Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study.

BACKGROUND: Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the "weekend effect" results in a higher mortality after admission for acute aortic dissection (AAD),-classified according to Stanford types-remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. METHODS: We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. RESULTS: Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07-1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06-1.48 vs. 1.17-1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64-1.09 vs. 0.40-2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). CONCLUSIONS: In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

Derivaciones de profesionales de la salud al Equipo de Psicopedagogía del Hospital General Carlos G. Durand / Referrals from health professionals to the psychopedagogy team of the General Hospital Carlos G. Durand

Proyecto de investigación de residentes de tercer año de Psicopedagogia en el Hospital General de Agudos Carlos Durand, de la Ciudad de Buenos Aires, centrado en el espacio de admisión, y en las expectativas de sus profesionales, al indicar admisión al Servicio de Psicopedagogía, en el período 2017-2019.

El plan de alta de enfermería y su impacto en la disminución de reingresos hospitalario / The nursing discharge plan and its impact on the reduction of hospital readmissions

En 1984 surgió el plan de alta en enfermería en Estados Unidos. Éste fue incluido dentro del sistema Medicare con el propósito de reducir los costos del sistema de salud, por lo que este se extendió rápidamente a Europa y América Latina. En México existen pocos estudios sobre al plan de alta en enfermería, por lo que es necesario evaluar la trascendencia y el impacto de su aplicación. material y métodos: Se realizó un estudio transversal, descriptivo y cuantitativo en un hospital de tercer nivel. La población de estudio fueron las enfermeras con licenciatura del turno matutino. El instrumento de recolección estuvo dividido en cuatro apartados (datos generales, elaboración y contenido del plan, así como el impacto de su aplicabilidad). Resultados: Las recomendaciones del plan de alta se centran en: los medicamentos, los signos y síntomas de alarma, los cuidados en el hogar y las medidas higiénico-dietéticas con 81%. Los profesionales de enfermería lo aplican de forma oral y escrita en 79%. Más de 50% no registra esta actividad en el expediente clínico. Su aplicación contribuye con el derecho que tienen los pacientes de estar informados, además del impacto en los reingresos hospitalarios. Conclusiones: La aplicación del plan de alta en enfermería es una de las formas para fomentar la reintegración del paciente a la sociedad, ya que nos proporciona una visión completa, rápida y veraz del estado de salud del paciente.

In 1984, there is the nursing discharge plan in the U.S. and this is included in the Medicare system, in order to reduce costs in the health system, so this quickly spread to Europe and Latin America. In Mexico there are few studies on the Nursing discharge plan, so it is necessary to evaluate the significance and impact of the implementation. material and methods: We conducted a cross-sectional, descriptive, quantitative, in a tertiary hospital. The study population consisted of nurses with bachelor’s morning shift. The survey instrument was divided into four sections (general information, preparation and content of the plan and the impact of its applicability. Results: The plan’s recommendations focus on high.

The increasing secondary care burden of idiopathic pulmonary fibrosis: hospital admission trends in England from 1998 to 2010.

BACKGROUND: The lack of mandatory clinical registries for idiopathic pulmonary fibrosis (IPF) has meant a reliance on routine clinical data to provide trends in disease incidence. Death certificate and primary care data suggest that the incidence of IPF has increased in the United Kingdom at a rate of approximately 5% per year, but due to possible concerns about the diagnostic validity of these clinical datasets, it is helpful also to analyze data from secondary care. We used national secondary care data to determine trends in hospital admissions for IPF clinical syndrome (IPF-CS) in England between 1998 and 2010. METHODS: We obtained the annual number of hospital admissions for all National Health Service (NHS) hospital trusts in England for the International Classification of Diseases and Related Health Problems, 10th Revision codes J84.1 and J84.9 between 1998 and 2010. We calculated annual admission-rate ratios, adjusting for age and sex, using Poisson regression. We also investigated changes in age at admission and length of stay, and we estimated hospitalization costs. RESULTS: The number of hospital admissions from IPF-CS increased at an annual rate of approximately 5%, from 5,524 patients in 1998 to 9,525 patients in 2010, and was highest in men and the older population. Mean age at admission increased from 66 to 71 years, while length of stay decreased by 2.1 days during the same period. CONCLUSIONS: Hospital admissions for IPF-CS in England follow a similar trend to other data sources in the United Kingdom . This has resulted in escalating costs of inpatient care, which is a significant financial burden on health-care resources.

