Effectiveness of Hospital Discharge Support by Medical and Nursing Care Workers in Reducing Readmission Rates of Patients in Long-Term Care Wards: An Observation Study in Japan.

For increasing medical care demand by aging population, the Japanese government is shifting to home medical care for treatments that do not necessarily require hospitalization. It is therefore essential to identify factors involved in improving the quality and outcomes of home medical care. This study examined the effect of hospital discharge support in long-term care wards on readmission rates. We used medical insurance and the Long-Term Care Insurance data of patients aged ≥ 65. Participants were patients who discharged between April 2012 and March 2016 from long-term care wards that did not require 24-hour monitoring and had no specific incurable diseases. Participants were divided into two groups according to hospital discharge support, defined by medical fee incentives for discharge planning and coordination of medical and nursing services after discharge. We explored the association between hospital discharge support and risk-adjusted readmission based on patient characteristics for one year beginning the month after patient discharge. This study involved a total of 10,998 patients: 2,563 patients with hospital discharge support and 8,435 patients without relevant support. In the group with hospital discharge support, there was a significant reduction in readmission rates. When examined by patients' characteristics, this association was significant in groups with age ≥ 85, care needs levels 1 to 2 (conditions requiring partial care for daily living), dementia or fracture. Our results suggest that hospital discharge support by medical and nursing care workers is effective in reducing readmission rates. Moreover, patients' age, care needs, and underlying disease should be considered.

The Distributions of Weekday Discharge Times at Acute Care Hospitals in the State of Florida were Static from 2010 to 2018.

When hospital capacity is near census, either due to limits on the number of physical or staffed beds, delays in patients' discharge can result in domino effects of congestion for the emergency department, the intensive care units, the postanesthesia care unit, and the operating room. Hospital administrators often promote increasing the percentage of patients discharged before noon as mitigation. However, benchmark data from multiple hospitals are lacking. We studied the time of weekday inpatient discharges from all 202 acute care hospitals in the state of Florida between 2010 and 2018 using publicly available data. Statewide, the average length of stay (4.63 days) did not change, but hospital discharges increased 6.1%. There was no change over years in the percentage of patients discharged before 12 noon (13.0% ± 0.28% standard error [SE]) or before 3 PM (42.2% ± 0.25% SE). For every year, the median hour of patient discharge was 3 PM. Only 9 of the 202 hospitals (4.5%) reliably achieved a morning weekday discharge rate ≥ 20.0%. Only 19 hospitals (9.4%) in the state reliably achieved a ≥ 50.0% weekday discharge rate before 3 PM. Hospital administrators seeking to achieve earlier patient discharges can use our provided data as realistic benchmarks to guide efforts. Alternatively, administrators could plan based on a model that beds will not be reliably available for new patients until late in the afternoon and apply other well-developed operational strategies to address bottlenecks affecting the internal transfer of patients within the hospital.

Experience of a rapid access falls and syncope service at a teaching hospital in Kuala Lumpur.

No abstract available.

[Communication with Migrant Patients and their Parents in Inpatient General Pediatric Care]. / Verständigung mit Patienten und Eltern mit Migrationshintergrund in der stationären allgemeinpädiatrischen Versorgung.

OBJECTIVES: Depending on the ethnic background of patients, the quality of communication between the parents of pediatric patients and clinicians, as well as the type and frequency of interpreter services was studied in an inpatient setting. METHODS: As part of a questionnaire-based survey, data from parents, doctors and nurses with reference to 220 pediatric patients treated in the Department of Pediatrics at the University Hospital Leipzig from February to May 2013 were analyzed; 18,2% of patients were migrants. RESULTS: No differences were found in the assessment of the quality of communication with clinic staff by migrant and non-migrant parents. Physicians as well as nurses rated the communication with migrant parents compared to non-migrant parents significantly lower. In up to 19,2% (data provided by nursing staff) and 15,3% (data provided by doctors) of the cases characterized by insufficient language skills on the part of migrant parents, interpreter services had to be procured. No professional interpreters were used. CONCLUSION: The results highlight once more the difficulties in communication between clinicians and migrant patients with insufficient language skills. More attention should be paid to the impact of the use of professional interpreters in the health care services.

A new concept of a multidisciplinary lymphoedema centre: established in connection to a department of dermatology and the Copenhagen Wound Healing Center.

