of HAC and its effects on in-hospital mortality and 30-day readmission. Generalised linear models were used to identify the impacts of HACs on hospital costs and the length of hospital stay. FINDINGS On average, 9.3% of multiple-day hospital admissions were associated with HACs. The average HAC rate can be reduced by two percentage points if all hospitals achieve the safety record of best-practice hospitals. Old age and multiple comorbidities were major driving factors of HACs. CONCLUSIONS Cardiovascular disease patients with HAC have a higher risk of death, stay longer in hospitals and incur higher health care costs. The average HAC rates can be reduced by two percentage points by learning from best-practice hospitals operating in the same region.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
| | - Clifford Afoakwah
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, G40, Gold Coast Campus, Griffith University QLD 4222, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, 170 Kessels Rd, Nathan, QLD 4111, Australia
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Duke GJ, Moran JL, Bersten AD, Bihari S, Roodenburg O, Karnon J, Hirth S, Hakendorf P, Santamaria JD. Hospital-acquired complications: the relative importance of hospital- and patient-related factors. Med J Aust 2021; 216:242-247. [PMID: 34970736 DOI: 10.5694/mja2.51375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To quantify the prevalence of hospital-acquired complications; to determine the relative influence of patient- and hospital-related factors on complication rates. DESIGN, PARTICIPANTS Retrospective analysis of administrative data (Integrated South Australian Activity Collection; Victorian Admitted Episodes Dataset) for multiple-day acute care episodes for adults in public hospitals. SETTING Thirty-eight major public hospitals in South Australia and Victoria, 2015-2018. MAIN OUTCOME MEASURES Hospital-acquired complication rates, overall and by complication class, by hospital and hospital type (tertiary referral, major metropolitan service, major regional service); variance in rates (intra-class correlation coefficient, ICC) at the patient, hospital, and hospital type levels as surrogate measures of their influence on rates. RESULTS Of 1 558 978 public hospital episodes (10 029 918 bed-days), 151 486 included a total of 214 286 hospital-acquired complications (9.72 [95% CI, 9.67-9.77] events per 100 episodes; 2.14 [95% CI, 2.13-2.15] events per 100 bed-days). Complication rates were highest in tertiary referral hospitals (12.7 [95% CI, 12.6-12.8] events per 100 episodes) and for episodes including intensive care components (37.1 [95% CI, 36.7-37.4] events per 100 episodes). For all complication classes, inter-hospital variation was determined more by patient factors (overall ICC, 0.55; 95% CI, 0.53-0.57) than by hospital factors (ICC, 0.04; 95% CI, 0.02-0.07) or hospital type (ICC, 0.01; 95% CI, 0.001-0.03). CONCLUSIONS Hospital-acquired complications were recorded for 9.7% of hospital episodes, but patient-related factors played a greater role in determining their prevalence than the treating hospital.
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Affiliation(s)
- Graeme J Duke
- Box Hill Hospital, Melbourne, VIC.,Eastern Health Clinical School, Monash University, Melbourne, VIC
| | | | | | | | - Owen Roodenburg
- Eastern Health Clinical School, Monash University, Melbourne, VIC.,Eastern Health, Melbourne, VIC
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6
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Sauro KM, Machan M, Whalen-Browne L, Owen V, Wu G, Stelfox HT. Evolving Factors in Hospital Safety: A Systematic Review and Meta-Analysis of Hospital Adverse Events. J Patient Saf 2021; 17:e1285-e1295. [PMID: 34469915 DOI: 10.1097/pts.0000000000000889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to estimate the frequency of hospital adverse events (AEs) and explore the rate of AEs over time, and across and within hospital populations. METHODS Validated search terms were run in MEDLINE and EMBASE; gray literature and references of included studies were also searched. Studies of any design or language providing an estimate of AEs within the hospital were eligible. Studies were excluded if they only provided an estimate for a specific AE, a subgroup of hospital patients or children. Data were abstracted in duplicate using a standardized data abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis estimated the occurrence of hospital AEs, and meta-regression explored the association between hospital AEs, and patient and hospital characteristics. RESULTS A total of 45,426 unique references were identified; 1,265 full-texts were reviewed and 94 studies representing 590 million admissions from 25 countries from 1961 to 2014 were included. The incidence of hospital AEs was 8.6 per 100 patient admissions (95% confidence interval [CI], 8.3 to 8.9; I2 = 100%, P < 0.001). Half of the AEs were preventable (52.6%), and a third resulted in moderate/significant harm (39.7%). The most evaluated AEs were surgical AEs, drug-related AEs, and nosocomial infections. The occurrence of AEs increased by year (95% CI, -0.05 to -0.04; P < 0.001) and patient age (95% CI = -0.15 to -0.14; P < 0.001), and varied by country income level and study characteristics. Patient sex, hospital type, hospital service, and geographical location were not associated with AEs. CONCLUSIONS Hospital AEs are common, and reported rates are increasing in the literature. Given the increase in AEs over time, hospitals should reinvest in improving hospital safety with a focus on interventions targeted toward the more than half of AEs that are preventable.
