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The prediction of hospital length of stay using unstructured data. BMC Med Inform Decis Mak 2021; 21:351. [PMID: 34922532 PMCID: PMC8684269 DOI: 10.1186/s12911-021-01722-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to assess the performance improvement for machine learning-based hospital length of stay (LOS) predictions when clinical signs written in text are accounted for and compared to the traditional approach of solely considering structured information such as age, gender and major ICD diagnosis.
Methods This study was an observational retrospective cohort study and analyzed patient stays admitted between 1 January to 24 September 2019. For each stay, a patient was admitted through the Emergency Department (ED) and stayed for more than two days in the subsequent service. LOS was predicted using two random forest models. The first included unstructured text extracted from electronic health records (EHRs). A word-embedding algorithm based on UMLS terminology with exact matching restricted to patient-centric affirmation sentences was used to assess the EHR data. The second model was primarily based on structured data in the form of diagnoses coded from the International Classification of Disease 10th Edition (ICD-10) and triage codes (CCMU/GEMSA classifications). Variables common to both models were: age, gender, zip/postal code, LOS in the ED, recent visit flag, assigned patient ward after the ED stay and short-term ED activity. Models were trained on 80% of data and performance was evaluated by accuracy on the remaining 20% test data.
Results The model using unstructured data had a 75.0% accuracy compared to 74.1% for the model containing structured data. The two models produced a similar prediction in 86.6% of cases. In a secondary analysis restricted to intensive care patients, the accuracy of both models was also similar (76.3% vs 75.0%).
Conclusions LOS prediction using unstructured data had similar accuracy to using structured data and can be considered of use to accurately model LOS. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01722-4.
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Cirillo W, Freitas LRC, Kitaka EL, Matos-Souza JR, Silva MR, Coelho OR, Coelho-Filho OR, Sposito AC, Nadruz W. Impact of emergency short-stay unit opening on in-hospital global and cardiology indicators. J Eval Clin Pract 2021; 27:1262-1270. [PMID: 33421284 DOI: 10.1111/jep.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Emergency short-stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in-hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in-hospital indicators at a whole general hospital and at its cardiology division (CARD). METHODS We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in-hospital indicators at the hospital and CARD before (2007-2011) and after (2011-2018) SSU opening. RESULTS After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P < .001) and in-hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P < .001) and CARD (50 [12] vs 54 [12], P = .004). In parallel, monthly in-hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P = .019), but not at the hospital (712 [73] vs 700 [104], P = .54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P < .001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P = .002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward. CONCLUSIONS SSU opening improved ED crowding, but was associated with changes in in-hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in-hospital cardiology services may need re-evaluation following SSU opening at a general hospital.
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Affiliation(s)
- Willian Cirillo
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Lidia R C Freitas
- Division of Informatics, Clinics Hospital, State University of Campinas, Campinas, Brazil
| | - Edson L Kitaka
- Division of Informatics, Clinics Hospital, State University of Campinas, Campinas, Brazil
| | - José R Matos-Souza
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Marcos R Silva
- Emergency Division, Clinics Hospital, State University of Campinas, Campinas, Brazil
| | - Otávio R Coelho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Otávio R Coelho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Andrei C Sposito
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, Brazil
