National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status.

Objectives-Objective-This report demonstrates the use of linked National Hospital Care Survey (NHCS) and U.S. Department of Housing and Urban Development (HUD) administrative data to examine demographic characteristics and maternal health outcomes among both patients who received and did not receive housing assistance. Methods-Administrative claims data and electronic health records data from the 2016 NHCS were linked to 2015-2017 HUD administrative data using patient identifiers. HUD administrative data for Housing Choice Voucher, Public Housing, and Multifamily housing program participation were used to identify patients who received housing assistance before, during, or after their delivery hospitalization. Exploratory analyses were conducted for patients who had a delivery hospitalization in 2016 and were eligible for linkage to HUD administrative data. Demographic characteristics and maternal health outcomes were compared by housing assistance status. The linked NHCS-HUD data are unweighted and not nationally representative. Results-In the 2016 NHCS, 146,672 patients had a delivery hospitalization and were eligible for linkage to 2015-2017 HUD administrative data (95.6% had a live birth, 1.0% had a stillbirth, and 3.4% were unspecified). Among this study population, 9,559 patients (6.5%) received housing assistance from 2015 to 2017. Among those who received housing assistance, 66.5% visited large metropolitan hospitals, 71.8% were insured by Medicaid, and 3.0% experienced severe maternal morbidity. Among patients who did not receive housing assistance, 74.0% visited large metropolitan hospitals, 35.6% were insured by Medicaid, and 1.9% experienced severe maternal morbidity. Nearly two-thirds of patients who received housing assistance from 2015 to 2017 were receiving housing assistance at the time of their delivery hospitalization (63.6%). Conclusion-Although these findings are not nationally representative, this report illustrates how linked NHCS-HUD data may provide insight into maternal health outcomes of patients who received housing assistance compared with those who did not.

Analysis of candidemia cases in a city hospital during the COVID-19 pandemic.

OBJECTIVE: The frequency and mortality of candidemia remain important. Non-albicans Candida species such as C. auris are increasing. PATIENTS AND METHODS: A retrospective review of adult patients diagnosed with bloodstream infection due to Candida species in the 17 months between July 1, 2020, and December 1, 2021, was performed. Yeast colonies grown in culture were identified by matrix-assisted laser desorption/ionization time-of-flight. Antifungal susceptibility tests of Candida strains were performed with Sensititre YeastOne (TREK Diagnostic Systems Inc., Westlake, Ohio) kits, and minimum inhibitory concentration values were evaluated according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints. RESULTS: In total, 217 patients (mean age 64.9±15.7 years) were included. C. albicans was the most common fungus (detected in 82 patients; 37.8%), followed by C. parapsilosis (17.1%), C. glabrata (15.2%), C. tropicalis (15.2%), and C. auris (9%). Candidemia developed in 175 (81.4%) of the cases during their intensive care unit stay. Fluconazole (41.0%) and caspofungin (36.4%) were the two most frequently used antifungal agents in antifungal therapy. There were 114 (52.3%) deaths in the study group. Mortality rates were found to be lower in patients infected with C. parapsilosis or C. auris. Age and previous COVID-19 infection were other important risk factors. When the 217 Candida spp. were examined, resistance and intermediate susceptibility results were higher when EUCAST criteria were used. While the two methods were found to be fully compatible only for fluconazole, a partial agreement was also observed for voriconazole. CONCLUSIONS: As our study observed, the COVID-19 pandemic brought increasing numbers of immunosuppressed patients, widespread use of antibacterials, and central venous catheters, increasing the frequency and mortality of candidemia cases. All health institutions should be prepared for the diagnosis and treatment of candidemia. In addition, C. auris, the frequency of which has increased in recent years, is a new factor that should be considered in candidemia cases.

The First Nations experience of accessing rheumatology services in a metropolitan hospital: A qualitative study.

