A Hospital System's Journey Toward Zero Harm: Reducing Postoperative Respiratory Failure

Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.

Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Cost of Illness of COVID-19 and Its Consequences on Health and Economic System.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Two-year impact of COVID-19 pandemic on hospitalized patients with skin diseases in China.

To investigate the clinical characteristics of skin disorders among hospitalized patients before and during the coronavirus disease 2019 (COVID-19) pandemic, a retrospective study was conducted based on hospitalized patients with skin diseases from Xiangya Hospital of Central South University, the largest hospital in the south-central region of China, between January 1, 2018, and December 31, 2021. A total of 3039 hospitalized patients were enrolled in the study, including 1681 patients in the prepandemic group and 1358 patients in the pandemic group. The total number of hospitalized patients in the pandemic group decreased by 19.2%, with an increased proportion of patients over 60 years of age (39.8% vs. 35.8%). Moreover, compared with the prepandemic group, there were decreases in the occurrence of most skin diseases in the pandemic group, but the proportions of keratinolytic carcinoma (6.6% vs. 5.2%), dermatitis (24.0% vs. 18.9%), and psoriasis (18.0% vs. 14.8%) were higher in the pandemic group. In addition, longer hospital stays (ß = 0.07, SE = 0.02, P = 1.35 × 10-3 ) and higher hospital costs (ß = 0.06, SE = 0.03, p = 0.031) were found in the pandemic group through general linear models, even after the corresponding adjustment. In summary, the COVID-19 pandemic has had a lasting impact on patients with skin diseases, with fewer hospitalized patients, increased proportions of older patients, longer hospital stays, and increased hospital costs. These findings will facilitate better preparation for the most effective response to future pandemics.

Operational and Financial Impacts of Digital Health Technology: A Study on Canadian Healthcare System during the COVID-19 Pandemic.

During COVID-19, hospital capacity was significantly reduced to limit the spread of the pandemic. The limitations affected the efficiency of service delivery. We examined the effects of pandemic-related challenges on patient experience and hypothesize that digital health implementation increased patient satisfaction. We surveyed nationally aggregated data in hospital occupancy, hospital funding and patient experience, and plotted their correlation. We found digital health to contribute to patient experience and service-delivery effectiveness. We evaluate the benefits of digital health in context of hospital service delivery. Post-COVID-19, we recommend a continued implementation of digital health and offer suggestions to further improve its efficiency and cost-effectiveness.

Comparative Analysis of Service Costs In Intensive Care Unit, Length of Stay and Mortality Rate Before and During the COVID 19 Pandemic

Objective: The aim of the present study was to compare the average length of stay, mortality rates and service costs in intensive care unit provided to patients during October-November-December 2019 (pre-pandemic), with the average length of stay, mortality rates and service costs in intensive care unit during October-November-December 2020 (pandemic). Methods: This was a retrospective cross-sectional comparative, single-center study. The demographic data (age, gender), average length of stay, mortality and hospital costs of intensive care patients during October-November-December 2019 (pre-pandemic) were compared using the hospital records with the same data of patients in the same intensive care unit during October-November-December 2020 (pandemic), and the factors affecting the cost were investigated. Results: Of the 437 patients included in the study, 233 were hospiṫ aliż ed in pre-pandemic period and 204 in pandemic period. Pre-pandemic period mean age was 65.04 ± 17.0, and pandemic period mean age was 68.07 ± 15.1 years. The majority of the cases in both periods were male (57.9% and 63.2%). Length of stay, cost and mortality rates were significantly higher in the pandemic group (p: 0.000). There was a significant positive correlation between length of stay and cost (p: 0.000). Conclusion: It was found that intensive care costs increased considerably during the COVID 19 period, along with the increases in the length of stay and mortality rates. Advanced age and increase in length of stay were found to be correlated with mortality, but only length of stay was correlated with cost.

Direct Inpatient Cost and Payments of COVID-19 in Iran: Quantile Regression Analysis.

