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Low D, Rutherford S. Investigating the weekend effect in decompressive thoracolumbar hemilaminectomy for acute intervertebral disc extrusion: An observational cohort study of 460 cases (2018-2023). Vet Surg 2024. [PMID: 38556784 DOI: 10.1111/vsu.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/24/2024] [Accepted: 03/03/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To investigate if weekend surgery is associated with poorer outcomes in dogs with acute thoracolumbar intervertebral disc extrusion (IVDE) undergoing decompressive thoracolumbar hemilaminectomy. STUDY DESIGN Retrospective observational cohort study. SAMPLE POPULATION A total of 460 consecutive cases were reviewed, with 401 dogs undergoing weekday surgery (Cohort WD), and 59 dogs undergoing weekend surgery (Cohort WE). METHODS Medical records of a surgical referral center in the UK were reviewed. Preoperative patient demographic and clinical data, and postoperative outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis was used to model the odds of a negative outcome. RESULTS Cohort WE had a higher preoperative proportion of nonambulatory dogs (p = .0115) but there were no significant differences between the nonambulatory (p = .3762) and deep-pain negative subgroups (p = .6199). Cohort WE had a higher risk of not recovering ambulation compared to Cohort WD [79.2% vs. 91.6% recovery; adjusted OR 3.010 (95% CI: 1.259-7.190); p = .0132] and had a higher risk of postoperative morbidity [32.2% vs. 17.2%; adjusted OR 2.015 (95% CI: 1.089-3.729); p = .0257]. There were no significant differences in other outcome measures between cohorts. CONCLUSION Weekend surgery in canine decompressive thoracolumbar hemilaminectomy may be associated with poorer patient outcomes, specifically higher postoperative morbidity and a poorer rate of recovery of ambulation. CLINICAL SIGNIFICANCE This study demonstrates a weekend effect in veterinary surgery, which may be important in surgical decision-making in acute thoracolumbar IVDE. Further scrutiny of the patient's journey through the veterinary healthcare system is warranted.
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Affiliation(s)
- Daniel Low
- Frank. Pet Surgeons., IVC Evidensia, Leeds, UK
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Baig MFA. Analysis of the Weekend Effect on Mortality, Diagnostic Coronary Angiography, and Percutaneous Coronary Intervention in Acute Myocardial Infarction Across Rural US Hospitals. Cureus 2024; 16:e53751. [PMID: 38465191 PMCID: PMC10921120 DOI: 10.7759/cureus.53751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Rural hospitals face several unique challenges in delivering healthcare to an underserved population. Achieving time-sensitive goals in a resource-scarce facility is often a difficult task without the right team at hand. Resources are further depleted on the weekends, exposing understaffed hospitals to poorer outcomes. Acute myocardial infarction (AMI) mortality depends on timely diagnosis and intervention. It is unknown to what extent resource shortages impact rural hospitals during weekends and how they affect AMI mortality. METHODS This cross-sectional study was performed on patients admitted on weekends with AMI using the National Inpatient Sample (NIS) 2019. Patients with type II non-ST-elevation myocardial infarction (NSTEMI) and missing information were excluded. The rates and timing of in-hospital diagnostic coronary angiograms, PCIs (percutaneous coronary interventions), and in-hospital mortality were studied. Regression models were used for data analyses. RESULTS A total of 161,625 patients met the inclusion criteria (58,690 females (36%), 114,830 Caucasians (71%), 17,910 African American (11%), 13,920 Hispanic (8.6%); mean (SD) age, 66.5 (0.5) years), including 47,665 (29.5%) ST-elevation myocardial infarction (STEMI) and 113,960 (70.5%) NSTEMI. Patients admitted to rural hospitals were less likely to undergo diagnostic coronary angiogram (adjusted odds ratio (aOR), 0.69; CI, 0.57-0.83; p<0.001) and PCI (aOR, 0.83; CI, 0.72-0.96; p 0.012). Rural hospitals had lesser odds of early diagnostic angiograms (aOR, 0.79; CI, 0.67-0.95; p<0.05) and PCI (aOR, 0.78; CI, 0.66-0.92; p<0.05) within 24 hours. The mortality difference between rural and urban hospitals was not significant (aOR, 1.08; CI, 0.85-1.4; p 0.52). CONCLUSIONS Diagnostic coronary angiograms and PCI are performed at a lesser rate in rural hospitals during weekends. This trend did not affect rural AMI mortality.