OBJECTIVE: First Nations Australians experience a higher burden and severity of Rheumatic Disease with poorer outcomes than the general population. Despite a widely acknowledged need to improve health outcomes, there has been minimal research assessing existing models of care from a First Nations perspective in Australia. The objective of this study was to describe First Nations experiences and barriers and enablers to accessing a hospital-based adult Rheumatology service in Sydney. METHODS: A qualitative study using semi-structured interviews was undertaken. Patients who self-identified as First Nations attending the Prince of Wales Hospital Rheumatology Clinic in 2021 were invited to participate. Interviews were conducted face-to-face or by telephone using culturally-appropriate Yarning methods with an Aboriginal Health Worker (AHW) at the request of participants. Thematic analysis was done in consultation with an Aboriginal Reference Group (ARG). RESULTS: Four categories, which encapsulated 11 themes were identified. Participants reported barriers to care such as logistics of the referral process, not feeling culturally safe because of uncomfortable clinic environments and health worker behaviours, inadequate cultural support and community perceptions of the specialty. Enabling factors included family member involvement, AHW support and telehealth consultation. CONCLUSION: The current model of care perpetuates access challenges for First Nations Australians within rheumatology. Barriers to care include the delayed referral process, limited cultural responsivity in the clinic environment and poor cross-cultural communication. There is a need for models of care that are co-designed with First Nations Peoples to address these barriers. PATIENT AND PUBLIC CONTRIBUTION: Participants were First Nations Australians with lived experience attending the rheumatology clinic. All interviewees were offered the opportunity to review their transcripts to ensure trustworthiness of the data. Preliminary thematic analysis was conducted in partnership with the AHW who has over 20 years experience. Following preliminary coding, a list of themes were presented to the ARG for iterative discussion and refinement. The ARG provided community representation and ensured that First Nations voices were privileged in the analysis. It's intended that the findings of this study will support the upcoming co-design of a First Nations health service for Rheumatology patients.

Anesthetic approach to trauma patients in the city hospital after the 2023 Maras earthquake.

BACKGROUND: The February 6, 2023, Kahramanmaras earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. METHODS: We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. RESULTS: A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. CONCLUSION: The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Social work collective leadership in a large urban hospital during an era of unprecedented transformational change.

This Department of Social Work Services (the Department) is one of the largest hospital social work departments in the country, with almost 600 staff, in the largest of eight hospitals and one medical school of a major health system. The Department's senior directors (three current and one former) share its innovative and effective collective leadership model that was initially developed in response to a confluence of unprecedented complex events stemming from the Covid-19 pandemic. The experiences of these co-leaders, an evaluation of the model, future internal considerations as its applicability to other health care settings will be discussed.

Trends in Patient Transfers From Overall and Caseload-Strained US Hospitals During the COVID-19 Pandemic.

Importance: Transferring patients to other hospitals because of inpatient saturation or need for higher levels of care was often challenging during the early waves of the COVID-19 pandemic. Understanding how transfer patterns evolved over time and amid hospital overcrowding could inform future care delivery and load balancing efforts. Objective: To evaluate trends in outgoing transfers at overall and caseload-strained hospitals during the COVID-19 pandemic vs prepandemic times. Design, Setting, and Participants: This retrospective cohort study used data for adult patients at continuously reporting US hospitals in the PINC-AI Healthcare Database. Data analysis was performed from February to July 2023. Exposures: Pandemic wave, defined as wave 1 (March 1, 2020, to May 31, 2020), wave 2 (June 1, 2020, to September 30, 2020), wave 3 (October 1, 2020, to June 19, 2021), Delta (June 20, 2021, to December 18, 2021), and Omicron (December 19, 2021, to February 28, 2022). Main Outcomes and Measures: Weekly trends in cumulative mean daily acute care transfers from all hospitals were assessed by COVID-19 status, hospital urbanicity, and census index (calculated as daily inpatient census divided by nominal bed capacity). At each hospital, the mean difference in transfer counts was calculated using pairwise comparisons of pandemic (vs prepandemic) weeks in the same census index decile and averaged across decile hospitals in each wave. For top decile (ie, high-surge) hospitals, fold changes (and 95% CI) in transfers were adjusted for hospital-level factors and seasonality. Results: At 681 hospitals (205 rural [30.1%] and 476 urban [69.9%]; 360 [52.9%] small with <200 beds and 321 [47.1%] large with ≥200 beds), the mean (SD) weekly outgoing transfers per hospital remained lower than the prepandemic mean of 12.1 (10.4) transfers per week for most of the pandemic, ranging from 8.5 (8.3) transfers per week during wave 1 to 11.9 (10.7) transfers per week during the Delta wave. Despite more COVID-19 transfers, overall transfers at study hospitals cumulatively decreased during each high national surge period. At 99 high-surge hospitals, compared with a prepandemic baseline, outgoing acute care transfers decreased in wave 1 (fold change -15.0%; 95% CI, -22.3% to -7.0%; P < .001), returned to baseline during wave 2 (2.2%; 95% CI, -4.3% to 9.2%; P = .52), and displayed a sustained increase in subsequent waves: 19.8% (95% CI, 14.3% to 25.4%; P < .001) in wave 3, 19.2% (95% CI, 13.4% to 25.4%; P < .001) in the Delta wave, and 15.4% (95% CI, 7.8% to 23.5%; P < .001) in the Omicron wave. Observed increases were predominantly limited to small urban hospitals, where transfers peaked (48.0%; 95% CI, 36.3% to 60.8%; P < .001) in wave 3, whereas large urban and small rural hospitals displayed little to no increases in transfers from baseline throughout the pandemic. Conclusions and Relevance: Throughout the COVID-19 pandemic, study hospitals reported paradoxical decreases in overall patient transfers during each high-surge period. Caseload-strained rural (vs urban) hospitals with fewer than 200 beds were unable to proportionally increase transfers. Prevailing vulnerabilities in flexing transfer capabilities for care or capacity reasons warrant urgent attention.