Background: COVID-19 pandemic imposes a substantial medical and socioeconomic burden on health systems. The study aimed to estimate the direct inpatient costs of COVID-19 in Iran. Methods: This is a Cost of Illness (COI) study with the bottom-up method. Provider perspective and prevalence approach were applied for cost identification. Data included inpatient charges and clinical characteristics of all COVID-19 cases (2015 patients) admitted to a teaching hospital during a financial year (March 2020 to February 2021). We extracted data from Hospital Information System (HIS) and applied the quantile regression to estimate determinant factors of COVID-19 inpatient cost using STATA software. Results: 1026 (50.92%) of admitted COVID-19 patients were female, and 42.3% were older than 65 years. More than 82% of discharged COVID-19 patients in this study recovered. 189 (9.38%) patients admitted to ICUs. Length of Stay (LOS) for about 70% of admitted COVID-19 cases was 7 days or less. The Total Inpatient Charges (TIC) was 155,372,056,826 Rials (5,041,836 PPP USD). The median charge was 42,410,477 Rials, and Average Inpatient Charges (AIC) was 77,107,720±110,051,702 (2,461 PPP USD) per person. Drugs and supplies accounted for 37% of total inpatient charges. Basic insurance companies would pay more than 79% of total claims and the share of Out-of-Pocket Payments (OOP) was 7%. ICUs admission and LOS of more than 3 days are associated with higher costs across all percentiles of the cost distribution (p<0.001). Conclusion: This study call attention to the substantial economic burden based on real-world data. According to the broad socio-economic impacts of COVID-19 and also multiple components of COI study designs, conducting meta-analysis approaches is needed to combine results from independent studies.

The Influence of Core Training In Cardiorespiratory Hospitalized Patients-Case Report

Keywords: Core Muscles;Functional Capacity;Peak Cough Flow;Hospitalized Patients;Case Report Introduction The "core" has been used to refer a three-dimensional space, the lumbopelvic-hip complex, which involves deeper muscles, such as the internal oblique, transverses abdominals, transversospinalis (multifidus, rotators, semispinalis), quadratus lumborum, and psoas major and minor, and superficial muscles, such as the rectus abdominis, external oblique, erector spinae (iliocostalis, spinalis, longissimus) latissimus dorsi, gluteus maximus and medius, hamstrings, and rectus femoris [1, 2]. At the beginning of the session HR, respiratory rate (RR), SpO2, Blood pressure (BP), dyspnea (using the MBS) was monitored for all patients and for those who have diabetes was also monitored glucose levels. Personal history (PH) of SARS-CoV2 pneumonia in March 2021 (hospitalized for 1 month in the Intensive Care Unit (ICU) using mechanically invasive ventilation), type 2 diabetes mellitus (DM) treated with premixed insulin, polyneuropathy for more than 10 years, arterial hypertension (AH), chronic kidney disease (CKD), coronary heart disease (placement stent in 2010), dyslipidaemia, chronic gastritis, lithiasis and renal cysts.

Retained Surgical Items: Overview of a Persistent Problem in Health Care: The Official Voice of Perioperative Nursing

In 2014, researchers estimated the hospital costs for one RSI to be approximately $70,000;2 and no dollar figure can be placed on the emotional effects of an RSI on surgical team members who pride themselves on providing excellent patient care. A RENEWED COMMITMENT The coronavirus disease 2019 pandemic resulted in unprecedented stress on health care workers and affected patient safety efforts. A February 2022 editorial written by leaders of the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention noted the decline of several patient safety metrics (eg, bloodstream infections, falls, pressure injuries) in both acute and postacute care settings during the pandemic.4 Now is the time for clinicians and administrators to renew their commitment to keeping patients safe from untoward events such as RSIs.

Comparison of hospitalized COVID-19 and influenza patients requiring supplemental oxygen in a cohort study: clinical impact and resource consumption.

BACKGROUND: To compare clinical characteristics, outcomes, and resource consumption of patients with COVID-19 and seasonal influenza requiring supplemental oxygen. METHODS: Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted due to seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. RESULTS: COVID-19 cases were younger (median years, 67 (IQR 54-78) vs 76 (IQR 64-83); p < 0.001) and more frequently overweight whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory and renal disease. Compared to influenza, COVID-19 cases had more pneumonia (98% vs 60%, <0.001), higher MEWS and CURB-65 scores and were more likely to show worse progression on the WHO ordinal scale (33% vs 4%; p < 0.001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (p = 0.001). The median age of non-surviving cases was 81 (IQR 74-88) and 77.5 (IQR 65-84) (p = 0.385), respectively. COVID-19 was independently associated with 30-day (HR 4.6, 95%CI, 2-10.4) and 90-day (HR 5.2, 95%CI, 2.4-11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. CONCLUSIONS: Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes.