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Dezzani EO. Pneumological problems in surgical practice. Minerva Surg 2023; 78:469-480. [PMID: 37870534 DOI: 10.23736/s2724-5691.23.10122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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Varagur K, Sullivan J, Chiang SN, Skolnick GB, Sacks JM, Christensen JM. Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5345. [PMID: 37850199 PMCID: PMC10578671 DOI: 10.1097/gox.0000000000005345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 10/19/2023]
Abstract
Background Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. Methods The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Results Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05]. Conclusion Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.
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Affiliation(s)
- Kaamya Varagur
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Janessa Sullivan
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Sarah N. Chiang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Gary B. Skolnick
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Justin M. Sacks
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Joani M. Christensen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
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Nguyen AT, Wisniewski J, Leang DW, Keller MS, Rosen S, Shane R, Pevnick JM. Effect of the population health inpatient Medicare Advantage pharmacist intervention on hospital readmissions: A quasi-experimental controlled study. J Manag Care Spec Pharm 2023; 29:266-275. [PMID: 36840959 PMCID: PMC10387964 DOI: 10.18553/jmcp.2023.29.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND: The population health inpatient Medicare Advantage pharmacist (PHIMAP) intervention is a pharmacist-led, transitions-of-care intervention that aims to reduce hospital readmissions among Medicare Advantage beneficiaries. PHIMAP includes inpatient pharmacist participation in interdisciplinary rounds, admission and discharge medication reconciliation, pharmacy staff delivery of discharge medications to the bedside, personalized discharge medication lists and counseling, and communication with outpatient pharmacists through an electronic health record. OBJECTIVE: To evaluate the effect of the PHIMAP intervention on unplanned 30-day same-hospital readmissions among Medicare Advantage patients. METHODS: Those included were patients admitted to a large urban academic medical center between May 2018 and March 2020 who had a Medicare Advantage plan and were aged at least 18 years. A 2-group, quasi-experimental design was utilized. Control patients received the usual care, which included a best possible medication history and a postdischarge phone call. A multivariable logistic regression model was estimated to predict unplanned 30-day same-hospital readmissions. This study was a Hypothesis Evaluating Treatment Effectiveness study. RESULTS: In total, 884 patients were included. The majority were White (59.0%), non-Hispanic (87.7%), English speaking (90.5%), and older adults (median age, 75 years; interquartile range, 70-83 years). We detected no statistically significant association between the PHIMAP intervention and unplanned 30-day same-hospital readmissions (odds ratio [OR] = 0.91, 95% CI = 0.56-1.52). After adjusting for patient demographics and clinical covariates, significant predictors of 30-day readmissions included the number of emergency department/inpatient visits within 180 days prior to index admission (OR = 1.40, 95% CI = 1.11-1.77); discharge to a post-acute care facility, such as an inpatient rehabilitation facility, long-term acute care facility, or skilled nursing facility (OR = 1.69, 95% CI = 1.06-2.66); hospital length of stay in days (OR = 1.04, 95% CI=1.01-1.07); and the Agency for Healthcare Research and Quality Elixhauser Comorbidity Index score (OR = 1.01, 95% CI = 1.01-1.02). CONCLUSIONS: Significant predictors of readmissions among Medicare Advantage beneficiaries were consistent with greater illness severity, including a recent history of prior hospital utilization, a discharge to post-acute care facility (vs home), a longer length of hospital stay, and a higher comorbidity burden. Although we detected no statistically significant association between PHIMAP and unplanned 30-day same-hospital readmissions, differences in study group assignment based on the day of hospital discharge (weekend vs weekday) was a noted limitation of this study. Future studies of inpatient pharmacist-led interventions should plan to minimize the risk of selection bias due to differences in the time of patient discharge. DISCLOSURES: This study was supported in part by the National Institute on Aging under award number R01AG058911 (to Pevnick) and the UCLA Clinical Translational Science Institute (UL1 TR001881). The sponsor had no role in the design and conduct of the study, nor the writing of this report.