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Prevalence and Clinical Characteristics of Patients With Sepsis Discharge Diagnosis Codes and Short Lengths of Stay in U.S. Hospitals. Crit Care Explor 2021; 3:e0373. [PMID: 33786449 PMCID: PMC7994044 DOI: 10.1097/cce.0000000000000373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: Some patients diagnosed with sepsis have very brief hospitalizations. Understanding the prevalence and clinical characteristics of these patients may provide insight into how sepsis diagnoses are being applied as well as the breadth of illnesses encompassed by current sepsis definitions. Design: Retrospective observational study. Setting: One-hundred ten U.S. hospitals in the Cerner HealthFacts dataset (primary cohort) and four hospitals in Eastern Massachusetts (secondary cohort used for detailed medical record reviews). Patients: Adults hospitalized from April 2016 to December 2017. Interventions: None. Measurements and Main Results: We identified hospitalizations with International Classification of Diseases, 10th Edition codes for sepsis (including sepsis, septicemia, severe sepsis, and septic shock) and compared “short stay sepsis” patients (defined as discharge alive within 3 d) versus nonshort stay sepsis patients using detailed electronic health record data. In the Cerner cohort, 67,733 patients had sepsis discharge diagnosis codes, including 6,918 (10.2%) with short stays. Compared with nonshort stay sepsis patients, short stay patients were younger (median age 60 vs 67 yr) and had fewer comorbidities (median Elixhauser score 5 vs 13), lower rates of positive blood cultures (8.2% vs 24.1%), lower rates of ICU admission (6.2% vs 31.6%), and less frequently had severe sepsis/septic shock codes (13.5% vs 36.6%). Almost all short stay and nonshort stay sepsis patients met systemic inflammatory response syndrome criteria at admission (84.5% and 87.5%, respectively); 47.2% of those with short stays had Sequential Organ Failure Assessment scores of 2 or greater at admission versus 73.2% of those with longer stays. Findings were similar in the secondary four-hospital cohort. Medical record reviews demonstrated that physicians commonly diagnosed sepsis based on the presence of systemic inflammatory response syndrome criteria, elevated lactates, or positive blood cultures without concurrent organ dysfunction. Conclusions: In this large U.S. cohort, one in 10 patients coded for sepsis were discharged alive within 3 days. Although most short stay patients met systemic inflammatory response syndrome criteria, they met Sepsis-3 criteria less than half the time. Our findings underscore the incomplete uptake of Sepsis-3 definitions, the breadth of illness severities encompassed by both traditional and new sepsis definitions, and the possibility that some patients with sepsis recover very rapidly.
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Verma AA, Guo Y, Kwan JL, Lapointe-Shaw L, Rawal S, Tang T, Weinerman A, Razak F. Characteristics of short general internal medicine hospital stays: a multicentre cross-sectional study. CMAJ Open 2019; 7:E47-E54. [PMID: 30692151 PMCID: PMC6349563 DOI: 10.9778/cmajo.20180181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Short hospital stays may represent opportunities to avert unnecessary admissions or expedite inpatient care. To inform the design of interventions that target patients with potentially avoidable hospital admissions or brief stays, we examined the patient, physician and situational characteristics associated with short stays among patients admitted to general internal medicine wards and describe the use of hospital resources by these patients. METHODS This was a multicentre cross-sectional study conducted between Apr. 1, 2012, and Mar. 31, 2015, at 5 teaching hospitals in Toronto. We included all general internal medicine admissions through the emergency department. We examined patient, physician and situational predictors of a short hospital stay, which was defined as the patient's being discharged home alive in 2 possible time windows: less than 24 hours, or 72 hours or less. RESULTS The final study sample included 56 055 admissions and 37 700 unique patients. Patients discharged in less than 24 hours and in 72 hours or less accounted for 4245 (7.6%) and 13 442 (31.6%) admissions, respectively. After we controlled for patient factors, patients of female physicians were less likely than those of male physicians to have stays lasting less than 24 hours (adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86) or 72 hours or less (adjusted OR 0.82, 95% CI 0.79-0.86). Patients admitted at night or on a weekday were significantly more likely than those admitted at other times to have stays lasting less than 24 hours (night: adjusted OR 2.73, 95% CI 2.44-3.06; weekday: adjusted OR 1.26, 95% CI 1.17-1.36) or 72 hours or less (night: adjusted OR 1.29, 95% CI 1.22-1.37, weekday: adjusted OR 1.05, 95% CI 1.01-1.10). Among stays lasting less than 24 hours and 24-72 hours, intravenously administered medications were ordered for 2788 (65.7%) and 10 722 (79.8%) patients, respectively, and computed tomography scans were performed for 1561 (36.8%) and 5354 (39.1%) patients, respectively. INTERPRETATION Short general internal medicine hospital stays were common and were associated with patient, physician and situational factors. Interventions to avert hospital admission or reduce length of stay may be more effective if they are accessible outside typical working hours and provide access to intravenous therapy and radiological investigations.