BACKGROUND: Lymphoedema is increasingly recognized as a significant problem in healthcare. The number of patients is growing, posing a future challenge to healthcare systems and economics. Over the past decade, specialized lymphoedema management has been established around the world to accommodate the growing demands. However, information on organization, experiences and outcome are scarce. OBJECTIVES: To conduct a clinical perspective analysis describing the establishment, organization, function and results of a new, multidisciplinary lymphoedema centre functioning as a university hospital unit in connection to a department of dermatology and the Copenhagen Wound Healing Center and integrated as a national expert function in the public healthcare organization of Denmark. METHODS: Data were collected following the establishment of a lymphoedema centre based on the structured, multidisciplinary organization of lymphoedema management. RESULTS: During the first 4·5 years a total of 8058 patient consultations were performed. The mean duration of symptoms at the first visit was 19 years (range 1-67) and 31% of patients had never received any diagnosis or treatment prior to referral. Complications were found in 48% of referred patients. All patients received appropriate diagnostic investigations and treatment according to best practice. Multidisciplinary assessment involving four or more different healthcare professions was needed in 86% of cases. Research opportunities and expert education of staff were enhanced. CONCLUSIONS: A multidisciplinary lymphoedema centre improves management, knowledge and awareness of lymphoedema. This model, with minor adjustments, may be applicable for other regions and countries.

Frequency, cost and impact of inter-island referrals in the Solomon Islands.

INTRODUCTION: Providing quality health services to people living in remote areas is central to global efforts to achieve universal access to health care. Effective referral systems are especially critical in resource-limited countries where small populations are separated by considerable distances, geographic challenges and the limitations of human resources for health. This study aimed to build an evidence base on inter-island referrals in the Solomon Islands, in particular regarding the number of referrals, reasons for referrals, and cost, to ultimately provide recommendations regarding referral practice effectiveness and efficiency. METHODS: Data were taken from the referral database collected and maintained by the National Referral Hospital (NRH) in the capital, Honiara. Data included age, sex, ward or department visited, date of travel back to home port, home port and province. Data were available and included for 2008, 6 months of 2009, all of 2010 and 1 month of 2011; a total of 31 months. Travel costs were taken from NRH administrative information and included in the analysis. In addition, 10 qualitative interviews were conducted with clinicians and policy-makers in the tertiary hospital and one provincial hospital to gather information regarding inter-island referrals, their appropriateness and challenges faced. RESULTS: In the Solomon Islands, referrals from outer islands to the NRH are substantial and are gradually increasing over time. The two most populous provinces outside of the capital, Western and Malaita, represented 51% of all referrals in the study period. Of those referred, 21% were less than 15 years of age - even though 40% of the country's population is under 15 - with 30% being young adults of 15-24 years. Orthopaedic conditions comprised the largest number of referrals, with obstetric and gynaecological conditions a close second. The cost of referrals is rapidly increasing and was almost US$350,000 per year for the NRH alone. The amount budgeted for patient travel from the provinces to the NRH was a fraction of what is needed to cover the current number of referrals leading to a substantial budget shortfall. There did not appear to be a clear link between number of doctors in each province and the rate of referrals. CONCLUSION: Improving the appropriateness of referrals can have a substantial impact on access, quality of care and costs. Improvements in equipment in remote facilities, in human resources for health and in information technology can strengthen the quality of care in outer islands. Reducing the burden on referral facilities will allow them to provide appropriate care to those most in need while building public trust in all layers of the health system.

Sharps injury prevention for hospital workers.

Objectives. The purpose of this study was to collect data on self-reported sharps injuries to develop best practices to reduce them. Methods. Data on sharps injuries were collected for the period of January-October 2008 using Adverse Event Notification Forms already in use at Sema Hospital. Results. On average, 0.2% of all self-reported injuries were sharps injuries averaging one injury per month. Housekeeping staff sustained 64% of such injuries, nurses sustained 36% (5 incidents). Outpatient clinics experienced the most injuries at 28%, followed by the Internal Diseases Inpatient Unit with 21% and the Medical Waste Room with 14%. Injuries often occurred during contact with medical waste bags (28%) and while replacing full sharp-boxes (14%). Conclusion. In summary, reducing needle stick injuries is an important component of the occupational and patient safety program at Sema Hospital. The research described in this study allowed the hospital to provide targeted interventions to increase awareness of the risks of needle stick injuries and reduce such injuries. The steps used in the study can be used in any health care organization in the world to design a customized improvement plan to reduce risk and injury.

Plastic physicians: The surgical salamanders of the COVID-19 pandemic.

At the time of writing, coronavirus disease-2019 (COVID-19) has affected 6.42 million people globally and over 380,000 deaths, with the United Kingdom now having the highest death rate in Europe. The plastic surgery department at Leeds Teaching Hospitals put necessary steps in place to maintain an excellent urgent elective and acute service whilst also managing COVID-positive medical patients in the ward. We describe the structures and pathways implemented together with complex decision-making, which has allowed us to respond early and effectively. We hope these lessons will prove a useful tool as we look to open conversations around the recovery of normal activity.