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Affiliation(s)
| | | | | | - Victoria Owen
- Department of Community Health Sciences & O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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7
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Saikali M, Tanios A, Saab A. Evaluation of a Broad-Spectrum Partially Automated Adverse Event Surveillance System: A Potential Tool for Patient Safety Improvement in Hospitals With Limited Resources. J Patient Saf 2021; 17:e653-e664. [PMID: 29166298 DOI: 10.1097/pts.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the sensitivity and resource efficiency of a partially automated adverse event (AE) surveillance system for routine patient safety efforts in hospitals with limited resources. METHODS Twenty-eight automated triggers from the hospital information system's clinical and administrative databases identified cases that were then filtered by exclusion criteria per trigger and then reviewed by an interdisciplinary team. The system, developed and implemented using in-house resources, was applied for 45 days of surveillance, for all hospital inpatient admissions (N = 1107). Each trigger was evaluated for its positive predictive value (PPV). Furthermore, the sensitivity of the surveillance system (overall and by AE category) was estimated relative to incidence ranges in the literature. RESULTS The surveillance system identified a total of 123 AEs among 283 reviewed medical records, yielding an overall PPV of 52%. The tool showed variable levels of sensitivity across and within AE categories when compared with the literature, with a relatively low overall sensitivity estimated between 21% and 44%. Adverse events were detected in 23 of the 36 AE categories defined by an established harm classification system. Furthermore, none of the detected AEs were voluntarily reported. CONCLUSIONS The surveillance system showed variable sensitivity levels across a broad range of AE categories with an acceptable PPV, overcoming certain limitations associated with other harm detection methods. The number of cases captured was substantial, and none had been previously detected or voluntarily reported. For hospitals with limited resources, this methodology provides valuable safety information from which interventions for quality improvement can be formulated.
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Affiliation(s)
| | - Alain Tanios
- Emergency Department, Lebanese Hospital Geitaoui-University Medical Center, Beirut, Lebanon
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8
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Duke GJ, Shann F, Knott CI, Oberender F, Pilcher DV, Roodenburg O, Santamaria JD. Hospital-acquired complications in critically ill patients. CRIT CARE RESUSC 2021; 23:285-291. [PMID: 38046077 PMCID: PMC10692509 DOI: 10.51893/2021.3.oa5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. Objectives: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. Design: Retrospective observational analysis of 5-year (July 2014 - June 2019) administrative dataset abstracted from medical records. Setting: All 47 hospitals with on-site intensive care units (ICUs) in the State of Victoria. Participants: All adults (aged ≥ 18 years) stratified into planned or unplanned, surgical or medical, ICU or other ward, and by hospital peer group (tertiary referral, metropolitan, regional). Main outcome measures: HAC rates in ICU compared with ward, and mixed-effects regression estimates of the association between HAC and i) risk of clinical deterioration, and ii) admission hospital site (intraclass correlation coefficient [ICC] > 0.3). Results: 211 120 adult ICU separations with mean hospital mortality of 7.3% (95% CI, 7.2-7.4%) reported 110 132 (42.6%) HAC events (commonly, delirium, infection, arrhythmia and respiratory failure) in 62 945 records (29.8%). Higher HAC rates were reported in elective (cardiac [50.3%] and non-cardiac [40.6%]) surgical subgroups compared with emergency medical subgroup (23.9%), and in tertiary (35.4%) compared with non-tertiary (22.7%) hospitals. HAC was strongly associated with on-admission patient characteristics (P < 0.001), but was weakly associated with hospital site (ICC, 0.08; 95% CI, 0.05-0.11). Conclusions: Critically ill patients have a high burden of HAC events, which appear to be associated with patient admission characteristics. HAC may an indicator of hospital admission complexity rather than hospital-acquired complications.
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Affiliation(s)
- Graeme J. Duke
- Intensive Care Service, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
| | - Frank Shann
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
- Intensive Care Department, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Cameron I. Knott
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
- Intensive Care Department, Bendigo Health, Bendigo, VIC, Australia
- Intensive Care Department, Austin Health, Melbourne, VIC, Australia
| | - Felix Oberender
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
- Paediatric Intensive Care Department, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - David V. Pilcher
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
- Intensive Care Department, Alfred Health, Melbourne, VIC, Australia
- Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Owen Roodenburg
- Intensive Care Service, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - John D. Santamaria
- INSIGHT Committee, Critical Care Clinical Network, Safer Care Victoria, Melbourne, VIC, Australia
- Critical Care Department, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
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9
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Fernando-Canavan L, Gust A, Hsueh A, Tran-Duy A, Kirk M, Brooks P, Knight J. Measuring the economic impact of hospital-acquired complications on an acute health service. AUST HEALTH REV 2021; 45:135-142. [PMID: 33334417 DOI: 10.1071/ah20126] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
Objective This study determined the economic impact of 16 'high-priority' hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an individual Australian health service. Methods A retrospective cohort study was performed using a deidentified patient dataset containing 93056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. Results In all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracranial injury were associated with the highest additional cost (A$17173). The biggest increase in additional LOS was unplanned admissions to the intensive care unit (5.42 days). Conclusions This study shows the economic impact of HACs from the perspective of an individual health service. The methodology used demonstrates how other health services could determine safety priorities corresponding to their own casemix. What is known about the topic? HACs are a major issue in Australian health care; however, their effect on cost and LOS at the individual health service level is not well quantified. What does this paper add? Additional cost and LOS implications for 16 high-priority HACs have been quantified within an Australian health service. There is substantial variation in terms of the number of HACs and the economic impact of each HAC. What are the implications for practitioners? This study provides a template for other health services to assess the economic impact of HACs corresponding to their own casemix and to inform targeted patient safety programs.