Epidemiology, clinical features and outcome of stroke in rural versus urban hospitals in Cameroon.

OBJECTIVES: Stroke is a major public health problem worldwide with disparities between urban and rural areas. The aim of this study was to compare the epidemiological, clinical features and outcomes of stroke between rural and urban hospitals in Cameroon. MATERIALS AND METHODS: We conducted a retrospective cohort study at the Douala General Hospital (urban) and Ad Lucem Hospital of Banka (rural) from January 1st, 2014, to December 31st, 2019. The medical records of all patients admitted for stroke, and meeting the inclusion criteria were reviewed. Diagnosis of stroke was based on brain imaging and/or the World Health Organization definition. Data were analyzed using SPSS version 20.0. RESULTS: Among the 15277 files reviewed, 752 were included with 623 cases (82.80%) in urban areas. The percentage of patients hospitalized for stroke were 9.06% and 2.85% in urban and rural hospitals respectively. The frequency of patients admitted for severe stroke (Glasgow coma scale ≤ 8) was higher in the rural hospital (p = 0.004). In-hospital mortality (p = 0.010), cumulative mortality at one-month (p = 0.018), poor functional recovery (p = 0.002), one-year stroke recurrence (p = 0.020) were significantly higher in rural setting. Undefined stroke was predictor of mortality in the rural hospital, while hemorrhagic stroke was predictor of mortality at one-month in the urban hospital. CONCLUSIONS: Stroke cases were significantly more severe with poor outcomes in the rural hospital. Efforts are needed to improve prevention, and access to stroke care for communities, especially in rural setting.

Telephone follow-up by nurse practitioners of geriatric patients discharged from the emergency department after traumatic injury.

INTRODUCTION: Geriatric patients discharged from the emergency department (ED) after an injury are at risk for adverse outcomes. Older patients are at a higher risk for sensory impairments and cognitive problems which can make comprehension of discharge instructions more difficult. Moreover, geriatric patients often have limited skills with or access to alternative sources of information, such as hospital web pages or phone applications, which could put them at a higher risk of undertreatment. Implementing telephone follow-up after discharge presents a potential solution to enhance information transfer and address problems related to the injury. METHODS: An exploratory cohort study was conducted in the ED of an inner-city hospital in the Netherlands between 2019-2020. Patients ≥70 years were included if they presented with an injury and were discharged home from the ED. Telephone follow-up was performed by an ED nurse practitioner within 48 hours after discharge to address any problems or questions relating to the injury. Feasibility was assessed by determining whether the intervention could be performed within the allotted time period during normal work hours (1 h per day). The frequency and type of additional advice given, as well as patient satisfaction with the intervention, were documented. RESULTS: 635 patients were eligible for inclusion, and 266 completed the intervention (median age 77 years; 32 % male). Nurse practitioners were able to complete the intervention on over 90 % of days. A total of 64 % of patients received additional advice during the telephone call, mostly related to pain medication adjustments and instructions to contact their GP. Patient satisfaction with the intervention was high (median score 8/10). CONCLUSION: Telephone follow-up is a feasible intervention that may be able to enhance older patients' comprehension of discharge instructions and help identify new problems after discharge. During the follow-up call, the majority of patients received additional advice, indicating a potential demand for this intervention. The main limitation was that not all eligible patients were approached or did not want to participate in the intervention. Future studies should investigate whether telephone follow-up can effectively reduce adverse events and improve the quality of life for these patients.