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Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass.
| | - Yishan Guo
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Janice L Kwan
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Lauren Lapointe-Shaw
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Shail Rawal
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Terence Tang
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Adina Weinerman
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
| | - Fahad Razak
- Li Ka Shing Knowledge Institute (Verma, Guo, Razak), St. Michael's Hospital; Department of Medicine (Verma, Kwan, Lapointe-Shaw, Rawal, Tang, Weinerman, Razak) and Institute of Health Policy, Management and Evaluation (Razak), University of Toronto; Department of Medicine (Kwan), Mount Sinai Hospital; Division of General Internal Medicine (Rawal), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Sunnybrook Health Sciences Centre (Weinerman), Toronto, Ont.; Harvard Center for Population and Development Studies (Razak), Cambridge, Mass
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5
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Emerging Trends in Health Care Costs and Reimbursement for Heart Failure. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Bryant PA, Hopper SM. Alternatives to ward admission from the emergency department. J Paediatr Child Health 2016; 52:237-40. [PMID: 27062630 DOI: 10.1111/jpc.13100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Abstract
There is ever-increasing pressure on hospital resources in general and emergency departments (ED) in particular. At the same time, there is increasing recognition that traditional inpatient ward-based care is not necessary for the majority of children presenting to the ED with acute illness, and that there are patient, family and hospital benefits to pursuing other options. Here, we describe alternative pathways for children presenting to the ED, including short stay and observational medicine, hospital-in-the-home and non-admission enhanced care, in other words, additional management practices or pathways for children who are discharged from the ED. We discuss the principles, models and practical considerations involved in each of these.
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Affiliation(s)
- Penelope A Bryant
- Departments of General Medicine and, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,RCH@Home, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute.,Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute
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7
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Nguyen MT, Woodman RJ, Hakendorf P, Thompson CH, Faunt J. Can the simple clinical score usefully predict the mortality risk and length of stay for a recently admitted patient? AUST HEALTH REV 2015; 39:522-527. [PMID: 25817909 DOI: 10.1071/ah14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the present study was to determine whether an aggregate simple clinical score (SCS) has a role in predicting the imminent mortality and in-hospital length of stay (LOS) of newly admitted, acutely unwell General Medical in-patients. METHODS Data were collected prospectively from adult patients admitted through an Acute Medical Unit between February and August 2013. Using logistic regression analysis before and after adjustment for age, the SCS was assessed for its association with LOS and mortality, including 30-day mortality, just for those patients for full resuscitation. Changes in sensitivity and specificity after adding SCS to age as a predictor, as well as the change in the net reclassification index, were determined using the predicted probabilities from the logistic regression models. RESULTS The SCS was superior to age in predicting mortality of any patient within 30 days. It did not assist in predicting 30-day mortality for those patients who were for full resuscitation. The ability of the SCS to predict long stay (> 72h) remained relatively low (64%) and was inferior to published rates achieved by bedside clinician assessment (74%-82%). CONCLUSION There was no useful prospective role for the SCS in predicting LOS and mortality of in-patients newly admitted to a General Medicine service.
