The impact of universal induction therapy on early hospital readmission of kidney transplant recipients / O impacto da terapia de indução universal na readmissão hospitalar precoce de receptores de transplante renal

ABSTRACT Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.

Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

Reasons and Risk Factors for Readmission Following Hospitalization for Community-acquired Pneumonia in South Korea / 결핵

BACKGROUND: Limited studies have been performed to assess readmission following hospitalization for community-acquired pneumonia (CAP) in an Asian population. We evaluated the rates, reasons, and risk factors for 30-day readmission following hospitalization for CAP in the general adult population of Korea.METHODS: We performed a retrospective observational study of 1,021 patients with CAP hospitalized at Yeungnam University from March 2012 to February 2014. The primary end point was all-cause hospital readmission within 30 days following discharge after the initial hospitalization. Hospital readmission was classified as pneumonia-related or pneumonia-unrelated readmission.RESULTS: During the study period, 862 patients who survived to hospital discharge were eligible for inclusion and among them 72 (8.4%) were rehospitalized within 30 days. In the multivariable analysis, pneumonia-related readmission was associated with para/hemiplegia, malignancy, pneumonia severity index class ≥4 and clinical instability ≥1 at hospital discharge. Comorbidities such as chronic lung disease and chronic kidney disease, treatment failure, and decompensation of comorbidities were associated with the pneumonia-unrelated 30-day readmission rate.CONCLUSION: Rehospitalizations within 30 days following discharge were frequent among patients with CAP. The risk factors for pneumonia-related and -unrelated readmission were different. Aspiration prevention, discharge at the optimal time, and close monitoring of comorbidities may reduce the frequency of readmission among patients with CAP.

Community health services and risk of readmission in public psychiatric hospitals of Belo Horizonte, Brazil, 2005-2011 / Cobertura de serviços extra-hospitalares e risco de reinternação nos hospitais psiquiátricos públicos de Belo Horizonte, 2005 a 2011

Abstract Introduction The readmission phenomenon in psychiatry not only reflects the severity and chronicity of the underlying disorders, but also indicates the quality of mental healthcare. In the context of the Brazilian mental healthcare reform, no study has included the availability of outpatient care among the potential determinants for psychiatric readmission. Objective To correlate the availability of community healthcare resources at the place of residence with the risk of psychiatric readmission. Methods All admission records from 2005 to 2011 in the two public psychiatric hospitals of Belo Horizonte were included (n=19,723). Variables related to patients and characteristics of hospitalization were collected, and indicators of community healthcare coverage were calculated for each place of residence yearly. The outcome of interest was early (<7 days), medium-term (8-30 days) and late (31-365 days) readmissions. The analysis was based on Cox regressions. Results The coverage of basic health units and of psychiatrists was associated with lower readmission risks. Coverage of specialized centers for psychosocial attention (Centros de Atenção Psicossocial [CAPS]) and psychologists did not show any protective effects. Young, male patients and those residing outside the capital had greater risk of early readmission. Compared to other psychotic disorders, mood disorders and neurotic disorders were seen as protective factors for readmission. Conclusion Regionalized attention offered by the CAPS did not result in reduced readmission risks.

Resumo Introdução O fenômeno da reinternação psiquiátrica reflete não apenas a gravidade e cronicidade da doença de base, mas também a qualidade dos serviços de saúde. Ainda não há estudos incluindo a disponibilidade de recursos assistenciais extra-hospitalares como preditor da readmissão psiquiátrica, no contexto da reforma da assistência à saúde mental brasileira. Objetivo Correlacionar a disponibilidade de recursos de assistência extra-hospitalar das localidades de residência com o risco de readmissão psiquiátrica. Métodos Foram analisados todos os registros de internações ocorridas de 2005 a 2011 nos dois hospitais psiquiátricos públicos de Belo Horizonte (n=19.723). Foram coletadas variáveis relativas aos pacientes e às características da internação, e calculados indicadores de cobertura em saúde extra-hospitalar para cada localidade de residência e ano. O desfecho de interesse foi a reinternação precoce (<7 dias), de médio prazo (8-30 dias) e tardia (31-365 dias). A análise se deu por regressões de Cox. Resultados A cobertura de unidades básicas de saúde e de psiquiatras se associou a menores riscos de reinternação. A cobertura de Centros de Atenção Psicossocial (CAPS) e de psicólogos não apresentou efeitos protetores. Pacientes jovens e do sexo masculino, assim como os residentes fora da capital, tiveram risco maior de reinternação precoce. Em comparação com outros transtornos psicóticos, os transtornos de humor e os transtornos neuróticos se apresentaram como fatores protetores para a reinternação. Conclusão A atenção regionalizada oferecida pelos CAPS não resultou em riscos reduzidos de reinternação.