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Affiliation(s)
- Liam Fernando-Canavan
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; ; ; and Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia. ; ; and Corresponding author.
| | - Anthony Gust
- Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia. ;
| | - Arthur Hsueh
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; ;
| | - An Tran-Duy
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; ;
| | - Michael Kirk
- Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia. ;
| | - Peter Brooks
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; ; ; and Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia. ;
| | - Josh Knight
- Centre for Health Policy, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; ;
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10
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Thu K, Nguyen HPT, Gogulan T, Cox M, Close J, Norris C, Sharma A. Care of Older People in Surgery for general surgery: a single centre experience. ANZ J Surg 2021; 91:890-895. [PMID: 33792142 DOI: 10.1111/ans.16728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Older patients undergoing emergency surgery experience higher mortality and morbidity. 'Care of Older People in Surgery' (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. METHODS The before-and-after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n = 212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28-day readmission rates. RESULTS The COPS group (n = 214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre-intervention cohort (n = 212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. CONCLUSION Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.
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Affiliation(s)
- Khin Thu
- Department of Geriatric Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | - Huong P T Nguyen
- Acute Surgical Unit, Department of General Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | | | - Michael Cox
- Acute Surgical Unit, Department of General Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Jacqueline Close
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Christina Norris
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Aged Care, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
| | - Anita Sharma
- Department of Geriatric Medicine, Nepean Hospital, Penrith, New South Wales, Australia.,Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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11
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Trentino KM, Mace H, Symons K, Sanfilippo FM, Leahy MF, Farmer SL, Watts RD, Hamdorf JM, Murray K. Associations of a Preoperative Anemia and Suboptimal Iron Stores Screening and Management Clinic in Colorectal Surgery With Hospital Cost, Reimbursement, and Length of Stay: A Net Cost Analysis. Anesth Analg 2021; 132:344-352. [PMID: 33105276 DOI: 10.1213/ane.0000000000005241] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In 2016, a preoperative clinic was implemented to screen, evaluate, and manage anemia and suboptimal iron stores at a major tertiary care medical center in Western Australia. Few studies compare the costs and reimbursements associated with preoperative anemia and suboptimal iron stores management. The objective of our study was to conduct a net cost analysis associated with the implementation of this clinic. METHODS We designed a retrospective cohort study involving elective colorectal surgical admissions over a 3-year period. The baseline year selected was the 2015-2016 financial year, with outcomes in the 2016-2017 and 2017-2018 year compared to baseline. The study perspective was the Western Australian Health System. Hospital costs were extracted from the health service clinical costing system, which captures costs at the admission level. The primary outcome was net cost, defined as gross cost minus reimbursement (or funding) received. RESULTS Our 3-year study included 544 admissions for elective colorectal surgery. After the implementation of the preoperative clinic, 73.4% (n = 257) of admissions were screened for anemia and suboptimal iron stores, and 31.4% (n = 110) received intravenous iron. In our adjusted analysis, when comparing the final year (2017-2018) with baseline (2015-2016), the units of red blood cells transfused per admission decreased 53% (142 vs 303 units per 1000 discharges; P = .006), and mean hospital length of stay decreased 15% (7.7 vs 9.1 days; P = .008). When comparing the final year with baseline, rectal resection admissions were associated with a mean decrease in the net cost of Australian dollar (A$) 7619 (95% confidence interval, 4230-11,008; P < .001) between 2015-2016 and 2017-2018. For small and large bowel procedures, there was a mean decrease of A$6744 (95% confidence interval, 2430-11,057; P = .002). CONCLUSIONS The implementation of a preoperative anemia and suboptimal iron stores screening and management clinic in elective colorectal surgery was associated with reductions in red cell transfusions, length of stay, and net costs.
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Affiliation(s)
- Kevin M Trentino
- From the School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Data and Digital Innovation, East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Hamish Mace
- From the School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Kylie Symons
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Frank M Sanfilippo
- From the School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael F Leahy
- Department of Haematology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine and Laboratory Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Shannon L Farmer
- Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia.,Medical School and Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Rory D Watts
- From the School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jeffrey M Hamdorf
- Medical School and Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- From the School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Smerdely P. Mortality is not increased with Diabetes in hospitalised very old adults: a multi-site review. BMC Geriatr 2020; 20:522. [PMID: 33272212 PMCID: PMC7712574 DOI: 10.1186/s12877-020-01913-0] [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] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient. Methods A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over 6 years (2012–2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital’s electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome. Results A total of 139,130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p < 0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p < 0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p < 0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p = 0.523). Conclusion Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.
