Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.
Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.
ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27?day mean deviation, 99% CI?=?±14.6), psychiatric diagnosis (13?day mean deviation, 99% CI?=?±6.2), abusive behaviours (12?day mean deviation, 99% CI?=?±10.7), and stroke (7?day mean deviation, 99% CI?=?±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.
A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
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Cites: J Am Geriatr Soc. 2003 Jan;51(1):96-10012534853
Cites: BMJ. 2002 Sep 21;325(7365):610-112242160
Cites: J Am Geriatr Soc. 2003 Apr;51(4):451-812657063
Cites: Am J Ind Med. 2003 Oct;44(4):392-914502767
Cites: Can J Nurs Res. 2004 Mar;36(1):142-5715133924
Cites: J Gen Intern Med. 2004 Jul;19(7):732-915209586
Cites: Br Med J (Clin Res Ed). 1986 May 10;292(6530):1253-63085802
Cites: Soc Sci Med. 1986;23(7):665-713095929
Cites: N Z Med J. 1988 Sep 14;101(853):575-73419687
Cites: J Clin Epidemiol. 1990;43(9):971-52170587
Cites: Health Serv Res. 1991 Aug;26(3):339-741869444
Cites: J Nurs Adm. 1992 Sep;22(9):62-51432246
Cites: Ann Intern Med. 1993 Feb 1;118(3):219-238417639
Cites: J Med Assoc Thai. 1992 Jul;75(7):418-221293259
Cites: J Gerontol. 1994 Jul;49(4):M174-828014392
Cites: J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128-337874589
Cites: Health Soc Work. 1995 May;20(2):133-97649506
Cites: Can Fam Physician. 1996 Mar;42:449-54, 457-618616285
Cites: Scand J Caring Sci. 1996;10(2):81-78717804
Cites: Age Ageing. 1996 Jul;25(4):268-728831870
Cites: Stroke. 1997 Mar;28(3):543-99056609
Cites: J Am Geriatr Soc. 1997 Aug;45(8):1017-249256857
Cites: BMC Geriatr. 2005;5:115627403
Cites: J Health Serv Res Policy. 2006 Jan;11(1):52-816378533
Cites: Ann Acad Med Singapore. 2006 Jan;35(1):27-3216470271
Cites: Am J Nurs. 2006 Jan;106(1):58-67, quiz 67-816481783
Cites: Aust Health Rev. 2007 Feb;31(1):50-6217266488
Cites: Health Soc Care Community. 2007 Jul;15(4):295-30517578390
Data on the association between acute infections and venous thromboembolism (VTE) are sparse. We examined whether various hospital-diagnosed infections or infections treated in the community increase the risk of VTE.
We conducted this population-based case-control study in Northern Denmark (population 1.8 million) using medical databases. We identified all patients with a first hospital-diagnosed VTE during the period 1999-2009 (n = 15 009). For each case, we selected 10 controls from the general population matched for age, gender and county of residence (n = 150 074). We identified all hospital-diagnosed infections and community prescriptions for antibiotics 1 year predating VTE. We used odds ratios from a conditional logistic regression model to estimate incidence rate ratios (IRRs) of VTE within different time intervals of the first year after infection, controlling for confounding.
Respiratory tract, urinary tract, skin, intra-abdominal and bacteraemic infections diagnosed in hospital or treated in the community were associated with a greater than equal to twofold increased VTE risk. The association was strongest within the first 2 weeks after infection onset, gradually declining thereafter. Compared with individuals without infection during the year before VTE, the IRR for VTE within the first 3 months after infection was 12.5 (95% confidence interval (CI): 11.3-13.9) for patients with hospital-diagnosed infection and 4.0 (95% CI: 3.8-4.1) for patients treated with antibiotics in the community. Adjustment for VTE risk factors reduced these IRRs to 3.3 (95% CI: 2.9-3.8) and 2.6 (95% CI: 2.5-2.8), respectively. Similar associations were found for unprovoked VTE and for deep venous thrombosis and pulmonary embolism individually.
Infections are a risk factor for VTE.
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Cites: World J Surg. 2005;29 Suppl 1:S30-415818472
Cites: Int J Epidemiol. 2011 Jun;40(3):819-2721324940
Research has demonstrated increased mortality rates in adolescent psychiatric in-patients.
To investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age.
A nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15-33 years after first hospitalisation by record linkage to the National Death Cause Registry.
The SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated.
A broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.
Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, adverse drug events are poorly described, and analytical methods are questionable. This leads to problems with imprecise estimates and generalizability of results.
BACKGROUND/LITERATURE REVIEW: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff.
The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints.
Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden.
The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.
Daily dosages of antipsychotic medications were evaluated to determine whether current guidelines advocating lower dosing are being followed. A chart review of 163 outpatients with schizophrenia was undertaken in three outpatient hospital settings-a general community hospital, a provincial hospital, and an academic teaching hospital. The daily dosage in chlorpromazine equivalents was significantly higher in the provincial hospital (773.8 mg) than in the community hospital (355 mg) or the academic hospital (424.8 mg). A greater proportion of patients at the provincial hospital received conventional antipsychotics than novel antipsychotics or depot antipsychotics, and a greater proportion received more than one antipsychotic.
We analyzed all appendectomies in Sweden 1989-1993 (n = 60,306) recorded in the national Inpatient Registry. Our focus was on diagnostic accuracy, incidence rate of appendicitis, perforative appendicitis, and length of stay by day of admission and hospital category. The incidence rate of appendectomy decreased by 9.8% in women compared to 4.1% in men. Since the number of patients with an end diagnosis of appendicitis remained almost constant, diagnostic accuracy increased each year. This was more pronounced in women than men, seen in all hospital categories, and was higher for those admitted during periods of low capacity (weekends/ holidays). Perforated appendicitis did not increase. Duration of hospital stay decreased continuously, especially among the oldest. We found no indications of an increased frequency of complications, such as increases in the incidence rate of perforations or in the length of stay.
It was the objective of this study to determine the proportion of patients who undergo an appropriate diagnostic work-up following a D-dimer test performed to evaluate suspected pulmonary embolism (PE) or deep vein thrombosis (DVT). We performed a retrospective cohort study at a tertiary care hospital. We included patients if they underwent D-dimer testing between 2002 and 2005, if the D-dimer was performed for evaluation of VTE, and if the D-dimer test was successful. We classified: the patients' clinical probability of DVT or PE according to the Wells models, the imaging results, and the appropriateness of the testing algorithm. Of 1,000 randomly selected patients, 863 met our study criteria. Seven hundred nineteen patients (83%) had testing during an emergency department visit, while 144 were tested as inpatients (17%). Physicians performed the D-dimer test to evaluate DVT and PE in 238 (28%) and 625 (72%) patients, respectively. Overall, the testing strategy was appropriate in 69% (95% confidence interval [CI]: 66%-72%) of cases. The testing strategy was more likely to be appropriate for emergency department versus inpatients (75% vs. 39%, p