O perfil das reinternações de um hospital de ensino de Belo Horizonte no ano de 2013 / Profile of re-hospitalization in a Belo Horizonte teaching hospital during 2013

Introdução: a reinternação hospitalar é constantemente empregada para análise do comportamento, funcionamento e melhoria das ações nas organizações e instituições hospitalares, podendo demonstrar a não eficácia do atendimento ao paciente ou apontar circunstâncias que remetam a complicações relacionadas à primeira internação. Além disso, a reinternação pode ser considerada evento sentinela para a qualidade dos cuidados de saúde prestados. Objetivos: descrever e analisar o perfil das reinternações e dos pacientes reinternados de um hospital de ensino, referência no atendimento em urgência e emergência, em Minas Gerais. Métodos: trata-se de uma pesquisa descritiva, utilizando-se dados secundários extraídos do sistema integrado da instituição em estudo. A amostra foi composta por 3.943 reinternações que corresponderam a 1.710 pacientes. As variáveis utilizadas foram: sexo, idade, município de residência, número de reinternações no período, tempo de permanência e motivo da alta. Utilizou-se como variável dependente o diagnóstico da reinternação. Foram considerados, para efeito de reinternação, os pacientes com mais de uma Autorização de Internação Hospitalar (AIH), no hospital, e que internaram no ano de 2013 e cujo intervalo entre os atendimentos foi superior a 48 horas. Realizou-se o tratamento dos dados no software PSPP. Resultados e Discussão: a taxa de reinternação foi de 22% e correspondeu a, em média, 2,3 reinternações por indivíduo. As reinternações mais frequentes foram decorrentes de traumas, advindas do município de Belo Horizonte, para faixa etária de 20-39 anos e do sexo masculino. O tempo médio de permanência foi de 0 a 3 dias, em geral, os pacientes reinternaram 2 ou 3 vezes e receberam alta melhorada ou curada. Conclusão: Entende-se que as reinternações podem sinalizar sobrecarga e má utilização do serviço de saúde. Assim, o presente estudo contribuiu para o conhecimento do perfil das reinternações do hospital, tornando-se uma ferramenta norteadora para a implementação de práticas de gestão que diminuam tais eventos. (AU)

Introduction: hospital re-hospitalization is constantly used to analyze the behavior, functioning and improvement of actions in hospital organizations and institutions, being able to demonstrate the lack of effectiveness of patient care or to point out circumstances that refer to complications related to the first hospitalization. In addition, re-hospitalization may be considered a sentinel event for the quality of health care provided. Objective: the present study aimed at describing and analyzing the profile of readmissions in a teaching hospital, reference in care in urgency and emergency, in Minas Gerais. Methods: this is a descriptive study using secondary data obtained from the integrated system of the institution. Sample consisted of 3,943 readmissions related to 1,710 patients. Gender, age, hometown, number of readmissions in the period, length of stay and reason for discharge were the variables used. Diagnosis forreadmission was the dependent variable. Researchers considered patients with more than one Hospitalization Authorization (AIH), in the hospital, and admitted in 2013, with at least 48 hours interval between visits. Data was analysed using PSPP software. Results: the readmission rate was 22 % and corresponding to an average of 2.3 hospitalizations per person. The most frequent readmissions were trauma cases referred from Belo Horizonte, in male patients aged 20-39 years. The average length of stay was 03 days; patients were readmitted twice or three times and were discharged after health improvement or cure. Conclusion: readmissions can indicate overload and mismanagement of the health service. The present study contributed to characterize the profile of hospital readmissions, guiding the implementation of management practices to reduce the occurrence of the above events. (AU)

A retrospective analysis of unplanned hospital readmissions of high-risk neonates in a tertiary hospital / 中国实用护理杂志

Objective To explore the causes and solutions of rehospitalization of the high-risk neonates. Methods The data collection form was designed based on the literature reviewing and the discussion of the nursing quality management team. Results The samples were retrospectively collected from January 2015 to October 2015. There were 106 cases readmitted among the 3012 discharged cases with the ratio of 3.52%. The average interval of readmission were (4.92±4.0) days, most of the cases were readmitted in 7 days after the first discharge with a ratio of 83.95%, the ratio of readmission within 3 days was 38.68%and that was 45.28%for the readmission within 4~7days. For the Preterm infants, the ratio of readmission within 3 days was 21.69%which was higher than that of the full term (16.98%), there was no statistically significant difference between the two groups(chi-square= 1.45, P>1.45). While the ratio of readmission within 7 days for premature infants was 49.06%(52/106), which was higher than that of full term infants [34.91%(37/106)], and there was statistically significant difference between the two groups(chi-square = 5.45, P3.58). But when compared between preterm infants and full term, a higher ratio was found in preterm infants (16.04%), and there was statistically significant difference (chi-square = 5.83, P< 0.05). Conclusion One week after discharge was the peak time of readmission.Jaundice was the main factor of readmission. Premature babies were more likely to have readmission due to feeding problems.