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Affiliation(s)
- Peter Smerdely
- Department of Aged Care, St George Hospital, 3 Chapel Street, Kogarah, Sydney, NSW, 2217, Australia. .,School of Population Health, University of NSW, Sydney, Australia.
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13
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study. PLoS One 2020; 15:e0238182. [PMID: 32915808 PMCID: PMC7485849 DOI: 10.1371/journal.pone.0238182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients. Methods Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states. Results Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI. Conclusions Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
- * E-mail:
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, Clayton, Victoria, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
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14
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Al Mutairi A, Schwebius D, Al Mutair A. Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia. Int Wound J 2020; 17:1135-1141. [PMID: 32757385 DOI: 10.1111/iwj.13459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022] Open
Abstract
A tertiary public hospital in Saudi Arabia set out in 2015 to establish a team focused on reducing hospital-acquired pressure ulcers (HAPUs). The pressure ulcer prevention program (PUPP) had a multifaceted approach and data were collected for a period of 5 years. The results showed a definite reduction in the incidences of HAPUs. Many such programs show similar positive results and echo many of the same considerations of risk, prevention strategies, and the need for early intervention. However, none of the other studies either replicate the hospital's PUPP nor the extent of the positive and lasting effect of the program. Eager to determine the contributing factor(s) in order that the project success could be continued and possibly replicated in other quality improvement projects, it was decided that an examination and comparison of other similar programs and their results would be necessary in order to uncover the answer. It was determined that the in-person in-home discharge follow-up portion of the program most likely had the largest effect on the outcomes. Outcomes that were supported by the pre-work completed during the hospital portion of the PUPP towards reducing HAPUs and readmissions.
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Affiliation(s)
- Alya Al Mutairi
- Department of Mathematics, Faculty of Science, Taibah University, Medina, Saudi Arabia
| | - Deborah Schwebius
- Nursing School, MSN Aspen University, Denver, Colorado, USA.,Research Center Director, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Abbas Al Mutair
- Research Center Director, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,Nursing College, University of Wollongong, Wollongong, New South Wales, Australia.,Health Science College, University of Sharjah, Sharjah, United Arab Emirates
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15
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Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia? Adv Prev Med 2020; 2020:6875463. [PMID: 32292604 PMCID: PMC7150733 DOI: 10.1155/2020/6875463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare-associated infection is a major public health problem, in terms of mortality, morbidity, and costs. Majorities of the cause of these infections were preventable. Understanding the potential risk factors is important to reduce the impact of these avoidable infections. The study was aimed to identify factors associated with healthcare-associated infections among patients admitted at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Methods A cross-sectional study was carried out among 433 patients over a period of five months at Hiwot Fana Specialized University Hospital. Sociodemographic and clinical data were obtained from a patient admitted for 48 hours and above in the four wards (surgical, medical, obstetrics/gynecology, and pediatrics) using a structured questionnaire. A multivariate logistic regression model was applied to identify predictors of healthcare-associated infections. A p value <0.05 was considered statistically significant. Results Fifty-four (13.7%) patients had a history of a previous admission. The median length of hospital stay was 6.1 days. Forty-six (11.7%) participants reported comorbid conditions. Ninety-six (24.4%) participants underwent surgical procedures. The overall prevalence of healthcare-associated infection was 29 (7.4%, 95% CI: 5.2–10.6). Cigarette smoking (AOR: 5.18, 95% CI: 2.15–20.47), staying in the hospital for more than 4 days (AOR: 4.29, 95% CI: 2.31–6.15), and undergoing invasive procedures (AOR: 3.58, 95% CI: 1.11–7.52) increase the odds of acquiring healthcare-associated infections. Conclusion The cumulative prevalence of healthcare-associated infections in this study was comparable with similar studies conducted in developing countries. Cigarette smoking, staying in the hospital for more than 4 days, and undergoing invasive procedures increase the odds of healthcare-associated infections. These factors should be considered in the infection prevention and control program of the hospital.
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16
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Silva TPRD, Carmo ASD, Novaes TG, Mendes LL, Moreira AD, Pessoa MC, Cosenza L, Pereira JFC, Matozinhos FP. Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle. Rev Saude Publica 2019; 53:64. [PMID: 31432929 PMCID: PMC6705548 DOI: 10.11606/s1518-8787.2019053000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.