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Affiliation(s)
- An T Nguyen
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jesse Wisniewski
- Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Donna W Leang
- Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sonja Rosen
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rita Shane
- Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua M Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Quirós-González V, Bueno I, Goñi-Echeverría C, García-Barrio N, Del Oro M, Ortega-Torres C, Martín-Jurado C, Pavón-Muñoz AL, Hernández M, Ruiz-Burgos S, Ruiz-Morandy M, Pedrera M, Serrano P, Bernal JL. [What about the weekend effect? Impact of the day of admission on in-hospital mortality, length of stay and cost of hospitalization]. J Healthc Qual Res 2022; 37:366-373. [PMID: 35659444 DOI: 10.1016/j.jhqr.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/04/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no agreement on the existence of the weekend effect in healthcare or, if it exists, on its possible causes. The objective of the study was to evaluate the differences in healthcare outcomes between patients admitted on weekdays or weekends in a high-complexity hospital. METHODS Observational and retrospective study of patients admitted between 2016 and 2019 in a public hospital with more than 1300 beds. Hospitalization episodes were classified according to whether admission took place between Friday at 3:00 p.m. and the following Monday at 8:00 a.m. (weekend admission) or not (admission on weekdays). Mortality, length of stay and associated costs were compared, applying their respective risk-adjustment models. RESULTS Of the total 169,495 hospitalization episodes analyzed, 48,201 (28.44%) corresponded to the weekend, presenting an older age (54.9 years vs. 53.9; P<.001), a higher crude mortality rate (5.22% vs. 4.59%; P<0.001), and a longer average length of stay (7.42 days vs. 6.74; P<.001), than those admitted on weekdays. The median crude cost of stay was lower (€731.25 vs. €850.88; P<0.001). No significant differences were found when applying the adjustment models, with a risk-adjusted mortality ratio of 1.03 (0.99-1.08) vs. 0.98 (0.95-1.01), risk-adjusted length of stay of 1.002 (0.98-1.005) vs. 0.999 (0.997-1.002) and risk-adjusted cost of stay of 0.928 (0.865-0.994) vs. 0.901 (0.843-0.962). CONCLUSION The results of the study reveal that the assistance provided during the weekends does not imply worse health outcomes or increased costs. Comparing the impact between hospitals will require a future homogenization of temporal criteria and risk adjustment models.
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Affiliation(s)
- V Quirós-González
- Oficina Estrategia 2020-2024 «Transforma 12», Hospital Universitario 12 de Octubre, Madrid, España.
| | - I Bueno
- Facultada de Ciencias Jurídicas y Sociales, Universidad Carlos III de Madrid, Madrid, España
| | - C Goñi-Echeverría
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España; Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - N García-Barrio
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Del Oro
- Servicio de Gestión Económica y Contabilidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Ortega-Torres
- Servicio de Gestión Económica y Contabilidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Martín-Jurado
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - A L Pavón-Muñoz
- Oficina Estrategia 2020-2024 «Transforma 12», Hospital Universitario 12 de Octubre, Madrid, España
| | - M Hernández
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Ruiz-Burgos
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Ruiz-Morandy
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Pedrera
- Servicio de Informática, Hospital Universitario 12 de Octubre, Madrid, España
| | - P Serrano
- Dirección de Planificación, Hospital Universitario 12 de Octubre, Madrid, España
| | - J L Bernal
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
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Liu C, Wu Q, Liang Z, Karimi L, Ferrier JA, Sheats J, Khalil H. Adaptation strategies in transnational education: a case study of an australian Master of Health Administration Course offered to chinese managers. BMC MEDICAL EDUCATION 2022; 22:52. [PMID: 35065649 PMCID: PMC8783661 DOI: 10.1186/s12909-021-03097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Management decisions in health influence patient care outcomes; however, health management development courses in China are rare. This study aims to document and evaluate a transnational Master of Health Administration (MHA) course launched in 2000 for the benefit of Chinese health managers. METHODS A case study of the MHA program jointly run by an Australian university and a Chinese Medical University was conducted. We reviewed the development of the MHA course through a document analysis (key events recorded in achieves, minutes, and audits) followed by reflection (by two course coordinators), extracting key themes related to adaptative strategies. We then conducted a questionnaire survey of 139 graduates seeking their views on relevance, satisfaction and challenges associated with each subject within the course, the relevance of key management skills (as determined by the Australasian College