[Splitting of supplemental revenues in intensive care medicine]. / Erlöszuordnung von Zusatzentgelten in der Intensivmedizin.

In patient care several clinical departments are often involved in the treatment of a single case. Due to this shared work and internal patient transfer between departments the respective departments have to share the single reimbursement sum which is granted for each hospital case in the German DRG system. The intensive care unit in particular, at least if maintained as an independent department, has a high rate of internal transfers and most of the patients will be transferred back to the original department prior to discharge from hospital. Different models have been suggested regarding the splitting of DRG reimbursement between clinical departments, however, no research has been done on the splitting of supplemental revenues. The allocation of supplemental revenues is especially complex for revenues generated over many days of hospital care or for clustered revenues. In most cases the supplemental revenues are simply allocated to the department from which the patient is ultimately discharged. This would lead to a significant economic risk for the intensive care unit, as a considerable proportion of medical services which are eligible for triggering supplemental revenues are applied there. In this study all cases treated in two intensive care units in a university hospital in 2007 were analyzed in which supplemental revenue-related medical services were performed over a longer period of time or graduated according to different amounts. In a total of 385 cases, 691 supplemental revenues were analyzed. Three different methods of supplemental revenues allocation were analyzed regarding the financial impact on the intensive care unit: allocation to the department from which the patient is discharged, allocation according to the length of stay in a particular department (in this case the intensive care unit) and allocation based on actually documented medical services eligible for supplemental revenues. The supplemental revenues take up a considerable share of the total reimbursement for intensive care. Based on the first 2 allocation methods the intensive care unit would receive 20% less supplemental revenues compared to the third allocation method, which supposedly reflects best the actual costs.

[Work-related musculoskeletal disorders: appropriateness of the requests of clinical consultation in occupational medicine departments]. / Le patologie muscoloscheletriche lavoro-correlate: l'appropriatezza nell'invio dei pazienti a strutture di secondo livello.

BACKGROUND AND OBJECTIVES: The authors analyze the results of the clinical assessment of patients suffering from suspected work-related muscular-skeletal disorders (WMSDs), observed during the course of 2008 in the Department of Occupational Medicine of the Ospedali Riuniti hospital in Bergamo. The aim was to analyse the appropriateness of the requests of clinical consultation, comparing the cases sent by general practitioners and by occupational physicians. METHODS: We assessed 149 patients (mean age 47 years, DS 9.4; mean work seniority 29.5 years, DS 10.2), investigating 218 disorders in different muscular-skeletal segments. The majority of patients (63.7%) for whom a clinical consultation was requested were sent by general practitioners, 32.9% by occupational physicians, 3.4% by the National Insurance Institute for Occupational Accidents and Diseases (INAIL). The assessment was made in two steps: first a clinical and instrumental definition of the disorders, prescribing the necessary medical investigations were the diagnosis was not already clear; secondly a definition of the aetiology, requesting documentation about working conditions when this was not clear from the medical history, experience and literature, or making an inspection. RESULTS: A majority of the patients (40.2%) were employed in the construction industry. Regarding symptoms, 54.4% of the subjects reported low back pain, 74.5% upper limb disorders (some of the patients reported several problems in different segments). The clinical diagnosis was already clear at the first consultation for 62.8% of all cases; for the other 37.2% it was necessary to prescribe some instrumental examinations or specialistic (neurologic, physiatric, orthopaedic) medical examinations. We concluded for a diagnosis of WMSDs in 99 (45.4%) of the 218 cases (50% of the assessments requested by occupational physicians, 45.3% of the assessments requested by general practitioners). The most frequent reason for rejecting an occupational aetiology was the lack of correlation between type of disease and occupational exposure, both for patients referred by occupational physicians (58.1%) and by general practitioners (51.8%). DISCUSSION: The results demonstrated that the appropriateness requests for clinical consultation was identical for general practitioners and occupational physicians. All physicians showed a high degree of attention for the upper limb disorders, which is a topical subject of great epidemiological interest. General practitioners and occupational physicians need to take more advantage of the diagnostic support and clinical evaluations offered by Occupational Medicine Departments and Universities for WMSDs.

Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments.

PURPOSE: Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety. MATERIALS AND METHODS: Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees' perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire). RESULTS: Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: -2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety. CONCLUSION: The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.

Screening and management of postoperative hypoparathyroidism-induced hypocalcemia in thyroidectomized patients in the endocrine ward compared with the surgical ward.

