Admission to the Intensive Care Unit is Associated With Changes in the Oral Mycobiome.
*Intensive Care Units; 80 and over; Adult; Aged; Candida albicans; Candida Albicans; Candida albicans/*isolation & purification; Candidiasis; critical care; Critical Care; Cross Infection/microbiology/prevention & control/*transmission; Female; Human; Humans; Length of Stay; Male; Middle Aged; mycobiome; Mycobiome/*immunology; Mycological Typing Techniques; Mycoses; Oral Health; Oral/microbiology/prevention & control/*transmission; Prospective Studies; Risk Factors; United States/epidemiology; Young Adult
A prospective exploratory study was conducted to characterize the oral mycobiome at baseline and determine whether changes occur after admission to the intensive care unit (ICU). We found that ICU admission is associated with alterations in the oral mycobiome, including an overall increase in Candida albicans.
Watkins Richard R; Mukherjee Pranab K; Chandra Jyotsna; Retuerto Mauricio A; Guidry Chrissy; Haller Nairmeen A; Paranjape Charudutt; Ghannoum Mahmoud A
Journal of intensive care medicine
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0885066615627757" target="_blank" rel="noreferrer noopener">10.1177/0885066615627757</a>
Altered Mental Status and Delirium
adults; Altered mental status; cognitive impairment; confusion assessment method; delirium; Dementia; Elderly; elderly-patients; Emergency Medicine; Emergency Medicine; emergency-department patients; haloperidol; intensive-care-unit; Length of Stay; Medical decision-making capacity; scale; screening tools
Older patients who present to the emergency department frequently have acute or chronic alterations of their mental status, including their level of consciousness and cognition. Recognizing both acute and chronic changes in cognition are important for emergency physicians. Delirium is an acute change in attention, awareness, and cognition. Numerous life threatening conditions can cause delirium; therefore, prompt recognition and treatment are critical. The authors discuss an organized approach that can lead to a prompt diagnosis within the time constraints of the emergency department.
Wilber S T; Ondrejka J E
Emergency Medicine Clinics of North America
2016
2016-08
Journal Article
<a href="http://doi.org/10.1016/j.emc.2016.04.012" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2016.04.012</a>
Antibiotics and Adverse Events: Doctors, Do No Harm!
Length of Stay; Patient Safety; Internal Medicine; Clostridium Infections; Adverse Drug Event; Drug Toxicity; Pruritus; Medical Practice; Evidence-Based; Antibiotics – Therapeutic Use; Antibiotics – Administration and Dosage; Antibiotics – Adverse Effects; Clostridium Infections – Etiology; Hospitalization – Statistics and Numerical Data; Adverse Drug Event – Classification; Adverse Drug Event – Etiology; Adverse Drug Event – Risk Factors; Anaphylaxis – Risk Factors
A retrospective study found that among 1,488 hospitalized patients who received an antibiotic, 298 (20%) experienced at least one antibiotic-associated adverse drug event. Furthermore, 287 (19%) of the antibiotic regimens were not clinically indicated, and 56 (20%) of these were associated with an adverse drug event.
Watkins Richard R
Hospital Medicine Alert
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antibiotics for Acute Appendicitis.
Postoperative Complications; Antibiotics; Length of Stay; Decision Making; Appendectomy; Tomography; Human; Multicenter Studies; X-Ray Computed; Intravenous; Administration; Treatment Outcomes; Patient Education; Randomized Controlled Trials; Emergency Treatment; Antibiotics – Therapeutic Use; Appendicitis – Ultrasonography; Appendicitis – Drug Therapy; Appendicitis – Surgery
The article reports that patients with uncomplicated acute appendicitis can fair well without surgery as compared to clinical trial patients who underwent surgery, and states that patients had lower risk of complications during the one-year follow-up period.
Watkins Richard R
Internal Medicine Alert
2015
2015-09-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Appendicitis in the elderly: a change in the laparoscopic era.
