HCAHPS: having constant communication augments hospital and patient satisfaction.

BACKGROUND AND AIM: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has become a standardised instrument to measure hospitalised patients' perception of care. Our hospital's HCAHPS scores for the 'communication with doctors' domain in medical service were suboptimal when compared with peer groups in December 2020. Our goal was to improve performance in the 'communication with doctors' domain to at least 50% from baseline over a 6-month period. INTERVENTION: Orientation of house staff, nurses and attendings on the Acknowledge, Introduce, Duration, Explain, Thank you (AIDET) approach. Implementation of the afternoon rounds (with documentation) along with the morning rounds to summarise the plan and discuss updates throughout the day to enhance doctor-patient communication. DATA ANALYSIS: HCAHPS domain scores for 'communication with doctors' with each subcategory were tracked monthly as well as the number of PM notes written as a measure of afternoon rounds. RESULTS: 'Communication with doctor' domain improved from 8% percentile rank in December to as high as 78%. 'Doctors treat you with courtesy/respect' improved from 24% percentile rank in December to as high as 90%. 'Doctors listen carefully to you' improved from 13% percentile rank in December to as high as 88%. 'Doctors explain in a way you understand' improved from 2% percentile rank in December to as high as 72%. CONCLUSIONS: Our results suggest that HCAHPS scores in the 'communication with doctors' domain can be improved when employing the AIDET approach with each patient encounter and the addition of afternoon rounds. Sustainability is vital to the success of these interventions, as we observed in our results that there is a direct proportional correlation with the number of afternoon rounds performed with higher scores.

Variation in clinical characteristics, outcomes, and mortality of hospitalized patients with COVID-19 during the second wave of the pandemic: a single-center experience.

As of February 2, 2021, the USA has 26,431,799 reported COVID-19 cases with 446,744 deaths. A high mortality rate (15%-40%) was reported among hospitalized patients with COVID-19 during the first wave of the pandemic. However, data regarding variation in COVID-19-related mortality and severity of illness among hospitalized patients with COVID-19 are heterogeneous. In this retrospective single-center study, we aimed to investigate the demographic characteristics, clinical presentations, disease severity, clinical outcomes, and in-hospital mortality of hospitalized patients with COVID-19 during the second wave of the pandemic. Adults with reverse transcription-PCR-confirmed SARS-CoV-2 infection were included. In-hospital mortality due to COVID-19 was the primary outcome, and intensive care unit admission, acute kidney injury, acute respiratory distress syndrome, respiratory failure requiring intubation, and septic shock were the secondary outcomes. A total of 101 adult patients were hospitalized with COVID-19 during the second wave study period. Of 101 patients, 8 were intubated and 6 died. The median duration of hospital stay was 6 days. Patients in the second wave were more likely to receive dexamethasone and remdesivir and less likely to require invasive mechanical ventilation. In-hospital mortality during the second wave was lower (5.9%) compared with the first wave (15.5%). At the last follow-up date, 86.1% were discharged alive from the hospital, 5.9% died and 7.9% were still in the hospital. Multivariate logistic regression showed higher odds of mortality were associated with higher age and elevated lactate dehydrogenase peak.

COVID-19 patients in a tertiary US hospital: Assessment of clinical course and predictors of the disease severity.

INTRODUCTION: Patients with severe COVID-19 can develop ventilator-dependent acute hypoxic respiratory failure (VDAHRF), which is associated with a higher mortality rate. We evaluated the clinical course of hospitalized COVID-19 patients and compared them with the patients who received invasive mechanical ventilation. Characteristics of intubated patients who were successfully weaned from the ventilator were compared with the patients who failed to be extubated or died in the hospital. OBJECTIVE: To investigate the clinical course of hospitalized COVID-19 patients, and assess the possible predictors of the disease severity leading to VDAHRF. METHODS: This is a single-center, retrospective study. The first 129 patients (18 years or older) with COVID-19 admitted to Monmouth Medical Center from March 1st to April 25th, 2020 were included. RESULTS: Out of 129 patients, 23.25% (n = 30) required invasive mechanical ventilation, and of those, six patients were successfully weaned from the ventilator. Multivariable logistic regression analysis showed increased odds of intubation associated with hypoxemia (odds ratio 17.23, 95% CI 5.206-57.088; p < 0.0001), elevated d-dimer by one unit mg/L of FEU (odds ratio 1.515, 95% CI 5.206-57.088; p = 0.0430) and elevated ferritin by one unit ng/ml (odds ratio 1.001, 95% CI 1.000-1.001, p = 0.0051) on admission, adjusted for other covariates. CONCLUSIONS: Patients who required invasive mechanical ventilation were more likely to have older age, male gender, coronary artery disease, diabetes, and obesity. The patients who were successfully weaned from the ventilator were more likely to be younger in age, and none of them had heart failure or CAD.

Is There any Additional Benefit of Multiple Doses of Tocilizumab in COVID-19 Patients?

Many patients with coronavirus disease 2019 (COVID-19) have a hyperactive immune response (cytokine storm) which has been incriminated in multiorgan dysfunction (MOD). Interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are the key cytokines involved in mediating systemic inflammation and triggering endothelial dysfunction. To limit these effects, IL-6 receptor inhibitors (IL6ri) have been used in COVID-19 patients. The best approach regarding the total number of doses in COVID-19 patients is still unclear. In this single-center retrospective study, we investigated if multiple doses of tocilizumab (TCZ) prevented deterioration of COVID-19 patients. Patients were divided into two cohorts based on the number of TCZ doses; cohort 1 (received one dose) and cohort 2 (received ≥ two doses). In both cohorts, all-cause-mortality was the primary outcome. Of 270 hospitalized patients with COVID-19, 81 patients received TCZ. Fifty patients received one dose of TCZ and 31 received ≥ two doses. All-cause-mortality in cohort 2 remained higher (41.9%) suggesting that there was no additional benefit of multiple doses of TCZ to prevent the primary outcome. In addition, multiple doses of TCZ did not change any other secondary outcome [(ICU admission, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), acute cardiac injury (ACI), thrombotic events, septic shock, and total hospital stay].