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Affiliation(s)
- Minh T Nguyen
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia. Email
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia. Email
| | - Paul Hakendorf
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia. Email
| | - Campbell H Thompson
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia. Email
| | - Jeff Faunt
- Department of General Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email
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8
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Galipeau J, Pussegoda K, Stevens A, Brehaut JC, Curran J, Forster AJ, Tierney M, Kwok ESH, Worthington JR, Campbell SG, Moher D. Effectiveness and safety of short-stay units in the emergency department: a systematic review. Acad Emerg Med 2015. [PMID: 26201285 DOI: 10.1111/acem.12730] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Overcrowding is a serious and ongoing challenge in Canadian hospital emergency departments (EDs) that has been shown to have negative consequences for patient outcomes. The American College of Emergency Physicians recommends observation/short-stay units as a possible solution to alleviate this problem. However, the most recent systematic review assessing short-stay units shows that there is limited synthesized evidence to support this recommendation; it is over a decade old and has important methodologic limitations. The aim of this study was to conduct a more methodologically rigorous systematic review to update the evidence on the effectiveness and safety of short-stay units, compared with usual care, on hospital and patient outcomes. METHODS A literature search was conducted using MEDLINE, the Cochrane Library, Embase, ABI/INFOM, and EconLit databases and gray literature sources. Randomized controlled trials of ED short-stay units (stay of 72 hours or less) were compared with usual care (i.e., not provided in a short-stay unit), for adult patients. Risk-of-bias assessments were conducted. Important decision-making (gradable) outcomes were patient outcomes, quality of care, utilization of and access to services, resource use, health system-related outcomes, economic outcomes, and adverse events. RESULTS Ten reports of five studies were included, all of which compared short-stay units with inpatient care. Studies had small sample sizes and were collectively at a moderate risk of bias. Most outcomes were only reported by one study and the remaining outcomes were reported by two to four studies. No deaths were reported. Three of the four included studies reporting length of stay found a significant reduction among short-stay unit patients, and one of the two studies reporting readmission rates found a significantly lower rate for short-stay unit patients. All four economic evaluations indicated that short-stay units were a cost-saving intervention compared to inpatient care from both hospital and health care system perspectives. Results were mixed for outcomes related to quality of care and patient satisfaction. CONCLUSIONS Insufficient evidence exists to make conclusions regarding the effectiveness and safety of short-stay units, compared with inpatient care.
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Affiliation(s)
- James Galipeau
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | | | | | - Jamie C. Brehaut
- The Faculty of Medicine; University of Ottawa; Ottawa Ontario Canada
| | | | - Alan J. Forster
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- The Faculty of Medicine; University of Ottawa; Ottawa Ontario Canada
| | | | - Edmund S. H. Kwok
- The Faculty of Medicine; University of Ottawa; Ottawa Ontario Canada
- The Ottawa Hospital; Ottawa Ontario Canada
| | | | | | - David Moher
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- The Faculty of Medicine; University of Ottawa; Ottawa Ontario Canada
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Collins S, Storrow AB, Albert NM, Butler J, Ezekowitz J, Felker GM, Fermann GJ, Fonarow GC, Givertz MM, Hiestand B, Hollander JE, Lanfear DE, Levy PD, Pang PS, Peacock WF, Sawyer DB, Teerlink JR, Lenihan DJ. Early management of patients with acute heart failure: state of the art and future directions. A consensus document from the society for academic emergency medicine/heart failure society of America acute heart failure working group. J Card Fail 2015; 21:27-43. [PMID: 25042620 PMCID: PMC4276508 DOI: 10.1016/j.cardfail.2014.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/28/2014] [Accepted: 07/10/2014] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition decisions cannot be underestimated. Predictive instruments that identify a cohort of patients safe for ED discharge, while simultaneously addressing barriers to successful outpatient management, have the potential to significantly impact quality of life and resource expenditures.
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Affiliation(s)
- Sean Collins
- Nashville Veterans Affairs Medical Center and Vanderbilt University, Nashville, Tennessee.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter S Pang
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - John R Teerlink
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California
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10
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Collins SP, Storrow AB, Levy PD, Albert N, Butler J, Ezekowitz JA, Michael Felker G, Fermann GJ, Fonarow GC, Givertz MM, Hiestand B, Hollander JE, Lanfear DE, Pang PS, Frank Peacock W, Sawyer DB, Teerlink JR, Lenihan DJ. Early management of patients with acute heart failure: state of the art and future directions--a consensus document from the SAEM/HFSA acute heart failure working group. Acad Emerg Med 2015; 22:94-112. [PMID: 25423908 DOI: 10.1111/acem.12538] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 08/24/2014] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) afflicts nearly 6 million Americans, resulting in 1 million emergency department (ED) visits and over 1 million annual hospital discharges. The majority of inpatient admissions originate in the ED; thus, it is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics, and alternatives to hospitalization. This article discusses contemporary ED management as well as the necessary next steps for ED-based acute HF research.