*Laparoscopy; 80 and over; Aged; Appendectomy/*methods; Appendicitis/diagnostic imaging/mortality/*surgery; Female; Humans; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies; Tomography; Treatment Outcome; X-Ray Computed
BACKGROUND: Appendicitis in elderly patients is associated with significant morbidity and mortality. Early and correct diagnosis together with minimally invasive surgery can lead to more favorable outcomes than occurred in the prelaparoscopic era. METHODS: A retrospective review of 116 elderly patients (age \textgreater 60) from 1999 to 2004 is compared with the authors' previously published studies from 1978 to 1988 (n = 96) and from 1988 to 1998 (n = 113), respectively. RESULTS: In our current series (1999-2004), more cases were managed laparoscopically (n = 68) than with open surgery (n = 48). Perforated appendicitis cases resulted in significantly longer hospital stays, more complications, and longer operating time than nonperforated cases. The laparoscopic cases had significantly shorter lengths of hospital stay and fewer complications than open cases, and comparable operating times. As compared with our previous studies from 1978 to 1988) and from 1988 to 1998, the current series (1999-2004) consists of patients presenting with fewer classical symptoms. Computed tomography (CT) scanning was more accurate in the current study and more routinely used. The patients in the current series had more correct preoperative diagnoses. Perforated appendicitis was encountered less frequently and associated with fewer complications. The 4% mortality rate in the previous two series decreased to less than 1% in this series. CONCLUSION: Minimally invasive surgery combined with increased use and accuracy of preoperative CT scans has changed the clinical management of acute appendicitis in elderly patients, leading to decreased lengths of stay, decreased mortality, and more favorable outcomes.
Paranjape C; Dalia S; Pan J; Horattas M
Surgical endoscopy
2007
2007-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s00464-006-9097-4" target="_blank" rel="noreferrer noopener">10.1007/s00464-006-9097-4</a>
Awake aortic aneurysm repair in patients with severe pulmonary disease.
*Consciousness; Abdominal/*surgery; Administration; Aged; Albuterol/administration & dosage/therapeutic use; Anesthesia; Aortic Aneurysm; Blood Loss; Bronchodilator Agents/administration & dosage/therapeutic use; Critical Care; Epidural; Forced Expiratory Volume/physiology; General; Home Care Services; Hospitalization; Humans; Hypnotics and Sedatives/administration & dosage; Iliac Aneurysm/*surgery; Inhalation; Intravenous; Length of Stay; Lung Diseases/*complications/drug therapy/therapy; Oxygen Inhalation Therapy; Retroperitoneal Space; Retrospective Studies; Risk Factors; Safety; Steroids/administration & dosage/therapeutic use; Surgical; Theophylline/administration & dosage/therapeutic use; Time Factors; Vital Capacity/physiology
BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
McGregor W E; Koler A J; Labat G C; Perni V; Hirko M K; Rubin J R
American journal of surgery
1999
1999-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9610(99)00153-1" target="_blank" rel="noreferrer noopener">10.1016/s0002-9610(99)00153-1</a>
Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients
after-discharge; alcohol; anemia; association; brain-injury; Function; injury severity score; intensive-care-unit; Length of Stay; life; outcomes; Patient Outcome Assessment; Recovery of; Rehabilitation; Rehabilitation; Sport Sciences; survival
Objective: The purpose of this study was to determine whether prolonged hospital length of stay (HLOS) and rehabilitation facility length of stay (RLOS) lead to poor functional outcomes, defined as a Functional Independence Measure (FIM) score of less than 76 (LFIM) at rehabilitation facility (RF) discharge. Design: This study analyzed retrospective data collected between 2002 and 2009 on 326 patients in a trauma center and affiliated RF. Factors predicting LFIM at RF discharge were determined using multivariate logistic regression, chi(2) tests, and t tests. Results: Significant multivariate predictors of LFIM included age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.07; P < 0.0001), spinal cord injury (OR, 7.22; 95% CI, 2.73-19.02; P = 0.000), female sex (OR, 2.34; 95% CI, 1.17-4.65; P = 0.01), and RF admission FIM (OR, 0.93; 95% CI, 0.91Y0.95; P < 0.001). An increased risk of LFIM (OR, 2.21; 95% CI, 1.41Y3.45; P = 0.001) was observed with an increased ratio of HLOS/RLOS after adjusting for injury severity score. Conclusion: An increased ratio of HLOS/RLOS increases the risk of LFIM more than 2-fold after adjusting for injury severity score, spinal cord injury, and FIM upon RF admission. Delays in transfer to an RF negatively affect patient functional outcomes. Studies to identify factors affecting delays in transfer from hospitals to RF should be conducted.
