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Acute-care Hospitals (acute-care + hospital)
Selected AbstractsOutcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Cost inefficiency and hospital health outcomesHEALTH ECONOMICS, Issue 7 2008Niccie L. McKay Abstract This study explores the association between cost inefficiency and health outcomes in a national sample of acute-care hospitals in the US over the period 1999,2001, with health outcomes being measured by both mortality and complications rates. The empirical analysis examines health outcomes as a function of cost inefficiency and other determinants of outcomes, using stochastic frontier analysis to obtain hospital cost inefficiency scores. The results showed no systematic pattern of association between cost inefficiency and hospital health outcomes; the basic results were unchanged regardless of whether cost inefficiency was measured with or without using instrumental variables. The analysis also indicated, however, that the association between cost inefficiency and health outcomes may vary substantially across geographical regions. The study highlights the importance of distinguishing between ,good' costs that reflect the efficient use of resources and ,bad' costs that stem from waste and other forms of inefficiency. In particular, the study's results suggest that hospital programs focused on reducing cost inefficiency are unlikely to be associated with worsened hospital-level mortality or complications rates, while, on the other hand, across-the-board reductions in cost could well have adverse consequences on health outcomes by reducing efficient as well as inefficient costs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Keeping the spirit high: why trauma team training is (sometimes) implementedACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2008T. WISBORG Background: Systematic and multiprofessional trauma team training using simulation was introduced in Norway in 1997. The concept was developed out of necessity in two district general hospitals and one university hospital but gradually spread to 45 of Norway's 50 acute-care hospitals over the next decade. Implementation in the hospitals has varied from being a single training experience to becoming a regular training and part of quality improvement. The aim of this study was to better understand why only some hospitals achieved implementation of regular trauma team training, despite the intentions of all hospitals to do so. Methods: Focus group interviews were conducted with multiprofessional respondents in seven hospitals, including small and large hospitals and hospitals with and without regular team training. Interviews were transcribed and analyzed using a Grounded Theory approach. Results: ,Keeping the spirit high' appeared to be the way to achieve implementation. This was achieved through ,enthusiasm,',strategies and alliances,' and ,using spin-offs.' It seems that the combination of enthusiasts, managerial support, and strategic planning are key factors for professionals trying to implement new activities. Conclusions: Committed health professionals planning to implement new methods for training and preparedness in hospitals should have one or more enthusiasts, secure support at the administrative level, and plan the implementation taking all stakeholders into consideration. [source] Thromboprophylaxis rates in US medical centers: success or failure?JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2007A. AMIN Summary.,Background:,As hospitalized medical patients may be at risk of venous thromboembolism (VTE), evidence-based guidelines are available to help physicians assess patients' risk for VTE, and to recommend prophylaxis options. The rate of appropriate thromboprophylaxis use in at-risk medical inpatients was assessed in accordance with the 6th American College of Chest Physicians (ACCP) guidelines.Methods:,Hospital discharge information from the Premier PerspectiveÔ inpatient data base from January 2002 to September 2005 was used. Included patients were 40 years old or more, with a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The appropriateness of VTE thromboprophylaxis was determined in seven groups with acute medical conditions by comparing the daily thromboprophylaxis usage, including type of thromboprophylaxis, dosage of anticoagulant and duration of thromboprophylaxis, with the ACCP recommendations.Results:,A total of 196 104 discharges from 227 hospitals met the inclusion criteria. The overall VTE thromboprophylaxis rate was 61.8%, although the appropriate thromboprophylaxis rate was only 33.9%. Of the 66.1% discharged patients who did not receive appropriate thromboprophylaxis, 38.4% received no prophylaxis, 4.7% received mechanical prophylaxis only, 6.3% received an inappropriate dosage, and 16.7% received an inappropriate prophylaxis duration based on ACCP recommendations.Conclusions:,This study highlights the low rates of appropriate thromboprophylaxis in US acute-care hospitals, with two-thirds of discharged patients not receiving prophylaxis in accordance with the 6th ACCP guidelines. More effort is required to improve the use of appropriate thromboprophylaxis in accordance with the ACCP recommendations. [source] Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilliRESPIROLOGY, Issue 1 2009Miquel FALGUERA Background and objective: Several sets of guidelines have advocated initial antibiotic treatment for community-acquired pneumonia due to Gram-negative bacilli in patients with specific risk factors. However, evidence to support this recommendation is scarce. We sought to identify risk factors for community-acquired pneumonia due to Gram-negative bacilli, including Pseudomonas aeruginosa, and to assess outcomes. Methods: An observational analysis was carried out on prospectively collected data for immunocompetent adults hospitalized for community-acquired pneumonia in two acute-care hospitals. Cases of pneumonia due to Gram-negative bacilli were compared with those of non-Gram-negative bacilli causes. Results: Sixty-one (2%) of 3272 episodes of community-acquired pneumonia were due to Gram-negative bacilli. COPD (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2,5.1), current use of corticosteroids (OR 2.8, 95% CI: 1.2,6.3), prior antibiotic therapy (OR 2.6, 95% CI: 1.4,4.8), tachypnoea ,30 cycles/min (OR 2.1, 95% CI: 1.1,4.2) and septic shock at presentation (OR 6.1, 95% CI: 2.5,14.6) were independently associated with Gram-negative bacilli pneumonia. Initial antibiotic therapy in patients with pneumonia due to Gram-negative bacilli was often inappropriate. These patients were also more likely to require admission to the intensive care unit, had longer hospital stays, and higher early (<48 h) (21% vs 2%; P < 0.001) and overall mortality (36% vs 7%; P < 0.001). Conclusions: These results suggest that community-acquired pneumonia due to Gram-negative bacilli is uncommon, but is associated with a poor outcome. The risk factors identified in this study should be considered when selecting initial antibiotic therapy for patients with community-acquired pneumonia. [source] Practitioner-researchers in occupational therapyAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2000Anne Cusick Few occupational therapy clinicians are research productive even though their involvement in research is encouraged. The role of ,research-practitioner' is put forward as a means by which practitioners can be research productive. There is, however, an absence of studies exploring experience of the minority of practitioners who do produce research. This study used a qualitative approach to do this in occupational therapy. Purposive sampling was conducted of all research productive clinicians in acute-care hospitals in one Australian city. Of the 20 possible researchers, 15 participated in in-depth interviews which explored their experience of research. Results were analysed using the constant comparative method and six conceptual categories were developed to describe their experience. The key findings were that clinicians who did research perceived themselves to be different from other clinicians in terms of attributes; and they described special ways of getting research done, and ways of reflecting on outcomes of their research involvement. The study provides an empirical foundation to further consider the practitioner-researcher role in practice professions such as occupational therapy. [source] | ||||||||||