Influence of language barriers on outcomes of hospital care for general medicine inpatients.

BACKGROUND: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency. OBJECTIVE: : To examine whether patients' primary language influences hospital outcomes. DESIGN AND SETTING: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003. PATIENTS: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese. MEASUREMENTS: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality. RESULTS: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively). CONCLUSIONS: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276-282. (c) 2010 Society of Hospital Medicine.

Transporte interhospitalario de largo recorrido. Utilidad de las escalas de gravedad / Long distance interhospital transport. Accuracy of severity scoring system

Objetivo. Evaluar el riesgo de mortalidad hospitalaria del paciente trasladado desde un hospital comarcal a un hospital de referencia de segundo nivel mediante las escalas Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), SAPS II y APACHE II. Diseño y ámbito. Estudio prospectivo observacional de los pacientes trasladados desde el hospital Sant Hospital de la Seu d'Urgell al Hospital Universitario Arnau de Vilanova de Lleida, a 132 km de distancia. Pacientes. Se incluyó a 134 pacientes consecutivos trasladados desde octubre de 2005 a julio de 2007. Variables principales. Se recogieron datos de filiación, estancia, nivel de gravedad, diagnóstico principal, servicio de destino y variables clínicas como ventilación mecánica, uso de inotrópicos, sedantes, relajantes musculares y antiarrítmicos. Se consideró como variable de resultado la mortalidad hospitalaria. Resultados. La media ± desviación estándar del tiempo de traslado fue 105 ± 14 min. El 31,6% ingresaron en una unidad de cuidados intensivos. Fallecieron durante el ingreso hospitalario 16 (11,9%)pacientes. El APACHE II y el SAPS II fueron significativamente más elevados en los pacientes que fallecieron. El RAPS y el REMS no mostraron diferencias significativas entre fallecidos y supervivientes. A mayor puntuación en APACHE II y SAPS II, se observó un aumento proporcional de mortalidad. El RAPS y el REMS no mostraron esta tendencia. El área bajo la curva ROC fue mejor para el APACHE II (0,76; intervalo de confianza [IC] del 95%, 0,63-0,89) y el SAPS II (0,78; IC del 95%, 0,67-0,89) que para el RAPS (0,59; IC del 95%, 0,43-0,75) y el REMS (0,63; IC del 95%, 0,49-0,78). Conclusiones. El nivel de gravedad medido con APACHE II y SAPS II es un método útil para determinar el pronóstico de los pacientes trasladados permitiendo adecuar los recursos sanitarios fundamentalmente ante trayectos prolongados (AU)

Objective. To evaluate the hospital mortality risk for patients transported from a regional hospital to its second-level reference hospital using several scoring systems: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), SAPS II and APACHE II Design and setting. Prospective observational study of patients transferred from the Sant Hospital in la Seu d'Urgell to the University Hospital Arnau de Vilanova in Lleida, at a distance of 132 km. Patients. Consecutive cohort of 134 patients transferred between October 2005 and July 2007. Main variables. Several data were collected, such as variables on demography, stay, severity score, diagnosis on admission, destination service and procedures, such as mechanical ventilation, inotropics, sedation, neuromuscular blockers and antiarrhythmics. Variable of result was hospital mortality. Results. The average transfer time was 105 ± 14 minutes; 31.6% of the patients were admitted to an ICU; 16 (11,9%) patients died during hospital stay. The APACHE II and SAPS II scores got significantly higher values in those patients who died. The RAPS and REMS scores showed no significant differences among dead and survivors. The higher the APACHE II and SAPS II scores, the higher the proportion of mortality. The RAPS and REMS scores did not prove to have that tendency. Area under ROC curve was higher for APACHE II (0.76; 95% CI, 0.63-0.89) and SAPS II (0.78; 95% CI, 0.67-0.89), compared to those of RAPS (0.59; 95% CI, 0.43-0.75) and REMS (0.63; 95% CI, 0.49-0.78). Conclusions. The severity of illness measured with APACHE II and SAPS II is able to identify those patients with a higher predictive of mortality. It is a priority to have the right previous stabilization and the adequately trained team to provide care during the transfer, when facing lengthy journey times (AU)

Weekends: a dangerous time for having a stroke?