Muakkassa F F; Marley R A; Billue K L; Marley M; Horattas S; Yetmar Z; Salvator A; Hayek A
American Journal of Physical Medicine & Rehabilitation
2016
2016-08
Journal Article
<a href="http://doi.org/10.1097/phm.0000000000000453" target="_blank" rel="noreferrer noopener">10.1097/phm.0000000000000453</a>
Effect of Intravenous Versus Subcutaneous Phytonadione on Length of Stay for Patients in Need of Urgent Warfarin Reversal
coagulopathy; controlled trial; excessive anticoagulation; Length of Stay; Pharmacology & Pharmacy; phytonadione; vitamin-k; warfarin
This institutional review board-approved retrospective cohort study evaluated the impact of intravenous versus subcutaneous phytonadione on length of stay in hospitalized patients requiring urgent warfarin reversal. All patients were 18 years or older, on warfarin therapy with an international normalized ratio (INR) between 3.1 and 10.0, and had warfarin therapy restarted at discharge. Patients who received intramuscular or oral phytonadione, phytonadione by more than 1 route, fresh frozen plasma, or any other blood products containing clotting factors, patients with active or severe liver disease, and patients who received other forms of anticoagulation were excluded. A total of 4425 patients receiving phytonadione were evaluated and 79 patients were included. Baseline characteristics were similar between the intravenous and subcutaneous groups, including mean age, gender, warfarin indication, Charlson comorbidity index, and indication for phytonadione. Geometric mean length of stay in the intravenous group was 211.7 hours compared with 191.0 hours in the subcutaneous group (P = 0.47). Though intravenous phytonadione administration resulted in significantly lower INRs at all time points <36 hours, geometric mean time to restart of warfarin therapy was not impacted (66.3 hours vs. 64.1 hours, P = 0.72). Despite demonstrating significantly greater INR reductions, hospital length of stay and time to restart of warfarin therapy were not improved with the administration of intravenous over subcutaneous phytonadione.
Mottice B L; Soric M M; Legros E
American Journal of Therapeutics
2016
2016-03
Journal Article
<a href="http://doi.org/10.1097/mjt.0000000000000170" target="_blank" rel="noreferrer noopener">10.1097/mjt.0000000000000170</a>
Effects of pharmacy interventions at transitions of care on patient outcomes.
discharge medication reconciliation; length of stay; medication adherence; medication errors; pharmacists; readmissions
PURPOSE: An interdisciplinary group developed a care transitions process with a prominent pharmacist role. METHODS: The new transitions process was initiated on a 32-bed medical/surgical unit. Demographics, reconciliation data, information on medication adherence barriers, medication recommendations, and time spent performing interventions were prospectively collected for 284 consecutive patients over 54 days after the pharmacy participation was completely implemented. Outcome data, including 30-day readmission rates and length of stay, were retrospectively collected. RESULTS: When comparing metrics for all intervention patients to baseline metrics from the same months of the previous year, the readmission rate was decreased from 21.0% to 15.3% and mean length of stay decreased from 5.3 days to 4.4 days. Further improvement to a 10.2% readmission rate and a 3.6-day average length of stay were observed in the subgroup of intervention patients who received all components of the pharmacy intervention. Additionally, greater improvements were observed in intervention-period patients who received the full pharmacy intervention, as compared to those receiving only parts of the pharmacy intervention, with a 10.2-percentage-point lower readmission rate (10.2% vs 20.4%, P = 0.016) and a 1.7-day shorter length of stay (3.6 days vs. 5.3 days; 95% confidence interval, 0.814-2.68 days; P = 0.0003). For patients receiving any component of the pharmacy intervention, an average of 9.56 medication recommendations were made, with a mean of 0.89 change per patient deemed to be required to avoid harm and/or increased length of stay. CONCLUSION: A comprehensive pharmacy intervention added to a transitions intervention resulted in an average of nearly 10 medication recommendations per patient, improved length of stay, and reduced readmission rates.
Fosnight S; King Philip; Ewald Jacqueline; Feucht John; Lamtman Angela; Kropp D; Dittmer Alison; Sampson Jordan; Shah Morali
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
2020
2020-05-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1093/ajhp/zxaa081" target="_blank" rel="noreferrer noopener">10.1093/ajhp/zxaa081</a>
Feasibility and safety of adopting next-day discharge as first-line option after transfemoral transcatheter aortic valve replacement.