Transient hypoparathyroid-associated hypocalcemia is a common side effect after thyroidectomy. Not only may it be life-threatening, but it also can distinctly affect length of hospital stay and treatment costs. Screening and treatment practices are suspected to differ between clinicians in endocrine and surgical wards. We therefore compared discipline-related differences in screening and treatment of hypocalcemia as well as the length of hospital stay of patients after thyroidectomy. Data from 170 patients treated with total thyroidectomy in the Department of Otolaryngology (n = 29), General Surgery (n = 49) and Endocrinology (n = 92) were analyzed, and measurements of postoperative calcium and parathyroid hormone, calcium at time of discharge, percentage of discharge with a calcium level <1.9 mmol/L (defined as severe hypocalcemia), treatment of hypocalcemia, and duration of hospitalization were compared between disciplines. Postoperative calcium levels were measured in 97.8% of patients in endocrine wards compared with 83.3% in surgical departments (p = 0.001), and discharge with a calcium level <1.9 mmol/L was statistically more frequent in surgical vs. endocrine wards. Additional to calcium supplementation, active vitamin D was administered in 95% of patients treated in endocrine wards vs. 35% in surgical wards. Length of hospitalization was 8.12 (±6.62) days (endocrinology) to 10.55 (±9.39) days (surgical wards) (p = 0.05). Monitoring of calcium levels is an important indicator of the quality of postoperative care after thyroidectomy. To prevent postoperative hypocalcemia-induced complications and to reduce the length of hospital stay, an interdisciplinary approach for the management of hypocalcemia after thyroidectomy might be a promising model for future treatment concepts.

Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department.

OBJECTIVES: The objectives of this study were to report on and evaluate the results of chiropractic care for patients with low back pain in an orthopedic department. METHODS: The target group consisted of 44 consecutive patients who experienced sudden and painful low back pain caused by lumbar flexion and rotation without axial loading. Clinical and neurologic examinations by orthopedic surgeons revealed no pathology; in addition, skeletal radiography, computerized tomography, and magnetic resonance imaging findings were all normal. Diagnosis before hospitalization was acute sciatica in all cases. Examination by the doctor of chiropractic indicated that the patients had lumbopelvic fixation. According to preestablished inclusion and exclusion criteria, 33 patients were treated in the chiropractor's clinic, whereas 11 who could not be transported were initially treated by the chiropractor in the hospital. The mean follow-up was 2 years. RESULTS: All but two patients returned to work. The period of sick leave among the patients was reduced by two thirds as compared with that associated with conventional medical treatment. CONCLUSIONS: To our knowledge, this is the first report on the work of a chiropractor participating within an orthopedic department of a Norwegian hospital as initiated by the hospital and with full support of the staff. The results support the initiative of the Norwegian government to increase reference to chiropractors in treating patients with neuromusculoskeletal dysfunctions. Based on our experience, we believe that the inclusion of chiropractors within hospital orthopedic departments is feasible and provides a patient care resource that may benefit not only the patients but also the department as a whole.

[Outbreak of hospital acquired Legionnaires' disease in patients of ophthalmic ward. Nosocomial Legionella infections for the first time observed in Poland]. / Ognisko choroby legionistów na oddziale okulistycznym. Szpitalne zakazenie Legionella pneumophila po raz pierwszy obserwowane w Polsce.

The aim of the paper is to describe the criteria used for identification of first and so far the only one outbreak of hospital bacterial infections due to L. pneumophila. The infected persons were patients hospitalized at ophthalmic ward for more than 10 days. Four patients were found ill among 27 hospitalized (15%) at ophthalmic ward and 3 of them died (75%) in spite treatment in intensive care unit. The source of infection was found in the hospital hot water system. It was shown that L. pneumophila sg 1 and sg 2-14 were settled in the tanks and pipelines of hot water installations. The high number of L. pneumophila sg I and sg 2-14 colony forming units (> 10 000 cfu /100 ml) were found in the water specimens taken from the hospital water system, showing the high risk of Legionella infection for patients. Cleaning and disinfection of hot water system was repeated three times using composition every time modified as stronger mechanical, thermal and chemical methods. Complete elimination of Legionella from hot water system was achieved after cutting off deadlegs of water and replacement of both old hot water reservoirs with new ones. Collected experience served for preparation of guidelines for control and prevention of Legionella infections in hospital buildings, published on National Institute of Hygiene web site A month later Polish Ministry of Health published the Directives concerning the quality of drinking water to which the control of Legionella infection has been included.

[Specialized palliative care in Denmark lacks capacity and accessibility].