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Affiliation(s)
- Sean P. Collins
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - Alan B. Storrow
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - Phillip D. Levy
- The Department of Emergency Medicine; Wayne State University; Detroit MI
| | - Nancy Albert
- The Division of Cardiology; Cleveland Clinic; Cleveland OH
| | - Javed Butler
- The Division of Cardiology; Emory University; Atlanta GA
| | | | | | - Gregory J. Fermann
- The Department of Emergency Medicine; University of Cincinnati; Cincinnati OH
| | - Gregg C. Fonarow
- The Division of Cardiology; Ronald Reagan-UCLA Medical Center; Los Angeles CA
| | | | - Brian Hiestand
- The Department of Emergency Medicine; Wake Forest University; Winston-Salem NC
| | - Judd E. Hollander
- The Department of Emergency Medicine; Thomas Jefferson University; Philadelphia PA
| | | | - Peter S. Pang
- The Department of Emergency Medicine; Northwestern University; Chicago IL
| | - W. Frank Peacock
- The Department of Emergency Medicine; Baylor University; Houston TX
| | - Douglas B. Sawyer
- The Department of Emergency Medicine; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
| | - John R. Teerlink
- The Division of Cardiology; San Francisco Veterans Affairs Medical Center; University of California at San Francisco; San Francisco CA
| | - Daniel J. Lenihan
- The Division of Cardiology; Vanderbilt University; Nashville Veterans Affairs Medical Center; Nashville TN
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11
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Powter L, Beale A, Probert B, Dhanda A. Development and validation of a tool to select patients for admission to medical short stay units. Clin Med (Lond) 2014; 14:371-5. [PMID: 25099837 PMCID: PMC4952829 DOI: 10.7861/clinmedicine.14-4-371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Medical short stay units help to increase patient flow and decrease length of stay, but selecting appropriate patients for admission to such units is difficult. The selection tool used in our unit was effective but cumbersome to apply. We collected prospective data on 297 unselected emergency medical admissions and developed a new scoring system based on four key variables using regression analysis. The model predicted a length of stay of <72 h with an area under the receiver operating characteristic curve of 0.68. The model was then used to select patients for admission to the short stay unit in our trust. Length of stay on the short stay unit had decreased by an average of 2.73 days with our original selection tool, but remained unchanged at an average of 3.02 days using the new simpler tool (p > 0.05). This model could now be adopted by other units.
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Affiliation(s)
- Louise Powter
- Department of Acute Medicine, Southmead Hospital, Bristol, UK
| | | | | | - Ashwin Dhanda
- Bristol Royal Infirmary, Bristol, UK and University of Bristol, Bristol, UK
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12
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Russell PT, Hakendorf P, Thompson CH. A general medical short-stay unit is not more efficient than a traditional model of care. Med J Aust 2014; 200:482-4. [PMID: 24794612 DOI: 10.5694/mja13.10739] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the efficiency of a short-stay unit (SSU) for undifferentiated medical patients and evaluate its effect on the overall efficiency of a general medicine department. DESIGN, SETTING AND PATIENTS Retrospective study of all general medical patients admitted to the SSU at Flinders Medical Centre, South Australia, during its 5 years of operation (2005-2009), compared with 4 years before its institution and 2 years after its closure. MAIN OUTCOME MEASURES Relative stay index (RSI); inhospital mortality; readmissions within 7 and 28 days. RESULTS 23 790 general medical patients were admitted overall, and 10 764 of these (45.2%) were admitted to the SSU. The RSI for the SSU during its years of operation was 0.79, compared with 1.34 for the long-stay unit. The overall RSI for the department did not improve during those years and was not significantly different to the periods before or after. CONCLUSIONS We found no evidence that an SSU for undifferentiated medical patients creates bed capacity. It does, however, appear to be safe.
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Vrabec S, Oltmann SC, Clark N, Chen H, Sippel RS. A short-stay unit for thyroidectomy patients increases discharge efficiency. J Surg Res 2013; 184:204-8. [PMID: 23688791 DOI: 10.1016/j.jss.2013.04.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/04/2013] [Accepted: 04/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. METHODS A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. RESULTS A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). CONCLUSIONS A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow.