Female; Humans; Male; Aged; Retrospective Studies; Cohort Studies; Follow-Up Studies; Severity of Illness Index; Time Factors; United States; Aged 80 and over; Survival Analysis; Patient Readmission/statistics & numerical data; Propensity Score; Ohio; Academic Medical Centers; Risk Assessment; Feasibility Studies; Patient Discharge; aortic stenosis; transcatheter aortic valve replacement; Length of Stay; early discharge; minimalist approach; next-day discharge; Patient Safety; Aortic Valve Stenosis/diagnosis/surgery; Transcatheter Aortic Valve Replacement/methods/mortality
OBJECTIVES: Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR. METHODS: We reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization. RESULTS: Sixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08). CONCLUSIONS: Utilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.
Ichibori Y; Li J; Davis A; Patel TM; Lipinski J; Panhwar M; Saric P; Qureshi G; Patel SM; Sareyyupoglu B; Markowitz AH; Bezerra HG; Costa MA; Zidar DA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-03
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30819977
Freestanding emergency departments and the trauma patient.
*Wounds and Injuries/diagnostic imaging/etiology/mortality; Adult; Aged; Ambulatory Care Facilities/*statistics & numerical data; Emergency Service; Female; freestanding emergency departments; Hospital/*statistics & numerical data; Humans; Length of Stay; Male; Middle Aged; Radiography; Retrospective Studies; tertiary care; trauma; Trauma Centers/*statistics & numerical data
BACKGROUND: Freestanding emergency departments (FEDs) continue to grow in number and more research is needed on these facilities. OBJECTIVE: We sought to characterize the types of injuries and patients who initially presented to two FEDs and were transferred to the main tertiary care ED for trauma team consult and admission. METHODS: This retrospective cohort descriptive study examined medical records of adult trauma patients who were initially seen at an FED and then transferred to the main ED. All patients who received a trauma consultation were included. Data collection included demographics, initial mode of transport to the ED, injury, mechanism of injury, ED, hospital course and outcome. RESULTS: Mean age was 61.8 +/- 23.8, 96.7% were Caucasian and 52.5% were male. Mode of transport to the FEDs included private vehicle (46.4%) and emergency medical services (53.6%). The main injury mechanisms were fall from standing (51.9%) and fall from an object (16%). A total of 12.7% were from motor vehicle accidents and 6.6% presented from bicycle and all-terrain vehicle accidents. Blunt traumatic injuries accounted for 97.8% (n = 177) patients. Computed tomography scanning was performed on 90.1% of patients. Median ED length of stay was 189 min. Mean hospital length of stay was 3 days and 2.2% (n = 4) of patients died from their injuries. CONCLUSIONS: Understanding the patients and traumatic injuries that present to FEDs will guide training and identify resources needed for patients requiring additional care at a trauma center.
Simon Erin L; Medepalli Kantha; Williams Carolyn J; Yocum Andrew; Abrams Eric; Griffin Gregory; Orlik Kseniya
The Journal of emergency medicine
2015
2015-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jemermed.2014.09.005" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2014.09.005</a>
Heparin free dialysis in critically sick children using sustained low efficiency dialysis (SLEDD-f): A new hybrid therapy for dialysis in developing world.
Humans; Adolescent; Retrospective Studies; Child; Infant; *Critical Care/methods; Acute Kidney Injury/blood/mortality/*therapy; Critical Illness/*therapy; Developing Countries; Feasibility Studies; Follow-Up Studies; Length of Stay; Renal Dialysis/adverse effects/instrumentation/*methods; Treatment Outcome; Preschool
BACKGROUND: In critically sick adults, sustained low efficiency dialysis [SLED] appears to be better tolerated hemodynamically and outcomes seem to be comparable to CRRT. However, there is paucity of data in critically sick children. In children, two recent studies from Taiwan (n = 11) and India (n = 68) showed benefits of SLED in critically sick children. AIMS AND OBJECTIVES: The objective of the study was to look at the feasibility and tolerability of sustained low efficiency daily dialysis-filtration [SLEDD-f] in critically sick pediatric patients. MATERIAL AND METHODS: Design: Retrospective study Inclusion criteria: All pediatric patients who had undergone heparin free SLEDD-f from January 2012 to October 2017. Measurements: Data collected included demographic details, vital signs, PRISM III at admission, ventilator parameters (where applicable), number of inotropes, blood gas and electrolytes before, during, and on conclusion of SLED therapy. Technical information was gathered regarding SLEDD-f prescription and complications. RESULTS: Between 2012-2017, a total of 242 sessions of SLEDD-f were performed on 70 patients, out of which 40 children survived. The median age of patients in years was 12 (range 0.8-17 years), and the median weight was 39 kg (range 8.5-66 kg). The mean PRISM score at admission was 8.77+/-7.22. SLEDD-f sessions were well tolerated, with marked improvement in fluid status and acidosis. Premature terminations had to be done in 23 (9.5%) of the sessions. There were 21 sessions (8.6%) terminated due to hypotension and 2 sessions (0.8%) terminated due to circuit clotting. Post- SLEDD-f hypocalcemia occurred in 15 sessions (6.2%), post- SLEDD-f hypophosphatemia occurred in 1 session (0.4%), and post- SLEDD-f hypokalemia occurred in 17 sessions (7.0%). CONCLUSIONS: This study is the largest compiled data on pediatric SLEDD-f use in critically ill patients. Our study confirms the feasibility of heparin free SLEDD-f in a larger pediatric population, and even in children weighing \textless20 kg on inotropic support.