of Health Service Management competency framework), and the impact of the course on their personal career trajectories. Chi-square tests identified differences in the responses by age, gender, pre-training position, and current workplace. RESULTS The curriculum pedagogy followed the principles of practice-based reflective learning. Research findings and student feedback shaped the curriculum design and subject content, to enhance management practices of the students. Survey participants expressed high levels of satisfaction and confirmed the relevance of all study subjects. Two subjects, health economics and data management, were perceived as being the most challenging. Of the ten management skills we assessed, relatively low self-rated confidence was found in "strategic thinking" and "planning". Younger and less experienced graduates were more likely to report learning challenges (p < 0.05). Frontline managers were least likely to obtain promotion by changing employers (χ2 = 6.02, p < 0.05) or being seconded to another position (χ2 = 9.41, p < 0.01). CONCLUSIONS This case study illustrates the suitability of cross-country partnerships in health management training, which offers opportunities for managers to systematically explore and acquire a comprehensive set of management skills applicable to their career needs. Opportunities for developing training aligned to career development opportunities are critical for attracting and developing a competent and well-prepared health service management workforce in China.
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Affiliation(s)
- Chaojie Liu
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Qunhong Wu
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
- School of Health Management, Harbin Medical University, 150081 Harbin Heilongjiang, China
| | - Zhanming Liang
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 4811 Townsville, Qld Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - J. Adamm Ferrier
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Jane Sheats
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, 3086 Melbourne, VIC Australia
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Marang-van de Mheen PJ, Vincent C. Moving beyond the weekend effect: how can we best target interventions to improve patient care? BMJ Qual Saf 2021; 30:525-528. [PMID: 33574083 DOI: 10.1136/bmjqs-2020-012620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, London, UK
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Martellucci J, Damigella A, Bergamini C, Alemanno G, Pantalone D, Coratti A, Muiesan P, Cianchi F, Prosperi P. Emergency surgery in the time of Coronavirus: the pandemic effect. Minerva Surg 2020; 76:382-387. [PMID: 33179465 DOI: 10.23736/s2724-5691.20.08545-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 epidemic became a challenge for Emergency Departments (ED) and a remarkable reduction in surgical emergencies has been widely noticed. The aim of the present study was to evaluate the impact of the pandemic period in the need of surgical emergencies. METHODS Between January 1, and May 31, 2020 all the consecutive general surgery emergencies performed by the Unit Hospital Emergency Surgery of the Careggi University (Florence, Italy) were prospectively recorded and compared to the same period of 2019. Demographic and clinical data were recorded and analyzed. RESULTS The number of surgical procedures decreased only in the month of March 2020 (compared to 2019), while in April the total numer of emergency surgical procedures was similar. Only appendectomy, complicated hernia repair and colonic resection were significantly reduced (40%, 48% and 33% respectively). The number of small intestine excision, cholecystectomy and lysis of peritoneal adhesions remained stable throughout the entire period. No statistically significant differences were found considering age, sex, Emergency Surgery Score, mortality, ICU postoperative admission and time between admission and surgery, even when analyzed with multivariate analysis for every single surgical procedure, suggesting a comparable disease severity and comorbility patterns. Mortality in COVID patients was 25%, compared to 7% of no-covid patients. CONCLUSIONS The COVID-19 pandemic has caused major changes in daily clinical practice, especially in areas such as Emergency. This has led to a temporary reduction and changes in the flow of patients to the emergency room, with implications also for emergency surgical activities.
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Affiliation(s)
- Jacopo Martellucci
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy -
| | - Andrea Damigella
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Carlo Bergamini
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanni Alemanno
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Desirè Pantalone
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Andrea Coratti
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy.,Department of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Paolo Muiesan
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy.,Unit of Digestive Surgery, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Paolo Prosperi
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
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