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Affiliation(s)
- Thales Philipe Rodrigues da Silva
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Ariene Silva do Carmo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Belo Horizonte, MG, Brasil
| | - Taiane Gonçalves Novaes
- Universidade Federal de Viçosa. Departamento de Nutrição. Programa de Pós-Graduação em Saúde e Nutrição de Grupos Populacionais. Viçosa, MG, Brasil
| | - Larissa Loures Mendes
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Alexandra Dias Moreira
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Milene Cristine Pessoa
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Luna Cosenza
- Instituto de Acreditação e Gestão em Saúde (IAG Saúde). Belo Horizonte, MG, Brasil
| | | | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
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Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. Complications, burden and in-hospital death among hospital treated injury patients in Victoria, Australia: a data linkage study. BMC Public Health 2019; 19:798. [PMID: 31226975 PMCID: PMC6588941 DOI: 10.1186/s12889-019-7080-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background A wide range of outcome measures can be calculated for hospital-treated injury patients. These include mortality, use of critical care services, complications, length of stay, treatment costs, readmission and nursing care after discharge. Each address different aspects and phases of injury recovery and can yield vastly different results. This study aims to: (1) measure and report this range of outcomes in hospital-treated injury patients in a defined population; and (2) describe the associations between injury characteristics, socio-demographics and comorbidities and the various outcomes. Methods A retrospective analysis was conducted of injury-related hospital admissions from July 2012 to June 2014 (152,835 patients) in Victoria, Australia. The admission records were linked within the dataset, enabling follow-up, to assess the outcomes of in-hospital death, burden, complications and 30-day readmissions. Associations between factors and outcomes were determined using univariate regression analysis. Results The proportion of patients who died in hospital was 0.9%, while 26.8% needed post-discharge care. On average patients had 2.4 complications (confidence interval (CI) 2.4–2.5) related to their initial injury, the mean cost of treating a patient was Australian dollars 7013 (CI 6929–7096) and the median length of stay was one day (inter quartile range 1–3). Intensive-care-unit-stay was recorded in 3% of the patients. All-cause 30-day readmissions occurred in 12.3%, non-planned 30-day readmissions in 7.9%, while potentially avoidable 30-day readmissions were observed in 3.2% of the patients. Increasing age was associated with all outcomes. The need for care post-discharge from hospital was highest among children and the oldest age group (85 years and over). Injury severity was associated with all adverse outcomes. Increasing number of comorbidities increased the likelihood of all outcomes. Overall, outcomes are shown to differ by age, gender, comorbidities, body region injured, injury type and injury severity, and to a lesser extent by socio-economic areas. Conclusions Outcomes and risk factors differ depending on the outcome measured, and the method used for measuring the outcome. Similar outcomes measured in different ways produces varying results. Data linkage has provided a valuable platform for a comprehensive overview of outcomes, which can help design and target secondary and tertiary preventive measures. Electronic supplementary material The online version of this article (10.1186/s12889-019-7080-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dasamal Tharanga Fernando
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia.
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Stuart Newstead
- Monash University Accident Research Centre, Monash University, Clayton Campus, 21 Alliance Lane, Clayton, Victoria, 3800, Australia
| | - Zahid Ansari
- Victorian Agency for Health Information, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia
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Suárez-Llanos JP, Rosat-Rodrigo A, García-Niebla J, Vallejo-Torres L, Delgado-Brito I, García-Bello MA, Pereyra-García-Castro F, Barrera-Gómez MA. Comparison of Clinical Outcomes in Surgical Patients Subjected to CIPA Nutrition Screening and Treatment versus Standard Care. Nutrients 2019; 11:E889. [PMID: 31010007 PMCID: PMC6520912 DOI: 10.3390/nu11040889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol (n = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; p < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group (p = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
| | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, HUNSC, 38010 Santa Cruz de Tenerife, Spain.
| | | | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain.
- Canary Islands Foundation for Health Research (FUNCANIS), 38109 Santa Cruz de Tenerife, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), 38010 Santa Cruz de Tenerife, Spain.
| | - Irina Delgado-Brito
- Canary Islands Cancer Research Institute (FICIC), 38204 Santa Cruz de Tenerife, Spain.
| | - Miguel A García-Bello
- Department of Clinical Epidemiology and Biostatistics, HUNSC; Primary Care Management, 38010 Santa Cruz de Tenerife, Spain.
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
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19
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Suárez-Llanos JP, Vallejo-Torres L, García-Bello MÁ, Hernández-Carballo C, Calderón-Ledezma EM, Rosat-Rodrigo A, Delgado-Brito I, Pereyra-García-Castro F, Benitez-Brito N, Felipe-Pérez N, Ramallo-Fariña Y, Romero-Pérez JC. Cost-effectiveness of the hospital nutrition screening tool CIPA. Arch Med Sci 2019; 16:273-281. [PMID: 32190136 PMCID: PMC7069439 DOI: 10.5114/aoms.2018.81128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool. MATERIAL AND METHODS An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively; n = 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs). RESULTS The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days; p = 0.230). On the surgical ward, more patients from the control group moved to critical care units (p = 0.014); the other clinical variables did not vary. Quality of life at discharge was similar (p = 0.53), although slightly higher in the CIPA group at 3 months (p = 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective. CONCLUSIONS The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Spain
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Miguel Ángel García-Bello
- Division of Clinical Epidemiology and Biostatistics, Research Unit, HUNSC, Primary Care Management, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | | | - Nestor Benitez-Brito
- Fundación Instituto Canario de Investigación del Cáncer, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Foundation for Health Research (FUNCANIS), Health Services Research on Chronic Patients Network (REDISSEC)
| | - Juan Carlos Romero-Pérez
- Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Triep K, Beck T, Donzé J, Endrich O. Diagnostic value and reliability of the present-on-admission indicator in different diagnosis groups: pilot study at a Swiss tertiary care center. BMC Health Serv Res 2019; 19:23. [PMID: 30626388 PMCID: PMC6327414 DOI: 10.1186/s12913-018-3858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Abstract
Background With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case’s severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. Methods We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. Results The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen’s kappa), but differed between diagnosis groups (0.558–0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group “thrombosis” SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group “decubitus ulcer” SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group “delirium” SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. Conclusions Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient’s level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient’s level. Electronic supplementary material The online version of this article (10.1186/s12913-018-3858-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Triep
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland. .,Direktion Medizin Insel Gruppe, Operatives Medizincontrolling Kodierung, University Hospital, Bern, CH-3010, Switzerland.