Sethi Sidharth Kumar; Bansal Shyam B; Khare Anshika; Dhaliwal Maninder; Raghunathan Veena; Wadhwani Nikita; Nandwani Ashish; Yadav Dinesh Kumar; Mahapatra Amit Kumar; Raina Rupesh
PloS one
2018
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1371/journal.pone.0195536" target="_blank" rel="noreferrer noopener">10.1371/journal.pone.0195536</a>
Mechanical Ventilation Antioxidant Trial.
Adult; Female; Humans; Male; Middle Aged; Time Factors; Aged; Length of Stay; Treatment Outcome; Prospective Studies; Oxidative Stress; Double-Blind Method; Intensive Care Units; Antioxidants/*therapeutic use; Antioxidants; Oxidative Stress/*drug effects; Critical Care/*methods; Human; Chi Square Test; Funding Source; Data Analysis Software; Middle Age; T-Tests; Ascorbic Acid/therapeutic use; Critical Illness; Cystine/analogs & derivatives/therapeutic use; Inflammation/*drug therapy/*etiology; Vitamin E/therapeutic use; Vitamins/therapeutic use; 80 and over; Artificial; Respiration; Artificial/*adverse effects; Randomized Controlled Trials; Double-Blind Studies; Acetylcysteine; Critically Ill Patients; Dietary Supplementation; Log-Rank Test; Mantel-Haenszel Test; Ventilator Weaning; Vitamin E; 80 and Over; Ascorbic Acid – Administration and Dosage
BACKGROUND: Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. OBJECTIVE: To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. METHODS: A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. RESULTS: Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. CONCLUSIONS: Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.
Howe Kimberly P; Clochesy John M; Goldstein Lawrence S; Owen Hugh
American journal of critical care : an official publication, American Association of Critical-Care Nurses
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4037/ajcc2015335" target="_blank" rel="noreferrer noopener">10.4037/ajcc2015335</a>
Outcomes among patients with heart failure with reduced ejection fraction undergoing transcatheter aortic valve replacement: Minimally invasive strategy versus conventional strategy.
Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Prognosis; Cohort Studies; Severity of Illness Index; Aged 80 and over; Logistic Models; Survival Rate; Length of Stay; Multivariate Analysis; Risk Assessment; Reference Values; Hospital Mortality; aortic stenosis; transcatheter aortic valve replacement; heart failure; Transcatheter Aortic Valve Replacement/methods/mortality; anesthesia; conscious sedation; Aortic Valve Stenosis/diagnostic imaging/epidemiology/therapy; Cardiac Catheterization/methods; Cardiac Output Low/diagnostic imaging; Conscious Sedation/methods; Echocardiography Transesophageal/methods; Heart Failure/diagnosis/epidemiology/therapy; Minimally Invasive Surgical Procedures/methods; Surgery Computer-Assisted/methods
OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50%, while 154 patients had EF ≤35%. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5% vs CS 8.8%; odds ratio for MIS, 0.60; 95% confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.
Panhwar MS; Li J; Zidar DA; Clevenger J; Lipinski J; Patel TR; Karim A; Saric P; Patel SM; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-03
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30555054
Outcomes of Patients With Syncope and Suspected Dementia.