The Economic Impact of Carbapenem Resistant-Non Lactose Fermenter and Enterobacteriaceae Infections on Hospital Costs in Dr. Soetomo General Academic Hospital Surabaya, Indonesia.

BACKGROUND: Carbapenem resistant-non lactose fermenter (CR-NLF) and Carbapenem resistant-Enterobacteriaceae (CR-E) bacterial infections are likely to be a global threat to people's health. However, studies on the economic impacts according to the hospital setting are very scarce. The study aimed to explore the impact of CR-NLF (Acinetobacter baumannii = CRAB) & Pseudomonas aeruginosa = CRPA) and CR-E (Escherichia coli = CREC) & Klebsiella pneumoniae = CRKP) infections on hospital costs from a payer perspective among patients admitted to Dr.Soetomo Hospital, Surabaya, Indonesia. METHODS: In the retrospective case-control study, medical records of all included patients hospitalized during 2018-2021 were reviewed for CRAB, CRPA, CREC, CRKP, and carbapenem sensitive (CSAB, CSPA, CSEC, CSKP) were collected. We retrieved the data of age, gender, clinical specimen, dates of admission, and discharge status. The outcomes of interest were hospital length of stay and hospitalization cost. RESULTS: The cost for CR-NLFs infections was higher than carbapenem sensitive, $3026.24 versus $1299.28 (p < 0.05). There was no significant difference between CR-E against carbapenem sensitive. It showed that the highest impact of the cost was CRAB, followed by CRPA, CRKP, and CREC. The bed, antibiotics, pharmacy, and diagnostic costs of CR-NLFIs were significantly higher than CR-E. CONCLUSION: This study showed that the hospital cost and expenditure of CR-NLFs per patient were higher than CS. The hospital cost per patient for CR-NLF was higher than CR-E.

A computational investigation of COVID-19 transmission inside hospital wards and associated costs.

The COVID-19 pandemic has placed a particular burden on hospitals: from intra-hospital transmission of the infections to reduced admissions of non-COVID-19 patients. There are also high costs associated with the treatment of hospitalised COVID-19 patients, as well as reductions in revenues due to delayed and cancelled treatments. In this study we investigate computationally the transmission of COVID-19 inside a hospital ward that contains multiple-bed bays (with 4 or 6 beds) and multiple single-bed side rooms (that can accommodate the contacts of COVID-19-positive patients). The aim of this study is to investigate the role of 4-bed bays vs. 6-bed bays on the spread of infections and the hospital costs. We show that 4-bed bays are associated with lower infections only when we reduce the discharge time of some patients from 10 days to 5 days. This also leads to lower costs for the treatment of COVID-19 patients. In contrast, 6-bed bays are associated with reduced hospital waiting lists (especially when there are also multiple side rooms available to accommodate the contacts of COVID-19-positive patients identified inside the 6-bed bays).

Self-harm in an older adult population during the COVID-19 pandemic

The COVID-19 pandemic has presented major challenges for all demographics of society. The strict lockdown measures utilised to control the spread of the virus have the potential unintended consequences of exacerbating social isolation and loneliness, which are recognised to be preexisting issues in the elderly population. Because of this, the pandemic may have disproportionality impacted the elderly population. One way that the distress caused by the pandemic could manifest is through self-harm and suicide. Here, the authors present a retrospective, cross-sectional study examining self-harm in an older adult population in the south west of England.

The Effect of Indoor Daylight Levels on Hospital Costs and Length of Stay of Patients Admitted to General Surgery.

BACKGROUND: Indoor daylight levels can directly affect the physical and psychological state of people. However, the effect of indoor daylight levels on the clinical recovery process of the patient remains controversial. This study was to evaluate the effect of indoor daylight levels on hospital costs and the average length of stay (LOS) of a large patient population in general surgery wards. METHODS: Data were collected retrospectively and analyzed of patients in the Second Affiliated Hospital of Zhejiang University, School of Medicine between January 2015 and August 2020. We measured daylight levels in the patient rooms of general surgery and assessed their association with the total hospital costs and LOS of the patients. RESULTS: A total of 2,998 patients were included in this study with 1,478 each assigned to two daylight level groups after matching. Overall comparison of hospital total costs and LOS among patients according to daylight levels did not show a significant difference. Subgroup analysis showed when exposed to higher intensity of indoor daylight, illiterate patients had lower total hospital costs (CNY ¥13070.0 vs. ¥15210.3, p = 0.018) and shorter LOS (7 vs. 10 days, p = 0.011) as compared to those exposed to a lower intensity. CONCLUSIONS: Indoor daylight levels were not associated with the hospital costs and LOS of patients in the wards of general surgery, except for those who were illiterate. It might be essential to design guidelines for medical staff and healthcare facilities to enhance the indoor environmental benefits of daylight for some specific populations.

