Careggi Re-Engineered Discharge project: standardize discharge and improve care coordination between healthcare professionals.

BACKGROUND: The hospital discharge process plays a key role in patient care. Careggi Re-Engineered Discharge (CaRED) aimed at establishing a meaningful relationship among general practitioners (GPs) and patients, throughout the discharge process. OBJECTIVE: The aim is to describe the activities and results in the period 2014-17 of the CaRED. METHODS: CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy for effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction. RESULTS: A total of 1549 hospitalizations were included, respectively, 717 in the pre and 832 in the post-intervention period. The 30-day hospital readmission rate decreased significantly in the post-intervention period (14.4% vs. 19.4%, χ2(1) = 8.03, P < 0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post-survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1) = 0.56, P = 0.03) and on what to do if conditions change (χ2(31) = 19.0, P < 0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3) = 19.6, P < 0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post-survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P < 0.01). CONCLUSIONS: CaRED significantly improved the discharge process and became a benchmark for local improvements in communication patterns with GPs.

Return to Work of Healthcare Workers after SARS-CoV-2 Infection: Determinants of Physical and Mental Health.

Introduction. The SARS-CoV-2 pandemic has involved healthcare workers (HCWs) both as caregivers and as patients. This study is a retrospective cross-sectional analysis of the HCWs working in a third-level hospital in Central Italy who were infected with COVID-19 from March 2020 to April 2021. This research aims at identifying the physical and mental health outcomes of HCWs infected with COVID-19 who returned to work after the infection, the determinants of those outcomes, such as age and sex, and the identification of possible vulnerable professional groups. Methods. A questionnaire about the acute illness, the experience of returning to work, and health perceptions after the disease was administered to 427 healthcare workers 3 months after recovering from the SARS-CoV-2 infection. Results. The majority interviewed (84.5%) reported symptoms at the time of the positive test, with no significant differences regarding age or sex, while a significant difference in the mean age was found regarding hospitalization (p < 0.001). At 3 months after the infection, females (p = 0.001), older workers (p < 0.001), and healthcare assistants (p < 0.001) were more likely to report persistent symptoms. Sex (p = 0.02) and age (p = 0.006) influenced the quality of sleep after the infection. At work, the nurses group reported increase in workload (p = 0.03) and worse relationships (p = 0.028). At 3 months after the infection, female workers perceived worse physical (p = 0.002) and mental (p < 0.001) health status according to the SF-12. A negative correlation was found between age and PCS score (p < 0.001) but not MCS score (p = 0.86). A significant difference in PCS score was found between nurses and physicians (p = 0.04) and between residents and all other groups (p < 0.001). Finally, the group of workers reporting sleep alterations showed lower PCS and MCS scores (p < 0.001) and working relationships had an impact on MCS scores (p < 0.001). Conclusions. Age, sex, and type of job had an impact on physical and mental outcomes. Organizing specific interventions, also tailored to professional sub-groups, should be a target for healthcare systems to protect and boost the physical and mental health of their workers.

Cryptic severe Plasmodium falciparum malaria in a Moroccan man living in Tuscany, Italy, August 2018.

In August 2018 a Moroccan man living in Tuscany developed Plasmodium falciparum malaria. The patient declared having not recently visited any endemic country, leading to diagnostic delay and severe malaria. As susceptibility to P. falciparum of Anopheles species in Tuscany is very low, and other risk factors for acquiring malaria could not be completely excluded, the case remains cryptic, similar to other P. falciparum malaria cases previously reported in African individuals living in Apulia in 2017.

[Microbiological quality of hemodialysis water: what are the risk factors?]

BACKGROUND: A dialyzed patient weekly gets in touch with a large amount of water (on average 350 liters) through the dialysis bath. It is therefore essential that this solution would have a high quality and purity. The aim of our study was to monitor the microbiological quality of the hemodialysis water in order to identify possible factors that could affect it. METHODS: We conducted a cross-sectional study from January 2015 to October 2017 collecting the dialysis water in AOU Careggi. Samples were aseptically collected by specialized technicians and then transported under ice at 4° C to the Laboratory of Biological Hazards of USL Toscana Centro for laboratory analyses. RESULTS: 126 water samples were collected. Coliforms, E. coli, Staphylococcus aureus, enterococci were not detected. Pseudomonas aeruginosa was found in only one sample. Both for CFU at 37° C and at 22° C, the type of device represented the only statistically significant risk factor (OR 15.21 and OR 10.25 respectively): SDS devices had a significantly higher risk of being positive for CFU at 37° C and 22° C. CONCLUSIONS: As our study demonstrated, the system producing dialysis water must be constantly monitored, especially in cases of SDS devices which may be subjected more frequently to a higher contamination, due to their discontinuous use.

Recommended vaccinations for asplenic and hyposplenic adult patients.