80 and Over; Aged; Dementia – Diagnosis – In Old Age; Dementia – Risk Factors; Dementia – Therapy; Emergency; Human; Iatrogenic Disease; Inpatients; Interviews; Length of Stay; Middle Age; Office Visits; Outcome Assessment; Outcomes (Health Care); Patient Assessment; Patient Discharge; Physicians; Prospective Studies; Surveys; Syncope – Diagnosis; Syncope – In Old Age; Syncope – Mortality
OBJECTIVES: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
Holden Timothy R; Shah Manish N; Gibson Tommy A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/acem.13414" target="_blank" rel="noreferrer noopener">10.1111/acem.13414</a>
Patient Hand-Off iNitiation and Evaluation (PHONE) study: A randomized trial of patient handoff methods.
*Internship and Residency; *Medical errors; *Patient handoff; *Patient outcomes; *Patient safety; *Physician communication; *Sign-out; Female; Hospitals; Humans; Length of Stay; Male; Medical Errors/prevention & control; Middle Aged; Patient Handoff/*organization & administration; Patient Outcome Assessment; Patient Safety; Prospective Studies; Teaching; United States
BACKGROUND: As residency work hour restrictions have tightened, transitions of care have become more frequent. Many institutions dedicate significant time and resources to patient handoffs despite the fact that the ideal method is relatively unknown. We sought to compare the effect of a rigorous formal handoff approach to a minimized but focused handoff process on patient outcomes. METHODS: A randomized prospective trial was conducted at a large teaching hospital over ten months. Patients were assigned to services employing either formal or focused handoffs. Residents were trained on handoff techniques and then observed by trained researchers. Outcome data including mortality, negative events, adverse events, and length of stay were collected and compared between formal and focused handoff groups using t-tests and a multivariate regression analysis. RESULTS: A total of 5157 unique patient-admissions were stratified into the two study groups. Focused handoffs were significantly shorter and included fewer patients (mean 6.3 patients discussed over 6.7 min vs. 35.2 patients over 20.6 min, both p \textless 0.001). Adverse events occurred during 16.7% of patient admissions. While overall length of stay was slightly shorter in the formal handoff group (5.50 days vs 5.88 days, p = 0.024) in univariate analysis only, there were no significant differences in patient outcomes between the two handoff methods (all p \textgreater 0.05). CONCLUSIONS: This large randomized trial comparing two contrasting handoff techniques demonstrated no clinically significant differences in patient outcomes. A minimalistic handoff process may save time and resources without negatively affecting patient outcomes.
Clanton Jesse; Gardner Aimee; Subichin Michael; McAlvanah Patrick; Hardy William; Shah Amar; Porter Joel
American journal of surgery
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.amjsurg.2016.10.015" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2016.10.015</a>
Prolonged Clostridium difficile Infection May Be Associated With Vitamin D Deficiency.
*adult; *gastroenterology; *immunonutrition; *life cycle; *nutrition; *research and diseases; *sepsis; *vitamins; 80 and over; 80 and Over; Aged; Clostridium Infections – Etiology; Clostridium Infections – Mortality; Clostridium Infections – Physiopathology; Clostridium Infections/*etiology/mortality/physiopathology; Diarrhea – Microbiology; Diarrhea – Physiopathology; Diarrhea/microbiology/physiopathology; Female; Humans; Iatrogenic Disease – Epidemiology; Iatrogenic Disease/epidemiology; Length of Stay; Male; Middle Age; Middle Aged; Nutritional Status; Psychological Tests; Recurrence; Retrospective Design; Retrospective Studies; Sepsis – Epidemiology; Sepsis/epidemiology; Severity of Illness Index; Severity of Illness Indices; Vitamin D; Vitamin D – Blood; Vitamin D Deficiency – Blood; Vitamin D Deficiency – Complications; Vitamin D Deficiency/blood/*complications; Vitamin D/analogs & derivatives/blood
BACKGROUND: Clostridium difficile infection (CDI) is one of the leading causes of hospital-acquired infections, creating a financial burden for the U.S. healthcare system. Reports suggest that vitamin D-deficient CDI patients incur higher healthcare-associated expenses and longer lengths of stay compared to nondeficient counterparts. The objective here was to evaluate the relationship between vitamin D level and CDI recurrence. MATERIALS AND METHODS: A retrospective chart review was conducted for 112 patients with vitamin D level drawn within 3 months of CDI diagnosis. Recurrence, severity of disease, 30-day mortality, and course of CDI were assessed. RESULTS: The vitamin D-deficient group included 56 patients, and the normal group included 56 patients. The mean age of vitamin D-deficient and -sufficient groups was 68 +/- 15.7 and 71 +/- 14.4 years, respectively. The mean 25(OH) D level in the deficient group was 11.7 +/- 4.6 ng/mL, and it was 36.2 +/- 16.2 ng/mL in the normal group. A longer course of diarrhea was apparent in the vitamin D-deficient group compared to the normal group: 6.1 days (95% confidence interval [CI], 4.9-7.2) vs 4.2 days (95% CI, 3.5-4.9; P = .01). Sepsis rate was 24% in vitamin D-deficient group and 13% in normal group (P = .03). There were no differences in CDI recurrence, length of stay, severity of illness, and mortality with respect to vitamin D status. CONCLUSION: There may be an association between course of diarrhea and increased rate of sepsis in vitamin D-deficient CDI patients.