| | - Thomas Beck
- Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland
| | - Olga Endrich
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland
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Swierkowski P, Barnett A. Identification of hospital cost drivers using sparse group lasso. PLoS One 2018; 13:e0204300. [PMID: 30303977 PMCID: PMC6179217 DOI: 10.1371/journal.pone.0204300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2018] [Indexed: 11/20/2022] Open
Abstract
Public hospital spending consumes a large share of government expenditure in many countries. The large cost variability observed between hospitals and also between patients in the same hospital has fueled the belief that consumption of a significant portion of this funding may result in no clinical benefit to patients, thus representing waste. Accurate identification of the main hospital cost drivers and relating them quantitatively to the observed cost variability is a necessary step towards identifying and reducing waste. This study identifies prime cost drivers in a typical, mid-sized Australian hospital and classifies them as sources of cost variability that are either warranted or not warranted-and therefore contributing to waste. An essential step is dimension reduction using Principal Component Analysis to pre-process the data by separating out the low value 'noise' from otherwise valuable information. Crucially, the study then adjusts for possible co-linearity of different cost drivers by the use of the sparse group lasso technique. This ensures reliability of the findings and represents a novel and powerful approach to analysing hospital costs. Our statistical model included 32 potential cost predictors with a sample size of over 50,000 hospital admissions. The proportion of cost variability potentially not clinically warranted was estimated at 33.7%. Given the financial footprint involved, once the findings are extrapolated nationwide, this estimation has far-reaching significance for health funding policy.
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Affiliation(s)
- Piotr Swierkowski
- AusHSI – Australian Centre for Health Services Innovation, Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Sunshine Coast Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Adrian Barnett
- AusHSI – Australian Centre for Health Services Innovation, Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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22
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Barnett AG, Oldmeadow C, Attia JR. Survival studies: competing risks, immortality and censoring. Med J Aust 2018; 208:475-477. [PMID: 29902402 DOI: 10.5694/mja17.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Adrian G Barnett
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD
| | - Christopher Oldmeadow
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW
| | - John R Attia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW
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Shepheard J, Lapiz E, Read C, Jackson TJ. Reconciling hospital-acquired complications and CHADx+ in Victorian coded hospital data. HEALTH INF MANAG J 2018; 48:76-86. [PMID: 29690788 DOI: 10.1177/1833358318770282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients. OBJECTIVE To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+). METHOD Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of "adverse events" embodied in the two systems. RESULTS As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems. DISCUSSION Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification. CONCLUSION A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.
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Affiliation(s)
| | - Elsa Lapiz
- 2 Victorian Agency for Health Information, Australia
| | - Carla Read
- 2 Victorian Agency for Health Information, Australia
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24
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Bail K, Draper B, Berry H, Karmel R, Goss J. Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications. PLoS One 2018; 13:e0193319. [PMID: 29474407 PMCID: PMC5825075 DOI: 10.1371/journal.pone.0193319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 02/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. METHOD To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data. RESULTS For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001). DISCUSSION Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective. CONCLUSIONS Complications and dementia were found to cost more than other kinds of inpatient complexity.
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Affiliation(s)
- Kasia Bail
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Brian Draper
- School of Psychiatry University of New South Wales, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Helen Berry
- Professor of Climate Change and Mental Health, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rosemary Karmel
- Australian Institute of Health and Welfare, Canberra, Australia
| | - John Goss
- Health Research Institute, University of Canberra, Canberra, Australia
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25
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Blay N, Roche M, Duffield C, Xu X. Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data. J Clin Nurs 2017; 26:4927-4935. [DOI: 10.1111/jocn.13976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Nicole Blay
- Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Broadway NSW Australia
- Centre for Applied Nursing Research (CANR); Western Sydney University; Liverpool NSW Australia
| | - Michael Roche
- Mental Health, Drug and Alcohol Nursing Northern Sydney Local Health District; School of Nursing, Midwifery and Paramedicine; Australian Catholic University; North Sydney NSW Australia
| | - Christine Duffield
- Nursing and Health Services Management; Centre for Health Services Management; Faculty of Health; University of Technology Sydney; Broadway NSW Australia
- Edith Cowen University; Joondalup WA Australia
| | - Xiaoyue Xu
- Faculty of Health; University of Technology Sydney; Broadway NSW Australia
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26
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Suárez-Llanos JP, Benítez-Brito N, Vallejo-Torres L, Delgado-Brito I, Rosat-Rodrigo A, Hernández-Carballo C, Ramallo-Fariña Y, Pereyra-García-Castro F, Carlos-Romero J, Felipe-Pérez N, García-Niebla J, Calderón-Ledezma EM, González-Melián TDJ, Llorente-Gómez de Segura I, Barrera-Gómez MÁ. Clinical and cost-effectiveness analysis of early detection of patients at nutrition risk during their hospital stay through the new screening method CIPA: a study protocol. BMC Health Serv Res 2017; 17:292. [PMID: 28424063 PMCID: PMC5397674 DOI: 10.1186/s12913-017-2218-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/01/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system. METHODS The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention. DISCUSSION This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital. TRIAL REGISTRATION Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Néstor Benítez-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Laura Vallejo-Torres
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Adriá Rosat-Rodrigo
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Juan Carlos-Romero
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jennifer García-Niebla
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio Llorente-Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Manuel Ángel Barrera-Gómez
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Hauck KD, Wang S, Vincent C, Smith PC. Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals. Med Care 2017; 55:125-130. [PMID: 27753744 PMCID: PMC5266418 DOI: 10.1097/mlr.0000000000000631] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. RESULTS The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. DISCUSSION The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.