Asplenic or hyposplenic (AH) individuals are particularly vulnerable to invasive infections caused by encapsulated bacteria. Such infections have often a sudden onset and a fulminant course. Infectious diseases (IDs) incidence in AH subjects can be reduced by preventive measures such as vaccination. The aim of our work is to provide updated recommendations on prevention of infectious diseases in AH adult patients, and to supply a useful and practical tool to healthcare workers for the management of these subjects, in hospital setting and in outpatients consultation. A systematic literature review on evidence based measures for the prevention of IDs in adult AH patients was performed in 2015. Updated recommendations on available vaccines were consequently provided. Vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended and should be administered at least 2 weeks before surgery in elective cases or at least 2 weeks after the surgical intervention in emergency cases. In subjects without evidence of immunity, 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella should be administered 4-8 weeks apart from each other; a booster dose of tetanus, diphtheria and pertussis vaccine should be administered also to subjects fully vaccinated, and a 3-dose primary vaccination series is recommended in AH subjects with unknown or incomplete vaccination series (as in healthy people). Evidence based prevention data support the above recommendations to reduce the risk of infection in AH individuals.

Large Nosocomial Outbreak of Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae Traced to Clonal Expansion of an mgrB Deletion Mutant.

We describe a large hospital outbreak (93 bloodstream infections) of colistin-resistant Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates which was mirrored by increased colistin consumption. The outbreak was mostly traced to the clonal expansion of an mgrB deletion mutant of an ST512 strain that produced KPC-3.

A retrospective analysis of hospital discharge records for S. pneumoniae diseases in the elderly population of Florence, Italy, 2010-2012.

Invasive pneumococcal diseases (IPD) and community acquired pneumonia (CAP) represent two of the major causes of out-patient visits, hospital admissions and deaths in the elderly. In Tuscany (Italy), in the Local Health Unit of Florence, a project aimed at implementing an active surveillance of pneumococcal diseases in the hospitalized elderly population started in 2013. The aim of this study is to show the results of the retrospective analysis (2010-2012) on hospital discharge records (HDRs) related to diseases potentially due to S. pneumoniae, using a selection of ICD9-CM codes. All ordinary hospitalizations (primary and secondary diagnoses) of the elderly population were included (11 245 HDRs). Among a population of about 200 000 inhabitants ≥65 y, the hospitalization rate (HR) increased with increasing age and was higher in males in all age groups. Almost all hospitalizations (95%) were due to CAP, only 5% were invasive diseases. Only few cases of CAP were specified as related to S. pneumoniae, the percentage was higher in case of meningitis (100%) or septicemia (22%). In-hospital deaths over the three-year period were 1703 (case fatality rate: 15%). The risk of dying, being hospitalized for a disease potentially attributable to pneumococcus (as primary diagnosis) increased significantly with age (P < 0.001), the odds ratio (OR) per increasing age year was 1.06 (95% CI 1.05-1.07) and was higher in patients with co-existing medical conditions with respect to patients without comorbidities. Currently, an active surveillance system on S. pneumoniae diseases with the inclusion of bio-molecular tests (RT-PCR), is a key step to assess the effectiveness of the PCV13 vaccine (13-valent pneumococcal conjugate vaccine) in the elderly population after implementation of vaccination policies. The results of this study will provide the comparator baseline data for the evaluation of a possible immunization programme involving one or more cohorts of the elderly in Tuscany.

The effect of leadership on hand hygiene: assessing hand hygiene adherence prior to patient contact in 2 infectious disease units in Tuscany.

We assessed hand hygiene adherence in 2 infectious disease units. In one unit, adherence declined slightly from year 1 (84.2%) to year 4 (71.0%) after a multimodal intervention but remained much higher than before intervention. Adherence dropped in the second unit after a loss of leadership (from 50.7% to 5.7%). Strong leadership presence may improve hand hygiene adherence.

HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence.

BACKGROUND: A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. OBJECTIVE: This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. METHODS: The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. RESULTS: A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. CONCLUSIONS: The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.

Patients' evaluation of hospital foodservice quality in Italy: what do patients really value?

OBJECTIVE: Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients' satisfaction with hospital food and investigated aspects influencing it. DESIGN: We conducted a cross-sectional study collecting patients' preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients' characteristics, hospital recovery aspects and overall foodservice satisfaction (OS). SETTING: A university hospital in Florence, Italy, in the period November-December 2009. SUBJECTS: Hospital patients aged 18+ years (n 927). RESULTS: Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha α(C) = 0.856), i.e. food quality (FQ; α(C) = 0·74), meal service quality (MSQ; α(C) = 0·73), hunger and quantity (HQ; α(C) = 0·74) and staff/service issues (SI; α(C) = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024). CONCLUSIONS: The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients' satisfaction were those related to food quality.