Specialized palliative care (SPC) has a core task in providing palliative care to patients and the families of patients suffering from life-threatening diseases. SPC-units also support the generalist palliative care level. In spring 2016, Denmark had a capacity of 55 units comprising hospices, palliative care teams and palliative hospital wards, which is an insufficient number according to the European Association for Palliative Care recommendations. Despite many non-cancer deaths, 96% of the patients receiving SPC have cancer. The accessibility to SPC is unequally distributed across the regions.

Prescribing practice in a Swiss primary and secondary acute care hospital.

QUESTIONS UNDER STUDY: Little is known about the prescribing behaviour of physicians in hospitals. This analysis, using data based on Computerised Physician Order Entry (CPOE), was performed to evaluate prescription patterns, to analyse possible over-prescribing of drugs and to assess the compliance with therapy-guidelines. METHODS: Within a 12 month period, 68,133 prescriptions in three departments were analysed with respect to drug class, duration of therapy, dosage, administration route, patient's age, patient's length of stay and number of prescriptions per patient. RESULTS: On average, each patient received 12 drugs. A steady increase in the number of prescribed drugs can be seen between the age of 20 and 85. The median duration of intravenously administered antibiotics was 4.0 days, the median duration of antibiotic therapy was 9.5 days. DISCUSSION: On average, patients were taking 5 drugs on a regular basis on admission to hospital. This number was doubled during the hospital stay where patients were prescribed 12 drugs on average. On discharge 6 drugs were prescribed and thus a reasonable reduction was made. Surgical and Internal Medicine wards were using very similar drug classes. Concerning the use of low molecular-weight heparin, guidelines were widely adhered to whereas proton-pump-inhibitors were prescribed too often and the duration of intravenous antibiotic therapy tended to be too long.

Social Media for Academic Neurosurgical Programs: The University of Toronto Experience.

BACKGROUND: There is a paucity of available strategies to increase visibility and engagement in social media (SM) within the neurosurgical community. The objective of this study was to investigate the possible factors for engagement and reach among SM users in neurosurgery. METHODS: Data from Facebook and Twitter accounts of our institution were collected. We extracted data on demographics and attributes of our current users, including sex, country, age group, device used, and language. Attributes of SM posts were also collected, including time of post, type and content of post, impressions, and engagements. Nonparametric analyses were conducted to evaluate differences in metrics. RESULTS: Metrics were obtained on 192 Facebook and Twitter posts, published online between October 1, 2013, and March 13, 2016. On both platforms, there was a greater representation of male users relative to female users. Facebook users were predominantly in the 18-34 years age range (83%), with most users being from outside of North America. Conversely, users from Canada and the United States comprised the highest proportion of Twitter users. On both platforms, posts containing photos or videos scored significantly higher in engagements and impressions (P < 0.05). Posts on weekdays and during work hours achieved higher visibility and engagements. Moreover, Facebook posts demonstrated higher SM metrics if they mentioned faculty with more than 16 years' experience (P < 0.05). CONCLUSIONS: The current study demonstrates that our SM users predominantly comprise a younger demographic and that content optimization with media materials may lead to higher visibility and engagement. The impact of high SM reach on academic neurosurgical programs remains to be determined.

[Participation of hospital nephrology departments in outpatient dialysis care. Joint Statement of the ¼Deutsche Gesellschaft für Nephrologie (DGfN)«, ¼Verband leitender Klinikärzte in der Nephrologie (VLKN)«, ¼Verband Deutsche Nierenzentren (DN) e.†V.« , ¼KfH Kuratorium für Dialyse und Nierentransplantation e.†V.« and ¼PHV - Der Dialysepartner Patienten-Heimversorgung«]. / Ambulante Dialyse an nephrologischen Krankenhausabteilungen. Gemeinsame Stellungnahme der Deutschen Gesellschaft für Nephrologie, des Verbandes leitender Klinikärzte in der Nephrologie, des Verbandes Deutsche Nierenzentren e.†V., des KfH Kuratorium für Dialyse und Nierentransplantation e.†V. und der PHV ­ Der Dialysepartner Patienten-Heimversorgung.

The proposals by health care providers to impose drastic limits on chronic dialysis in hospitals to the extent that it can only be provided on loss-making terms, will jeopardize the cost efficiency of nephrological departments in hospitals and hence their continued existence. Such departments play a key role within the discipline, however, as the training of nephrologists is tied to them by further training regulations. The authors take the view that the proposals by health care providers are short-sighted with regard to the quality of care and the safeguarding of care in the future, and that they counteract the goals of quality assurance currently dominating the health policy agenda.