The Effect of COVID-19 on Cardiac Surgical Volume and its Associated Costs.

The COVID-19 pandemic significantly affected health care and in particular surgical volume. However, no data surrounding lost hospital revenue due to decreased cardiac surgical volume have been reported. The National Inpatient Sample database was used with decreases in cardiac surgery at a single center to generate a national estimate of decreased cardiac operative volume. Hospital charges and provided charge to cost ratios were used to create estimates of lost hospital revenue, adjusted for 2020 dollars. The COVID period was defined as January to May of 2020. A Gompertz function was used to model cardiac volume growth to pre-COVID levels. Single center cardiac case demographics were internally compared during January to May for 2019 and 2020 to create an estimate of volume reduction due to COVID. The maximum decrease in cardiac surgical volume was 28.3%. Cumulative case volume and hospital revenue loss during the COVID months as well as the recovery period totaled over 35 thousand cases and 2.5 billion dollars. Institutionally, patients during COVID months were younger, more frequently undergoing a CABG procedure, and had a longer length of stay. The pandemic caused a significant decrease in cardiac surgical volume and a subsequent decrease in hospital revenue. This data can be used to address the accumulated surgical backlog and programmatic changes for future occurrences.

COVID-19-associated hospitalizations among children less than 12 years of age in the United States.

OBJECTIVES: To describe the characteristics, healthcare resource use and costs associated with initial hospitalization and readmissions among pediatric patients with COVID-19 in the US. METHODS: Hospitalized pediatric patients, 0-11 years of age, with a primary or secondary discharge diagnosis code for COVID-19 (ICD-10 code U07.1) were selected from 1 April 2020 to 30 September 2021 in the US Premier Healthcare Database Special Release (PHD SR). Patient characteristics, hospital length of stay (LOS), in-hospital mortality, hospital costs, hospital charges, and COVID-19-associated readmission outcomes were evaluated and stratified by age groups (0-4, 5-11), four COVID-19 disease progression states based on intensive care unit (ICU) and invasive mechanical ventilation (IMV) usage, and three sequential calendar periods. Sensitivity analyses were performed using the US HealthVerity claims database and restricting the analyses to the primary discharge code. RESULTS: Among 4,573 hospitalized pediatric patients aged 0-11 years, 68.0% were 0-4 years and 32.0% were 5-11 years, with a mean (median) age of 3.2 (1) years; 56.0% were male, and 67.2% were covered by Medicaid. Among the overall study population, 25.7% had immunocompromised condition(s), 23.1% were admitted to the ICU and 7.3% received IMV. The mean (median) hospital LOS was 4.3 (2) days, hospital costs and charges were $14,760 ($6,164) and $58,418 ($21,622), respectively; in-hospital mortality was 0.5%. LOS, costs, charges, and in-hospital mortality increased with ICU admission and/or IMV usage. In total, 2.1% had a COVID-19-associated readmission. Study outcomes appeared relatively more frequent and/or higher among those 5-11 than those 0-4. Results using the HealthVerity data source were generally consistent with main analyses. LIMITATIONS: This retrospective administrative database analysis relied on coding accuracy and inpatient admissions with validated hospital costs. CONCLUSIONS: These findings underscore that children aged 0-11 years can experience severe COVID-19 illness requiring hospitalization and substantial hospital resource use, further supporting recommendations for COVID-19 vaccination.