Occurrence and source identification of antibiotics and antibiotic resistance genes in groundwater surrounding urban hospitals.

Urban groundwater, serving as a critical reservoir for potable water, faces susceptibility to contamination from discrete sources such as hospital wastewater. This study investigates the distribution and plausible origins of antibiotics and antibiotic resistance genes (ARGs) in urban groundwater, drawing comparisons between areas proximal to hospitals and non-hospital areas. Ofloxacin and oxytetracycline emerged as the prevalent antibiotics across all samples, with a discernibly richer array of antibiotic types observed in groundwater sourced from hospital-adjacent regions. Employing a suite of multi-indicator tracers encompassing indicator drugs, Enterococci, ammonia, and Cl/Br mass ratio, discernible pollution from hospital or domestic sewage leakage was identified in specific wells, correlating with an escalating trajectory in antibiotic contamination. Redundancy analysis underscored temperature and dissolved organic carbon as principal environmental factors influencing antibiotics distribution in groundwater. Network analysis elucidated the facilitating role of mobile genetic elements, such as int1 and tnpA-02 in propagating ARGs. Furthermore, ARGs abundance exhibited positive correlations with temperature, pH and metallic constituents (e.g., Cu, Pb, Mn and Fe) (p < 0.05). Notably, no conspicuous correlation manifested between antibiotics and ARGs. These findings accentuate the imperative of recognizing the peril posed by antibiotic contamination in groundwater proximal to hospitals and advocate for the formulation of robust prevention and control strategies to mitigate the dissemination of antibiotics and ARGs.

Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis.

INTRODUCTION: Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. METHODS: This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. RESULTS: A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors.  CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.

Modelling Planned vs. Actual Start Time to Control the Efficiency of Surgery.

To control the efficiency of surgery, it is ideal to have actual starting times of surgical procedures coincide with their planned start time. This study analysed over 4 years of data from a large metropolitan hospital and identified factors associated with surgery commencing close to the planned starting time via statistical modelling. A web application comprising novel visualisations to complement the statistical analysis was developed to facilitate translational impact by providing theatre administrators and clinical staff with a tool to assist with continuous quality improvement.

Point prevalence of antibiotic usage in major referral hospital in Turkey.

INTRODUCTION: The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. MATERIALS AND METHODS: A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. RESULTS: Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). CONCLUSION: Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.

COVID-19 Preparedness, Stressors, and Data-Driven Solutions for Healthcare Workers at a Regional Rural-Urban Hospital System: A Longitudinal Total Worker Health® Study.

BACKGROUND: During the COVID-19 pandemic in the United States, healthcare workers were devastated by the insufficient preparedness to respond to their patients' and personal health needs. A gap exists in resources to prevent or reduce acute and long-term healthcare worker mental illnesses resulting from COVID-19 frontline response. METHODS: We performed an exploratory, mixed methods, longitudinal study of healthcare workers at a regional rural-urban hospital system in the Midwest United States during the COVID-19 response (4 timepoints, 2020). Using the Total Worker Health® (TWH) participatory needs assessment approach, self-identified frontline COVID-19 workers participated in a survey including Health-Related Quality of Life, Impact of Event Scale, and a modified version of the American Nursing Association COVID-19 survey; and a hospital timeline tracked system-level activities. FINDINGS: Response rate at Timepoint (T)1 was 21.7% (N = 39) and of those, 14 (36%) completed all four surveys. From T1 to T4, the rate of COVID-19 patients steadily increased, staff exceeded the threshold for post-traumatic stress disorder at T1 and T4; staff reported not enough rest or sleep 50% of the month, T1-T4. Helpfulness of family support increased but community support decreased, T1-T4. Concerns with performing new tasks increased; the challenges related to lack of protective equipment and negative media decreased. Workers wanted to be involved in decision-making, desired timely communication, and needed adequate physical, environmental, and psychological supports. CONCLUSIONS/APPLICATIONS FOR PRACTICE: Utilization of a TWH® strategy for describing health needs, hospital response, and multi-level staff suggestions to workplace health solutions during the COVID-19 pandemic identified evidence-based health promotion interventions in a hospital system.