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Affiliation(s)
- Katharina D. Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London
| | | | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford
| | - Peter C. Smith
- Imperial College Business School, Imperial College London, London, UK
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28
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Sandø A, Schultz M, Eugen-Olsen J, Rasmussen LS, Køber L, Kjøller E, Jensen BN, Ravn L, Lange T, Iversen K. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial. Scand J Trauma Resusc Emerg Med 2016; 24:100. [PMID: 27491822 PMCID: PMC4974743 DOI: 10.1186/s13049-016-0290-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022] Open
Abstract
Background Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complications or deaths. Our aim is to determine whether measurement of the blood level of the biomarker soluble urokinase plasminogen activator receptor (suPAR) can enhance early risk stratification leading to reduced mortality, lower rate of complications, and improved patient flow in acutely admitted adult patients at the ED. The main hypothesis is that the availability of suPAR can reduce all-cause mortality, assessed at least 10 months after admission, by drawing attention towards patients with an unrecognized high risk, leading to improved diagnostics and treatment. Methods The study is designed as a cross-over cluster randomized interventional trial. SuPAR is measured within 2 h after admission and immediately reported to the treating physicians in the ED. All ED physicians are educated in the prognostic capabilities of suPAR prior to the inclusion period. The inclusion period began January 11th 2016 and ends June 6th 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. Discussion The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability of prognostic information can improve outcome in acutely admitted patients. This might have an impact on health care organization and decision-making. Trial registration The trial is registered at clinicaltrials.gov (ID NCT02643459, November 13, 2015) and at the Danish Data Protection agency (ID HGH-2015-042 I-Suite no. 04087).
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Affiliation(s)
- Andreas Sandø
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Martin Schultz
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.,Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Erik Kjøller
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Birgitte Nybo Jensen
- Department of Emergency Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Lisbet Ravn
- Department of Emergency Medicine, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
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Plesner LL, Iversen AKS, Langkjær S, Nielsen TL, Østervig R, Warming PE, Salam IA, Kristensen M, Schou M, Eugen-Olsen J, Forberg JL, Køber L, Rasmussen LS, Sölétormos G, Pedersen BK, Iversen K. The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department. Scand J Trauma Resusc Emerg Med 2015; 23:106. [PMID: 26626588 PMCID: PMC4667414 DOI: 10.1186/s13049-015-0184-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/12/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low-risk patients has only been sparsely examined. The broader aims of the TRIAGE study are to develop methods to identify low-risk patients appropriate for early ED discharge by combining information from a wide range of new inflammatory biomarkers and vital signs, the present baseline article aims to describe the formation of the TRIAGE database and characteristize the included patients. METHODS We included consecutive patients ≥ 17 years admitted to hospital after triage staging in the ED. Blood samples for a biobank were collected and plasma stored in a freezer (-80 °C). Triage was done by a trained nurse using the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database. RESULTS Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46-76), 49.8 % were male and median length of stay was 1 day (IQR 0-4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219 (3.6 %) died within 30 days. A higher triage acuity level was associated with numerous events, including acute surgery, endovascular intervention, i.v. treatment, cardiac arrest, stroke, admission to intensive care, hospital transfer, and mortality within 30 days (p < 0.001). CONCLUSION The TRIAGE database has been completed and includes data and blood samples from 6005 unselected consecutive hospitalized patients. More than 40 % experienced no events and were therefore potentially unnecessary hospital admissions.