Comparisons of Clinical Characteristics Affecting Readmission between Late Preterm Infants and Moderate Preterm Infants or Full-Term Infants

PURPOSE: We aimed to describe the differences in clinical characteristics that affect readmission between late and moderate preterm or full-term infants. METHODS: Medical records were reviewed for 881 patients with gestational ages of ≥31⁺⁰ weeks who were born at Inje University Sanggye Paik Hospital between1 January 2013 and 20 September 2015. The patients were categorized into three subgroups as follows moderate preterm infants: those born at 31-33 weeks' gestation (n=73), late preterm infants: those born at 34–36 weeks' gestation (n=169),and full-term infants: those born at ≥37 weeks' gestation (n=639). We compared the late and moderate preterm or full-term infants in terms of clinical characteristics that affect readmission. RESULTS: The readmission rate was 18.9% in the late preterm infants, 21.9% in the moderate preterm infants, and 16.7% in the full-term infants. The independent risk factors of readmission were gestational age in the late preterm infants, positive pressure ventilation at birth in the moderate preterm infants, and air-leak syndrome in the full-term infants. In addition, antenatal care at the first trimester of pregnancy was an independent protective factor against readmission in the full-term infants. CONCLUSION: Our results suggest that gestational age may affect the readmission rate of late preterm infants.

Factors Influencing Readmission of Home Ventilator-Assisted Children

PURPOSE: This study was conducted to analyze factors affecting readmission of children with home ventilator care. METHODS: To collect patient data, a retrospective chart review was done of medical records of children admitted between June 1, 2007 and May 31, 2010 at one children's hospital located in Seoul. During that period 30 children were discharged with a home ventilator. RESULTS: Twenty-one of these children had a total of 63 readmissions during the study period, averaging 2.1 readmissions per child with a mean duration of hospitalization of 7.4 days. Children with nasogastric tubes were more frequently readmitted (t=7.232, p=.012) and duration of hospitalization was significantly longer (t=4.761, p=.038). Children who had cardio-pulmonary comorbidity were more frequently readmitted and had longer hospitalization than children without comorbidity (t=5.444, p=.027). When home ventilator assisted children were admitted via emergency room, they were hospitalized longer (t=14.686, p<.001). Cardio-pulmonary morbidity and readmission via ER explained 38.1% of variation for readmission. Feeding method explained 15.0% of variation in length of hospitalization. CONCLUSION: The results suggest that health care providers must give individualized education on home ventilator care to parents with children who are at risk for readmission due to cardio-pulmonary comorbidities, nasogastric tube, or readmission via ER.

Perfil de idosos em situação de readmissão hospitalar: implicações para a enfermagem gerontológica / Profile of elderly in hospital readmission situation: implications for gerontological nursing