Minority-Serving Hospitals Are Associated With Low Within-Hospital Disparity.

BACKGROUND: Disparities in obstetric care have been well documented, but disparities in the within-hospital population have not been as extensively explored. The objective is to assess cesarean delivery rate disparities at the hospital level in a nationally recognized low risk of cesarean delivery group. METHODS: An observational study using a national population-based database, Nationwide Inpatient Sample, from 2008 to 2011 was conducted. All patients with nulliparous, term, singleton, vertex pregnancies from Black and White patients were included. The primary outcome was delivery mode (cesarean vs vaginal). The primary independent variable was race (Black vs White). RESULTS: A total of 1,064,351 patients were included and the overall nulliparous, term, singleton, and vertex pregnancies cesarean delivery rate was 14.1%. The within-hospital disparities of cesarean delivery rates were lower in minority-serving hospitals (OR: 1.20 95% CI: 1.12-1.28), rural hospitals (OR 1.11 95% CI: 1.02-1.20), and the South (OR 1.24 95% CI 1.19-1.30) compared to their respective counterparts. Non-minority serving hospitals (OR: 1.20 95% CI 0.12-1.25), and urban hospitals (OR1.32 95% CI 1.28-1.37), the Northeast (OR 1.41 95% CI 1.30-1.53) or West (OR 1.52 95% CI 1.38-1.67), had higher within-hospital racial disparities of cesarean delivery rates. The odds ratios reported are comparing within-hospital cesarean delivery rates in Black and White patients. DISCUSSION: Significant within-hospital disparities of cesarean delivery rates across hospitals highlight the importance of facility-level factors. Policies aimed at advancing health equity must address hospital-level drivers of disparities in addition to structural racism.

Implementing and Evaluating a Discharge Before Noon Initiative in a Large Tertiary Care Urban Hospital.

BACKGROUND: Discharging clinically ready patients before noon on their discharge day may influence overall discharge process quality, emergency department (ED) boarding times, and length of stay (LOS). This study evaluated the effectiveness of a discharge before noon (DBN) initiative. METHODS: Many DBN components were refined or added during a pilot, including incorporating the DBN process into daily rounds, an electronic tracking system, and other elements for possible DBN patients such as a car service when appropriate and expedited lab results and physical therapy consults. DBN was evaluated through a retrospective pre-post study (12-month periods). Study patients were from Maimonides Medical Center's medicine units. Kaplan-Meier estimates and a log-rank test characterized and compared the discharge time probabilities in pre-DBN and post-DBN groups. Log-logistic accelerated failure time (AFT) analysis assessed the influence of DBN on discharge time. Secondary analyses examined the relationship between LOS and readmission within 30 days for any cause and DBN. RESULTS: The percentage of patients discharged before noon increased from 5.0% to 11.4% pre/post-DBN (p < 0.001). The AFT analysis estimated that post-DBN patients had discharge times 41.5% earlier (p < 0.001). DBN as an independent factor was not associated with LOS or subsequent readmissions within 30 days for any cause. Despite an increase in the percentage of patients admitted during the daytime (8:00 a.m. to 5:00 p.m.), the median ED boarding time increased by 41 minutes in post-DBN patients (p < 0.001). CONCLUSION: The DBN initiative was associated with an increased percentage of patients discharged before noon. Further research is needed to identify strategies that reliably improve discharge timeliness while reducing ED boarding.

Heatstroke presentations to urban hospitals during BC's extreme heat event: lessons for the future.

BACKGROUND: Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC's 2021 heat dome. METHODS: We conducted a review of consecutive adults presenting to 7 hospitals in BC's Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality. RESULTS: Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3). INTERPRETATION: Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.