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Affiliation(s)
- Sara Vrabec
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792-7375, USA
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Bosch X, Jordán A, López-Soto A. Quick diagnosis units: avoiding referrals from primary care to the ED and hospitalizations. Am J Emerg Med 2013; 31:114-23. [DOI: 10.1016/j.ajem.2012.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/15/2012] [Accepted: 06/16/2012] [Indexed: 01/10/2023] Open
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Chadaga SR, Maher MP, Maller N, Mancini D, Mascolo M, Sharma S, Anderson ML, Chu ES. Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies. J Hosp Med 2012; 7:649-54. [PMID: 22791678 DOI: 10.1002/jhm.1951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 05/01/2012] [Accepted: 05/06/2012] [Indexed: 11/09/2022]
Abstract
Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow.
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Affiliation(s)
- Smitha R Chadaga
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado 80204-4507, USA.
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16
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Serafini F, Bonanni L, Zancanaro A, Fricano G, Giannoccaro M, Zulian E, Dalla Vestra M, Atanasio P, Conton P, De Riva C, Fantin G, Presotto F. Area di Accoglimento e Degenza Breve (ADB): parte integrante di un reparto di Medicina Interna organizzato per intensità di cure. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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17
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Chu ES, Gaudiani JL, Mascolo M, Statland B, Sabel A, Carroll K, Mehler PS. ACUTE center for eating disorders. J Hosp Med 2012; 7:340-4. [PMID: 22271490 DOI: 10.1002/jhm.1906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/17/2011] [Accepted: 11/27/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs. METHODS We developed the ACUTE Center at Denver Health Medical Center to medically stabilize adults with the medical complications of severe malnutrition due to an eating disorder. The first 2 years of patient characteristics and outcomes are reported. RESULTS From October 2008 through December 2010, the ACUTE unit had 76 admissions of which 62 were for medical stabilization, comprising 54 patients. Eighty-nine percent of patients were female. The mean age was 27 years old (range 17-65). The mean body mass index on admission was 12.9 kg/m(2) (standard deviation [SD] 2.0). At admission, patients were hyponatremic, anemic, and leukopenic, with low bone density, but had normal albumin levels. The mean body mass index on discharge was 13.1 ± 1.9 kg/m(2). Median length of stay was 16 days (interquartile range [IQR] 9-29 days). Eighteen percent were discharged to home and eighty-two percent were discharged to inpatient psychiatric eating disorder units. Inpatient mortality was zero. DISCUSSION Patients with this degree of severe malnutrition due to eating disorders are medically complex and relatively uncommon. Regionalized subspecialty centers of excellence, in which a multidisciplinary team is led by practitioners of hospital medicine who have developed expertise in a rare condition, may improve clinical outcomes, optimize healthcare resources, and provide unique professional and academic opportunities for the clinicians involved.
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Affiliation(s)
- Eugene S Chu
- Division of Hospital Medicine, Department of Medicine, Boulder Community Hospital, Denver, Colorado, USA
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18
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Bosch X, Jordán A, Coca A, López-Soto A. Quick diagnosis units versus hospitalization for the diagnosis of potentially severe diseases in Spain. J Hosp Med 2012; 7:41-7. [PMID: 22135217 DOI: 10.1002/jhm.931] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/20/2011] [Accepted: 03/21/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We describe the functioning of a quick diagnosis unit (QDU) in a Spanish public university hospital to ascertain the utility and cost of the model compared to conventional hospitalization. DESIGN Observational study with a prospective and retrospective cohort. SETTING Spanish tertiary public university hospital. PATIENTS Two thousand consecutive patients evaluated between December 2007 and July 2010 with potentially severe diseases normally requiring hospitalization for diagnosis. For comparative purposes, we analyzed a randomized, retrospective cohort of 1454 hospitalized patients. MEASUREMENTS Variables measured included source of referral, reason for consultation, time to diagnosis and length-of-stay, hospitalizations avoided, Charlson comorbidity index, costs, and patient satisfaction using a telephone survey. RESULTS Suspected anemia, cachexia-anorexia syndrome, febrile syndrome, adenopathies and/or palpable masses, abdominal pain, diarrhea, and lung abnormalities accounted for 88% of QDU patients. The most-frequent diagnoses were cancer (26.3%) and iron-deficiency anemia. QDU patients with anemia were significantly younger than hospitalized patients with the same diagnosis (P < 0.0001). Other parameters were similar between QDU and hospitalized patients. The mean cost of treatment was 3153.87 Euros for hospitalization and 702.33 Euros for the QDU. Patients expressed a high degree of satisfaction with QDU care. CONCLUSIONS QDUs can manage the diagnosis of patients with potentially severe diseases equally as well as traditional hospitalization, and saves costs. QDU patients expressed a high degree of satisfaction, with most preferring this model to hospitalization.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Lucas BP, Candotti C, Margeta B, Mba B, Kumapley R, Asmar A, Franco-Sadud R, Baru J, Acob C, Borkowsky S, Evans AT. Hand-carried echocardiography by hospitalists: a randomized trial. Am J Med 2011; 124:766-74. [PMID: 21663885 DOI: 10.1016/j.amjmed.2011.03.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/03/2011] [Accepted: 03/09/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse. METHODS We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography. RESULTS The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, -12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P=.0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography. CONCLUSION Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, IL, USA.