Trata-se de um estudo com abordagem quantitativa, com delineamento descritivo retrospectivo e transversal, tendo como objetivo caracterizar idosos em situação de readmissão hospitalar, associar tais características ao desfecho readmissão hospitalar e discutir as implicações para a Enfermagem Gerontológica. A pesquisa foi realizada em um hospital universitário, localizado em Niterói, RJ. Os sujeitos foram 94 pacientes com idade igual ou superior a 60 anos que, entre janeiro e dezembro de 2010, sofreram readmissão hospitalar em enfermarias de clínica médica. A média de idade foi de 72,3 ± 10,7 anos, idosos do sexo masculino, procedentes do Município de Niterói, RJ; casados, com média de 2,8 ± 2,4 filhos e composição familiar de 2,8 ± 1,1 pessoas, aposentados e com cuidador familiar. As doenças prevalentes foram cardiovasculares, gastrointestinais, neoplásicas e respiratórias. A maioria dos idosos apresentou até 2 comorbidades; o tempo de permanência hospitalar foi de 19,9 ± 18,8 dias; a média de internações em 4 anos foi de 2 internações, ocorrendo, em geral, nos últimos 12 meses precedentes a última internação; a maioria dos idosos apresentou dependência parcial ou total dos cuidados de Enfermagem, não recebeu orientações de Enfermagem para a alta hospitalar, realizou acompanhamento através do ambulatório hospitalar e utilizou serviços de emergência entre as internações. A referida população exige mais cuidados de Enfermagem e por consequência, maior conhecimento do processo do envelhecimento e das peculiaridades do cuidado ao idoso com múltiplas patologias. Os fatores de risco para readmissão entre idosos identificados foram internação prévia no último ano e tempo de permanência hospitalar de 8 a 30 dias. Os resultados desta investigação fornecem subsídios para o planejamento de programas de atenção à saúde do idoso no contexto hospitalar e para acompanhamento comunitário. Recomenda-se a capacitação dos profissionais de saúde e implantação de programas de planejamento de alta hospitalar, com base em ações educativas que promovam o autocuidado, bem como orientações aos cuidadores, de forma integrada junto aos demais níveis de atenção. Tais intervenções têm o propósito de otimizar a assistência prestada, os recursos investidos sejam eles humanos, materiais ou financeiros, diminuir as readmissões hospitalares e promover melhoria na qualidade de vida do idoso e sua família

It is a study with quantitative approach, with retrospective descriptive and transversal profile, having as objective to characterize elders in situation of hospital readmission, to associate such characteristics to closing of readmission and to discuss the implications to the Gerontology Nursing. The research was performed at a university hospital, located in Niterói, RJ. The subjects were 94 patients who were 60 years old or more and that, between January and December 2010, had experienced hospital readmission in medical clinical wards. The age average was 72.3 ± 10.7 years, male elderly patients, from the Niterói/ RJ; married, with an average of 2.8 ± 2.4 sons and family composition of 2.8 ± 1.1 persons, retired and with family caretaker. The prevailing illnesses were cardiovascular, gastrointestinal, neoplastic and respiratory. Most of the elders had up to 2 comorbidities; the time of hospital stay was of 19.9 ± 18.8 days; institutionalization average in 4 years was of 2 institutionalizations, generally occurring in last 12 months preceding the last institutionalization; most of elders presented partial or total dependency of the Nursing cares, did not received guidelines from the Nursing for the hospital discharging, had follow-up through the hospital ambulatory and used emergency services between the institutionalizations. The mentioned population requires more Nursing care and, therefore, a better knowledge of the aging process and singularities of the multiple-pathology elders care-taking. Risk factors of the readmission among identified elders have been previous institutionalization in the last year and the term of hospital stay from 8 up to 30 days. The results of this investigation provide subsidies to the planning of health attention programs to the elders in the hospital context and to community follow up. It is recommended the qualification of health professionals and implantation of hospital discharge, based in educative actions that promote self-care, as well as guidelines to the caretakers, in an integrated way in relation to the other levels of care-taking. Such interventions have the objective to optimize the assistance offered and the resources invested ­ being humane, material or financial -, to reduce hospital readmissions and to promote the improvement in life quality of elders and their families

Tratase de un estudio con abordaje cualitativo con delineamiento descriptivo y transversal, teniendo como objetivo caracterizar ancianos en situación de readmisión en el hospital, asociar tales características al cerramiento readmisión en el hospital y discutir las implicaciones para los enfermeros que actúan en Gerontología. La pesquisa fue realizada en un hospital universitario, ubicado en Niterói, RJ. Los sujetos fueron 94 pacientes con edad igual o superior a 60 años que, entre enero y diciembre de 2010, han sufrido readmisión en el hospital en enfermarías de clínica medica. La media de edad fue de 72,3 ± 10,7 años, ancianos del sexo masculino, procedentes del municipio de Niterói, RJ; casados, con media de 2,8 ± 2,4 hijos y composición familiar de 2,8 ± 1,1 personas, pensionados y con cuidador familiar. Las enfermedades prevalentes han sido cardiovasculares, gastrointestinales, neoplásicas y respiratorias. La mayoría de los ancianos ha presentado hasta 2 morbosidades simultaneas; el tiempo de permanencia en el hospital ha sido de 19,9 ± 18,8 días; la media de internaciones en 4 años fue de 2 internaciones, ocurriendo, en general, en los 12 meses antes de la última internación; la mayoría de los ancianos ha presentado dependencia parcial o total de los cuidados de los enfermeros, no ha recibido orientaciones de los profesionales de enfermaría para el día de dar de alta, ha realizado acompañamiento a través del ambulatorio en el hospital y ha usado servicios de emergencia entre las internaciones. La referida populación exige más cuidados de los profesionales de enfermaría y, así, mayor conocimiento del proceso de envejecimiento y de las peculiaridades del cuidado al anciano con múltiples patologías. Los factores de riesgo para readmisión entre ancianos identificados han sido internación previa en el último año y tiempo de permanencia en el hospital de 8 hasta 30 días. Los resultados de esa investigación fornecen subsidios para el planeamiento de programas de atención a la salud del anciano en el contexto del hospital y para acompañamiento comunitario. Recomendase la capacitación de los profesionales de salud y la implementación de programas de planeamiento de dar de alta, con base en acciones educativas que promuevan el autocuidado, bien como orientaciones a los cuidadores en una forma integrada a los demás niveles de atención. Tales intervenciones tienen el propósito de optimizar la asistencia prestada, los recursos investidos - sean humanos, materiales o financieros -, reducir las readmisiones en los hospitales y promover la mejora en la cualidad de vida del anciano y su familia