BACKGROUND AND PURPOSE: Weekend admissions are associated with higher in-hospital mortality. However, limited information is available concerning the "weekend effect" on stroke mortality. Our aim was to evaluate the impact of weekend admissions on stroke mortality in different settings. METHODS: We analyzed all hospital admissions for ischemic stroke from April 2003 to March 2004 through the Hospital Morbidity Database. The Hospital Morbidity Database is a national database that contains patient-level sociodemographic, diagnostic, procedural, and administrative information including all acute care facilities across Canada. The major inclusion criterion was admission to an acute care facility with a principal diagnosis of ischemic stroke. Clinical variables and facility characteristics were included in the analysis. RESULTS: Overall, 26,676 patients were admitted to 606 hospitals for ischemic stroke. Weekend admissions comprised 6629 (24.8%) of all admissions. Seven-day stroke mortality was 7.6%. Weekend admissions were associated with a higher stroke mortality than weekday admissions (8.5% vs 7.4%; odds ratio, 1.17; 95% CI, 1.06 to 1.29). Mortality was similarly affected among patients admitted to rural versus urban hospitals or when the most responsible physician was a general practitioner versus specialist. In the multivariable analysis, weekend admissions were associated with higher early mortality (odds ratio, 1.14; 95% CI, 1.02 to 1.26) after adjusting for age, sex, comorbidities, and medical complications. CONCLUSIONS: Stroke patients admitted on weekends had a higher risk-adjusted mortality than did patients admitted on weekdays. Disparities in resources, expertise, and healthcare providers working during weekends may explain the observed differences in weekend mortality.

The key to improving prognosis for aneurysmal subarachnoid hemorrhage remains in the pre-hospitalization period.

BACKGROUND: Despite advances in neurosurgical management, aneurismal subarachnoid hemorrhage (aSAH) still has high mortality and morbidity. This study aimed to clarify how delaying hospital admission after aSAH contributes to worse prognosis even today and to find the possibility for an improvement of its prognosis by early admission. METHODS: Four hundred twenty-one consecutive patients are the basis for this study. Cause of delay was classified into 5 categories: patient delay (PD), doctor delay (DD), transportation delay (TD), no delay (ND) (within 2 hours of onset), and others. Condition of each patient was assessed at time of onset and admission using H&K. The relationships between cause of delay and worsening of Hunt and Kosnik grading (H&K) were examined. RESULTS: The median delay time was 1.7 days. Only 41% of patients visited our institution without delay. Admission delay, especially PD and DD, exhibited a significant correlation to worsening of H&K. In addition to nondirect admission, misdiagnosis or delayed diagnosis contributed significantly to worsening of H&K. Incidence of DD has declined in recent years, whereas that of PD has increased. Consequently, no change in total number of delays was found. CONCLUSIONS: There remains much room for an improvement of prognosis for aSAH by early admission. We need to fully realize this reality and to directly face this problem.

Servicio de Admisión / Admissions Service

En este trabajo describimos el desarrollo de las actuaciones del Servicio de Admisión durante el día de los atentados terroristas, 11 de marzo de 2004. En primer lugar intentamos describir los objetivos y líneas de actuación que consideramos debíamos cubrir desde nuestro servicio. A continuación, relatamos cómo nos organizamos en grupos de trabajo a fin de intentar coordinar las actividades y sincronizarlas de la forma más efectiva posible. Asimismo, se explican las dificultades que fueron surgiendo a lo largo del día en relación con el cumplimiento de algunas de nuestras funciones. Seguidamente referimos la secuencia de las acciones que se ejecutaron desde el inicio de la jornada hasta el día en que se dio de alta la última víctima del atentado. Se concluye el trabajo con una valoración del conjunto de actuaciones que se llevaron a cabo (AU)

In the present article we describe the activity of the admissions service on the day of the terrorist attacks, 11 March, 2004. Firstly, we try to describe the objectives and lines of intervention that we believe should be covered by our service. Subsequently, we describe how we organized ourselves into teams in order to organize and synchronize activities as effectively as possible. The difficulties that arose during the course of the day in performing some our functions are discussed. Next, we report the sequence of interventions that were carried out from the morning of 11 March until the last victim of the terrorist attack was discharged. The article concludes with an overall evaluation of the activity performed (AU)

The epidemiology of organophosphate poisoning in urban Zimbabwe from 1995 to 2000.