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Yong TY, Li JYZ, Roberts S, Hakendorf P, Ben-Tovim DI, Thompson CH. The selection of acute medical admissions for a short-stay unit. Intern Emerg Med 2011; 6:321-7. [PMID: 21161437 DOI: 10.1007/s11739-010-0490-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
Objective of this study is to evaluate the selection of patients to be admitted to a hospital medical short-stay unit (SSU) where acute medical admissions with a predicted length of stay of between 24 and 72 h are managed. This is a retrospective observational study evaluating outcomes of all admissions to the medical SSU between January 2005 and December 2008. Factors that influence inappropriate allocation of patients to the SSU or alternative longer stay medical units were evaluated. Length of stay (LOS), mortality, Charlson score, admission to intensive care unit (ICU) (from the SSU), discharge diagnosis, and 7-day readmission rate were analysed. Over 4 years, 45% of the general medical inpatient take, 9,125 admission episodes, were managed by the medical SSU. On an average, 72% of these admissions to the SSU stayed fewer than 72 h. After excluding in-hospital deaths, there were 8,381 admissions to the general medical unit discharged within 72 h, and 77% of these were managed by the SSU during the study period. Inappropriate admissions to the SSU (LOS more than 72 h) tended to be older patients with more complex medical comorbidities. Other factors contributing to prolonged stay in the SSU included weekend admissions, and transfers to the ICU. The 7-day readmission rate was low at 3%; the all-cause hospital mortality for patients admitted to the medical SSU was 2% despite a 32% increase in workload in the medical SSU over these 4 years. In the context of fixed resources and a steeply increasing patient workload, a large proportion of general medical patients can be managed in a medical SSU with the majority being discharged home within 72 h while keeping all-cause in-hospital mortality and readmission rates low. More accurate identification of appropriate patients on admission by using a physiological clinical score and addressing operational issues particularly on weekends could lead to a more efficient SSU.
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Affiliation(s)
- Tuck Y Yong
- Department of General Medicine, Flinders Medical Centre and Flinders University, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
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Bosch X, Foix A, Jordan A, Coca A, López-Soto A. Outpatient Quick Diagnosis Units for the evaluation of suspected severe diseases: an observational, descriptive study. Clinics (Sao Paulo) 2011; 66:737-41. [PMID: 21789373 PMCID: PMC3109368 DOI: 10.1590/s1807-59322011000500005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/02/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN Observational, descriptive study. METHODS Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, Institut d'Investigacio Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Lucas BP, Candotti C, Margeta B, Evans AT, Mba B, Baru J, Asbury JK, Asmar A, Kumapley R, Patel M, Borkowsky S, Fung S, Charles-Damte M. Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program. J Hosp Med 2009; 4:340-9. [PMID: 19670355 DOI: 10.1002/jhm.438] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain. OBJECTIVE To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program. DESIGN Prospective cohort study. SETTING Large public teaching hospital. PATIENTS A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007. INTERVENTION Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE. MEASUREMENTS Diagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC). RESULTS A total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5-fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2-fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments. CONCLUSIONS The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA.
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