Behavioural Economics of Safety Culture Management in Companies

Most companies care for money and profits more than the safety of their human resources. Why companies’ managements and employers do not decide to spend on safety cultural aspects, as because they are not concerned or less sensitive towards unsafe way of working leading to disaster, incidents, family suffering, impact on new generations, gas leakages or they are not aware that the benefits of safety implementation in any company, small or big, would definitely outweigh the monetary gains of not implementing it. This article discusses these factors based on observations of 309 industry professionals, and makes recommendations for HSE policy and planning towards a culture of safe businesses caring for human cost or losses. While considering the economics of safety management approach, it is important to understand as to why companies stop and refresh their actions for programs leading to longterm safety culture. Though, the slogan seems to have changed, i.e. behaviour first, as we used to say, safety first. However, a large number of Indian companies (90%) are still not able or willing to decide over safety culture management for a variety of reasons as discussed herein. This paper adds an in-depth sense of qualitative data on the topic.

Intensive Care Nurse Workload and Patient Acuity in Sfax, Tunisia: A COVID-19 Global Process Improvement Project

[...]managers must assign the right employees to the right job while ensuring a balanced workload to increase productivity, job efficiency, and equity among workers. According to Javanmardnejad and coauthors (2021), an essential step in increasing productivity is understanding factors involved in job satisfaction, quality of life, and happiness of nurses. [...]assigning every available nurse to the right place at the right time to do the right job was a significant concern of healthcare organizations. According to the THM and Regional Health Directorate of Sfax, on August 28, 2021, total cases reached 53,555 with 1,633 deaths, The number of patients suffering from health problems due to COVID-19 and requiring medical interventions has increased dramatically, creating an added workload for nurses in hospital intensive care units (ICUs) or COVID-19 centers (see Figure 1).

Clinical and economic benefits of lenzilumab plus standard of care compared with standard of care alone for the treatment of hospitalized patients with COVID-19 in the United States from the hospital perspective.

AIMS: Estimate the clinical and economic benefits of lenzilumab plus standard of care (SOC) compared with SOC alone in the treatment of patients hospitalized with COVID-19 pneumonia from the United States (US) hospital perspective. MATERIALS AND METHODS: A per-patient cost calculator was developed to report the clinical and economic benefits associated with adding lenzilumab to SOC in newly hospitalized COVID-19 patients over 28 days. Clinical inputs were based on the LIVE-AIR trial, including failure to achieve survival without ventilation (SWOV), mortality, time to recovery, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) use. Base case costs included the anticipated list price of lenzilumab, drug administration, and hospital resource costs based on the level of care required. A scenario analysis examined projected one-year rehospitalization costs. RESULTS: In the base case and all scenarios, lenzilumab plus SOC improved all specified clinical outcomes relative to SOC alone. Lenzilumab plus SOC resulted in estimated cost savings of $3,190 per patient in a population aged <85 years with C-reactive protein (CRP) levels <150 mg/L and receiving remdesivir (base case). Per-patient cost savings were observed in the following scenarios: (1) aged <85 years with CRP <150 mg/L, with or without remdesivir ($1,858); (2) Black and African American patients with CRP <150 mg/L ($13,154); and (3) Black and African American patients from the full population, regardless of CRP level ($2,763). In the full modified intent-to-treat population, an additional cost of $4,952 per patient was estimated. When adding rehospitalization costs to the index hospitalization, a total per-patient cost savings of $5,154 was estimated. CONCLUSIONS: The results highlight the clinical benefits for SWOV, ventilator use, time to recovery, mortality, time in ICU, and time on IMV, in addition to an economic benefit from the US hospital perspective associated with adding lenzilumab to SOC for COVID-19 patients.

THE IMPACT OF COVID-19 ON THE ROMANIAN HOSPITALS' EXPENSES. A CASE STUDY TOWARD THE FINANCIAL RESILIENCE AFTER THE PANDEMIC

The Coronavirus disease 2019 (COVID-19) affected almost all activities worldwide. The medical sector was one of those which were most significantly impacted because the medical infrastructure was not sized for such a high scale shock, specialized human resources and medical infrastructure proving to be much undersized and with slow growth potential. Many changes were required, important financial resources being mobilized in order to motivate medical staff, offer treatments for the most severely affected patients, but also to create new facilities where the increasing number of sick persons could be cured. In our research we want to offer a hospital cost perspective based on empirical analysis of the COVID-19 impact on different categories of expenses made by Romanian hospitals that treated patients with COVID-19 in different stages of their disease. The period analyzed was January 2019 to December 2020 on a monthly basis. Our results showed that expenses with goods and services, drugs, reagents and human resources are influenced by COVID-19 in a significant manner.