RéSUMé: CONTEXTE: Les changements climatiques entraînent une augmentation des épisodes de chaleur extrême dans les climats tempérés qui ont généralement de faibles niveaux de préparation. Notre objectif était de décrire les caractéristiques, les traitements et les résultats des adultes présentant un coup de chaleur à l'hôpital pendant le dôme de chaleur de 2021 en Colombie-Britannique. MéTHODES: Nous avons effectué un examen des adultes consécutifs qui se sont présentés dans sept hôpitaux du Lower Mainland de la Colombie-Britannique. Nous avons examiné les dossiers de triage de tous les patients qui se sont présentés entre le 25 et le 30 juin 2021 pour les plaintes liées à la chaleur et examiné les dossiers complets de ceux qui répondaient aux critères de coup de chaleur. Notre principal résultat était la mortalité à l'hôpital. Nous avons utilisé les tests de Mann-Whitney U et la régression logistique pour étudier les associations entre le patient et les facteurs de traitement et la mortalité. RéSULTATS: Parmi les 10247 présentations consécutives aux hôpitaux urbains pendant l'événement de chaleur extrême, 1,3 % (139; intervalles de confiance [IC] à 95 %) répondaient aux critères de coup de chaleur. Parmi les patients ayant subi un coup de chaleur, 129 (90,6 %) ont été classés dans les deux niveaux d'acuité les plus élevés. Les patients atteints d'un coup de chaleur avaient un âge médian de 84,4 ans, 122 (87,8 %) vivant seuls et 101 (84,2 %) incapables d'activer le 911 eux-mêmes. Une minorité (< 5, < 3,6 %) de patients se sont présentés dans les 48 heures suivant l'apparition de la chaleur extrême. La plupart des patients (107, 77,0 %) ont dû être admis et 11,5 % (16) sont décédés à l'hôpital. L'hypotension au moment de la présentation était associée à la mortalité (rapport de cotes [RC] 5.3). INTERPRéTATION: Les patients atteints d'un coup de chaleur n'ont pas pu activer le 911 eux-mêmes, et la plupart se sont présentés avec un délai de 48 heures. Ce délai peut représenter une fenêtre critique d'opportunité pour les systèmes préhospitaliers et hospitaliers de se préparer à l'afflux de patients à forte intensité de ressources.

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey.

INTRODUCTION: Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. METHODS: Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. RESULTS: There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). CONCLUSION: This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.

When undergoing elective surgery, patients who develop anemia or who need a transfusion of blood products may develop further complications. This study aimed to understand the impact of patient blood management on blood usage in cardiovascular surgeries. Patient blood management is a patient-centered approach that aims to optimize a patient's red cell mass, minimize blood loss in patients undergoing surgery, and maximize a patient's tolerance to anemia. In addition, this study assessed the cost-effectiveness of patient blood management using an economic model based on red blood cells in cardiovascular surgeries and assessed the impact of patient blood management on budget. The patient blood management program resulted in a 21% decrease in use of red blood cells and 23.7% decrease in use of all blood products. The cost savings from reduction of red blood cells transfusions per patient were 518.68 Turkish lira and cost savings for the hospital were 1,635,948 Turkish lira. Fewer complications and lower costs were demonstrated after implementation of patient blood management in the cost-effectiveness analysis. Between December 2020 and July 2022, the hospital's cardiovascular surgery department saved 6,596,934 Turkish lira (€342,302). Overall, this hospital-based study has shown that patient blood management is a budget-saving and cost-effective option in Turkey.

Inadvertent hypothermia in paediatric radiotherapy practices under sedation: a single centre observational study.

OBJECTIVE: To detect changes in body temperature during outpatient procedures and to identify factors associated with hypothermia in the paediatric population undergoing radiotherapy under sedation. METHODS: The observational study was conducted between July and October 2022 at Ankara City Hospital, Turkey, and comprised paediatric cancer patients aged from 1 month to 18 years who needed sedation or general anaesthesia during radiotherapy. Baseline body temperature T1 was measured before transportation to the radiotherapy room, while body temperature T2 was taken after radiotherapy. Data was analysed using SPSS 20. RESULTS: A total of 152 radiotherapy sessions related to 13 children were evaluated. There were 8(61%) boys and 5(38%) girls with overall mean 4.46±3.45 years (range: 2-13 years). The mean body surface area as 0.70±0.212. Radiotherapy was performed in 9(69%) patients, while 4(31%) patients underwent tomotheraphy. The dose used was 180cGy in 12(92.3%) patients. Hypothermia was observed in at least one session in 12(92.3%) patients. There was significant difference in body temperature at baseline and post-radiotherapy (p<0.05). CONCLUSIONS: There were significant changes in body temperature during outpatient procedures in the paediatric population undergoing radiotherapy under sedation.