Reinternação hospitalar precoce: avaliação de um indicador de qualidade assistencial / Early hospital readmission: an indicator of hospital quality of care assessment

Introdução: A reinternação hospitalar precoce é um indicador de qualidade assistencial. Além de desconforto ao paciente, acarreta ônus ao sistema de saúde, fazendo-se necessária uma avaliação do perfil dos pacientes de maior risco. Objetivo: Definir o perfil dos pacientes com reinternação precoce em um hospital universitário. Metodologia: Seleção de todos pacientes clínicos, cirúrgicos e pediátricos que reinternaram em até 7 dias após alta hospitalar nos meses de janeiro a março de 2007. Resultados: Entre 5363 internações, 135 (3%) adultos e 71 (7%) crianças reinternaram em 7 dias. A maioria dos pacientes eram do sexo masculino, com internação nos últimos 3 meses pelo mesmo diagnóstico. As especialidades com maior taxa de reinternação na população adulta foram medicina interna (9,7%), hematologia (9,1%), cardiologia (5,7%), emergência adulto (5,5%), gastroenterologia (5,2%) e cirurgia geral (2,2%). A maioria das internações adultas se deveu a doenças cardiovasculares (20), gastrintestinais (18), respiratórias (17), neoplásicas (17) e urinárias (13). As comorbidades mais comuns nos adultos foram hipertensão arterial (39%), diabetes (24%), tabagismo (18,5%), insuficiência renal (17%), cardiopatia isquêmica (16%), doença pulmonar obstrutiva crônica (16%) e insuficiência cardíaca (15%). As reinternação pediátricas foram predominantemente na população oncológica (42,4%). A média de comorbidades foi de 2,7 por paciente adulto. Do total das reinternações, 13% das crianças e 5 % dos adultos foram a óbito. Conclusão: Os dados apresentados permitem um melhor conhecimento do perfil de pacientes com reinternação precoce, sendo na sua maioria pacientes portadores de neoplasias e múltiplas comorbidades clínicas, devido ao perfil de pacientes crônicos atendidos na instituição.

Background: Early hospital readmission is an indicator of hospital quality of care. It is important to assess readmission risk factors, as it imposes additional burden on patients, families and high cost to healthcare system. Objectives: To define the characteristics of patients with early readmission to a university hospital. Methods: Selection of all patients readmitted in 7 days after hospital discharge from January to March of 2007. Results: All 5363 patients admitted were assessed. 135 (3%) adults and 71 (7%) children were readmitted in 7 days. Most of them were males, with previous admission in the last 3 months with the same diagnosis. Specialities with most common readmission tax in adults were internal medicine (9.7%), hematology (9%), cardiology (5.7%), adult emergency (5.5%), gastroenterology (5%) and general surgery (2.2%). Main causes of adult readmissions were cardiovascular disease (20), gastrintestinal disease (18), respiratory disease (17), cancer (17) and urinary tract disease (13). Most common co-morbidities in adults were hypertension (39%), diabetes (24%), smoke (18.5%), renal failure (17%), ischemic heart disease (16%), chronic obstructive lung disease (16%) and heart failure (15%). Pediatric readmissions were mainly on oncology population (42.4%). Adults had co-morbidities rate of 2.7. Thirteen percent of children and 5 % of adults died during readmission. Conclusions: Patients characteristics may identify those at higher risk of early readmission. Most of them had multiple medical co-morbidities or had oncologic diagnosis. These findings reflect the chronic condition of patients admitted to our institution.