The objective of this study was to examine current organophosphate usage in Zimbabwe. A cross-sectional descriptive study was done to determine the trends in admissions for organophosphate poisonings in an urban Zimbabwe hospital from 1995 to 2000. Variables such as sex, age, season, geographic area, and intent were examined. In 183,569 records, 599 cases of organophosphate poisoning were found. Organophosphate poisonings increased by 320% over the six years. The male and female admissions' rates were similar (48% vs 52%); 82% of the patients were less than 31 years old. Suicide was the predominant reason for poisoning (74%). Of admissions of children under the age of 10, 62% were due to accidental ingestion. Mortality from organophosphate poisonings was 8.3% over the six years. Organophosphate poisoning is increasing rapidly. In the background of this alarming trend is the physical, mental, and social state of a Zimbabwean society wrought with hardships.

Evaluación del uso hospitalario según el aep (protocolo de evaluación de la adecuación) en un servicio de cirugía general / Evaluation of hospital utilization in a general surgery department according to the AEP (appropriateness evaluation protocol)

Introducción. La evaluación del uso hospitalario ha cobrado gran interés por su posible utilidad a la hora de reducir el gasto sanitario sin disminuir la calidad de la asistencia. Una de las aproximaciones más usadas cuando se revisa el uso hospitalario es el estudio retrospectivo de las historias clínicas con instrumentos objetivos como el protocolo de evaluación de la adecuación (AEP). Este trabajo trata de estudiar mediante dicho método la adecuación de los ingresos y días de estancia de los pacientes ingresados en un servicio de cirugía general durante un mes, así como las principales causas de inadecuación. Pacientes y métodos. Se calcularon dos muestras, una de ingresos y otra de estancias a estudiar, ambas para una precisión del 7 por ciento y un error alfa del 5 por ciento. La muestra de ingresos fue de 66 pacientes y la de estancias de 125. En ambas la selección se llevó a cabo de manera aleatoria. Resultados. Se estudiaron 66 ingresos, 29 programados y 37 urgentes. La adecuación de la admisión en los ingresos programados fue del 72,4 por ciento, mientras que la adecuación en la oportunidad del ingreso fue del 86,2 por ciento. El 97,3 por ciento de los ingresos urgentes fueron adecuados, siendo la principal causa de inadecuación que las pruebas se podrían haber realizado de manera ambulatoria. La estancia media del conjunto de pacientes estudiados fue de 7,9 días (DE = 5,8). El 50 por ciento de los pacientes tuvieron una estancia igual o inferior a 6 días. De las 125 estancias estudiadas, resultaron adecuadas 90 (72 por ciento) e inadecuadas 35 (28 por ciento). La causa más frecuente de inadecuación de la estancia fue que el paciente estuviera pendiente de resultados de pruebas diagnósticas o terapéuticas, seguida de la permanencia hospitalaria del paciente cuando éste ya no recibía o requería los servicios de un centro de agudos y de la inexistencia de un plan de diagnóstico y/o tratamiento. Conclusiones. El AEP (protocolo de la evaluación de la adecuación) es un sistema válido a la hora de valorar el uso hospitalario. De entre los resultados del estudio que hemos realizado destacan la mayor adecuación de ingresos urgentes respecto a los programados y la significación que existió entre la mayor inadecuación en la estancia prequirúrgica respecto a la posquirúrgica (AU)

Reimaginar el servicio de admisión a la atención abierta / Reimagine the admission service to an open care

En el Centro de Referencia del Hospital San Martín de Quillota se encuentra la Unidad de Admisión Abierta, la cual cumple con el rol fundamental de ser el punto de relación entre los usuarios y los dispositivos de atención ambulatorio del establecimiento. Dadas las múltiples dificultades en el funcionamiento adecuado de esta unidad y los altos niveles de insatisfacción de los usuarios, detectados en el diagnóstico de situación, se da inicio a un proceso de modernización de esta unidad tendiente a contribuir a la mejoría global de la calidad de la atención entregada, a mejorar la cobertura de atención y a transparentar los mecanismos de acceso a la atención ambulatorio. Luego de un año de trabajo se han alcanzado logros concretos a través de la mecanización de los procesos de admisión, coordinación más eficaz con los qiveles locales y una mejor organización de las agendas médicas