Comportamiento de la accidentabilidad laboral atendida en un Hospital de Lima Metropolitana durante la pandemia de la COVID-19 / Work-related accident rates at a metropolitan Lima hospital during the COVID-19 pandemic: a behavioral analysis

Introducción: El comportamiento de la accidentabilidad durante la pandemia (2020-2021) fue distinto para cada país; además, se observó cambios en las características de los accidentes de trabajo.Objetivos:Describir el comportamiento y los fatores asociados a la accidentabilidad laboral atendida en el Servicio de Emergencia de un hospital del Seguro Social de Perú de Lima Metropolitana, durante la pandemia de la COVID-19. Material y Métodos: Estudio transversal analítico, que revisó la data de los reportes de accidentes que llegaron a un hospital del seguro social peruano, se tomó como variable principal al período de ocurrencia, según eso se obtuvo estadísticos descriptivos y analíticos. Resultados: De los 5753 accidentes analizados, los años con más accidentes fueron el 2018 (45,7%) y el 2019 (23,1%), durante la pandemia (2020 - 2021) hubo 26,0% de la totalidad de accidentes. En el modelo multivariado se encontró que en la pandemia hubo más accidentes por aplastamiento (RPa: 2,1; IC95%: 1,5-2,9; valor p<0,001) y de agresiones por arma (RPa: 1,2; IC95%: 1,1-1,4; valor p=0,005). Los accidentes más prevalentes fueron por trauma interno (RPa: 1,6; IC95%: 1,1-2,3; valor p=0,025), por torcedura (RPa: 1,2; IC95%: 1,0-1,4; valor p=0,025) y por fracturas (RPa: 1,5; IC95%: 1,1-1,9; valor p=0,002). Las zonas más afectadas fueron la región lumbosacra (RPa: 1,4; IC95%: 1,1-1,8; valor p=0,009) y los dedos (RPa: 1,1; IC95%: 1,0-1,3; valor p=0,046). Conclusión: Durante la pandemia, hubo más accidentes por aplastamiento, por agresiones, por trauma interno, por torcedura, por fracturas, en la región lumbosacra y en los dedos. (AU)

Introduction: The behavior of the accident rate during the pandemic (2020-2021) was different for each country; In addition, changes in the characteristics of work accidents were observed.Objective:To describe the behavior of occupational accidents attended in the Emergency Service of a Peruvian Social Security hospital in Metropolitan Lima, during the COVID-19 pandemic. Material and Methodo: Cross-sectional study, which reviewed the data from accident reports that arrived at a Peruvian social security hospital, taking the period of occurrence as the main variable, according to which descriptive and analytical statistics were obtained. Results: Of the 5,753 works accidents analyzed, the years with the most accidents were 2018 (45.7%) and 2019 (23.1%), during the pandemic (2020-2021) there were 26.0% of all accidents. In the multivariate model, it was found that during the pandemic there were more accidents due to crushing (aPR: 2,1; 95% CI: 1,5-2,9; value p<0,001) and attacks by weapons (aPR: 2,1; IC95%: 1,5-2,9; value p<0,001). The most prevalent accidents due to internal trauma (aPR: 1.6; 95%CI: 1.1-2.3; p value=0.025), sprain (aPR: 1.2; 95%CI: 1.0-1.4; p value=0.025) and fractures (aPR: 1.5; 95% CI: 1.1-1.9; p value=0.002). The most affected areas were the lumbosacral region (aPR: 1.4; 95% CI: 1.1-1.8; p value=0.009) and in fingers (aPR: 1.1; 95% CI: 1.0-1.3; p value=0.046). Conclusion: During the pandemic, there were more accidents due to crushing, assaults, internal trauma, sprains, fractures, in the lumbosacral region and in the fingers. (AU)