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Affiliation(s)
- Louis Lind Plesner
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Anne Kristine Servais Iversen
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Sandra Langkjær
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Ture Lange Nielsen
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rebecca Østervig
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Peder Emil Warming
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Idrees Ahmad Salam
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Michael Kristensen
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Morten Schou
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - Jakob Lundager Forberg
- Emergency Department, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - György Sölétormos
- Department of Clinical Biochemistry, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Kasper Iversen
- Department of Cardiology, Endocrinology and Nephrology, North Zealand Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
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Cromarty J, Parikh S, Lim WK, Acharya S, Jackson TJ. Effects of hospital-acquired conditions on length of stay for patients with diabetes. Intern Med J 2015; 44:1109-16. [PMID: 25070621 DOI: 10.1111/imj.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inpatients with diabetes have longer length of stays (LOS). Understanding patterns of in-hospital complications between patients with diabetes and others may reveal measures to improve patient welfare and minimise LOS. AIM This study evaluates the rates and types of hospital-acquired conditions among patients with and without diabetes and assesses any effects on LOS. METHODS A total of 47 615 admission episodes from The Northern Hospital over 12 months was reviewed. Episodes were divided into four groups: (i) patients without diabetes; (ii) patients with diabetes without end-organ sequelae (EOS); (iii) patients with diabetes with EOS; and (iv) a subset of non-diabetic patients with a Charlson Co-morbidity score ≥1 (comparison group). The Classification of Hospital Acquired Diagnoses (CHADx) was applied to the groups to compare rates and types of inpatient complications. Linear regression was used to analyse the impact of the number of CHADx on LOS. RESULTS Almost 30% of admissions of patients with diabetes and EOS had at least one CHADx, compared with 13% for non-diabetes patients and 17% for the comparison group. The types of CHADx experienced by diabetes patients with EOS were similar to the comparison group. However, rates were 10 times higher. Linear regression demonstrated diabetes patients with EOS have increased LOS and each CHADx per episode has a larger effect on LOS. CONCLUSION We demonstrate that diabetes patients have consistently higher rates of CHADx and longer LOS than similar patients with complex and chronic conditions. This provides a foundation for future studies to investigate preventative practices for this high-risk patient population.
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Affiliation(s)
- J Cromarty
- The Northern Hospital, Melbourne, Victoria, Australia; Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia
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Trentino KM, Farmer SL, Swain SG, Burrows SA, Hofmann A, Ienco R, Pavey W, Daly FFS, Van Niekerk A, Webb SAR, Towler S, Leahy MF. Increased hospital costs associated with red blood cell transfusion. Transfusion 2014; 55:1082-9. [PMID: 25488623 DOI: 10.1111/trf.12958] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/26/2014] [Accepted: 10/17/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Red blood cell (RBC) transfusion is independently associated in a dose-dependent manner with increased intensive care unit stay, total hospital length of stay, and hospital-acquired complications. Since little is known of the cost of these transfusion-associated adverse outcomes our aim was to determine the total hospital cost associated with RBC transfusion and to assess any dose-dependent relationship. STUDY DESIGN AND METHODS A retrospective cohort study of all multiday acute care inpatients discharged from a five hospital health service in Western Australia between July 2011 and June 2012 was conducted. Main outcome measures were incidence of RBC transfusion and mean inpatient hospital costs. RESULTS Of 89,996 multiday, acute care inpatient discharges, 4805 (5.3%) were transfused at least 1 unit of RBCs. After potential confounders were adjusted for, the mean inpatient cost was 1.83 times higher in the transfused group compared with the nontransfused group (95% confidence interval, 1.78-1.89; p < 0.001). The estimated total hospital-associated cost of RBC transfusion in this study was AUD $77 million (US $72 million), representing 7.8% of total hospital expenditure on acute care inpatients. There was a significant dose-dependent association between the number of RBC units transfused and increased costs after adjusting for confounders. CONCLUSION RBC transfusions were independently associated with significantly higher hospital costs. The financial implication to hospital budgets will assist in prioritizing areas to reduce the rate of RBC transfusions and in implementing patient blood management programs.
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Affiliation(s)
- Kevin M Trentino
- Performance Unit, South Metropolitan Health Service, Perth, Western Australia
| | - Shannon L Farmer
- School of Surgery, University of Western Australia, Perth, Western Australia.,Centre for Population Health Research, Curtin University, Perth, Western Australia
| | - Stuart G Swain
- Performance Unit, South Metropolitan Health Service, Perth, Western Australia
| | - Sally A Burrows
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
| | - Axel Hofmann
- School of Surgery, University of Western Australia, Perth, Western Australia.,Centre for Population Health Research, Curtin University, Perth, Western Australia
| | - Rinaldo Ienco
- Performance Unit, South Metropolitan Health Service, Perth, Western Australia
| | - Warren Pavey
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia
| | - Frank F S Daly
- Royal Perth Group, South Metropolitan Health Service, Perth, Western Australia.,Center for Clinical Research in Emergency Medicine, University of Western Australia, Perth, Western Australia
| | - Anton Van Niekerk
- Department of Anaesthesiology, Fremantle Hospital, Fremantle, Western Australia
| | - Steven A R Webb
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Simon Towler
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia.,Service 4, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michael F Leahy
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.,Department of Haematology, PathWest, Fremantle Hospital, Fremantle, Western Australia
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Board N. Patient safety in hospitals - can we measure it? Med J Aust 2013; 199:521-2. [PMID: 24138366 DOI: 10.5694/mja13.10626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/18/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Neville Board
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia.
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