Assessment of a Novel Tool for Identifying Hospitalized Patients with Heart Failure at Risk for 30-Day Readmission, High Cost, and Longer Length of Stay.

Hospitals are penalized financially for high 30-day readmission rates for specific diagnoses, including heart failure. The economic imperative exists to better manage the heart-failure population and acute care providers are in need of appropriate tools to aid in their efforts. This study was conducted to determine if the Rothman Index score may be useful to prospectively identify patients with heart failure at risk for extended hospitalization, high inpatient cost of care, and 30-day readmission. Results from this study suggest the Rothman Index score can be a useful adjunct to current clinical assessment methods in helping multidisciplinary teams better manage patient care and limited resources.

Medical economic impact of tracheotomy patients on a hospital system.

BACKGROUND: Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system. METHODS: A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated. RESULTS: There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ∼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed. CONCLUSIONS: There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.