Wong Ken Koon; Lee Rebecca; Watkins Richard R; Haller Nairmeen A
JPEN. Journal of parenteral and enteral nutrition
2016
2016-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0148607114568121" target="_blank" rel="noreferrer noopener">10.1177/0148607114568121</a>
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis.
Aged; Humans; Male; Adult; Female; Hospitalization; Middle Aged; Adolescent; Young Adult; Length of Stay; Retrospective Studies; Prevalence; Health Resources; Opioid-Related Disorders/epidemiology; Pancreatitis Chronic/drug therapy
OBJECTIVES: We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients. METHODS: A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients. RESULTS: A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness. CONCLUSIONS: Opioid use disorder-related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Bilal M; Chatila A; Siddiqui MT; Al-Hanayneh M; Shah AR; Desai M; Wadhwa V; Parupudi S; Casey BW; Krishnan K; Hernandez-Barco YG
Pancreas
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/mpa.0000000000001430" target="_blank" rel="noreferrer noopener">10.1097/mpa.0000000000001430</a>
Short-term and long-term outcomes of patients undergoing urgent transcatheter aortic valve replacement under a minimalist strategy.
Female; Humans; Male; Retrospective Studies; Treatment Outcome; Risk Factors; United States/epidemiology; Follow-Up Studies; Severity of Illness Index; Time Factors; Aged 80 and over; Length of Stay; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement/methods; minimalist approach; Hospital Mortality/trends; severe aortic stenosis; urgent procedure; Aortic Valve Stenosis/diagnosis/mortality/surgery; Aortic Valve/diagnostic imaging/surgery; Cardiac Catheterization/methods; Echocardiography Transesophageal; Elective Surgical Procedures/methods; Femoral Artery
OBJECTIVES: Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral [TF] approach with conscious sedation and no transesophageal echocardiography guidance). METHODS: After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent
Ichibori Y; Li J; Patel T; Lipinski J; Ladas T; Saric P; Kobe D; Tsushima T; Peters M; Patel S; Davis A; Markowitz AH; Bezerra HG; Costa MA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30700628
The Hidden Value of Variation in Practice.
Length of Stay; Hospitals; Pediatric; ANTIBIOTICS; CHILDREN'S hospitals; CYSTIC fibrosis; DISEASE exacerbation; LENGTH of stay in hospitals; LUNG diseases; Antibiotics – Administration and Dosage; Cystic Fibrosis – Drug Therapy; Disease Exacerbation – Drug Therapy; Lung Diseases – Drug Therapy
McBride John T; Stokes Dennis C
Pediatrics
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1542/peds.2016-3876" target="_blank" rel="noreferrer noopener">10.1542/peds.2016-3876</a>
The impact of hospital boarding on the emergency department waiting room.
length of stay; crowding; emergency department boarding; emergency department wait times; hospital occupancy; waiting room
BACKGROUND: Patient boarding in the emergency department (ED) is a significant issue leading to increased morbidity/mortality, longer lengths of stay, and higher hospital costs. We examined the impact of boarding patients on the ED waiting room. Additionally, we determined whether facility type, patient acuity, time of day, or hospital occupancy impacted waiting rooms in 18 EDs across a large healthcare system. METHODS: This was a retrospective multicenter study that included all ED encounters between January 1, 2018, and September 30, 2019. Encounters with missing Emergency Severity Index (ESI) level were excluded. ESI levels were defined as high (ESI 1,2), middle (ESI 3), and low (ESI 4,5). Spearman correlation coefficients measured the relationship between boarded patients and number of patients in ED waiting room. A multivariable mixed effects model identified drivers of this relationship. RESULTS: A total of 1,134,178 encounters were included. Spearman correlation coefficient was significant between number of patients in the ED waiting room and patient boarding (0.54). For every additional patient boarded/hour, the number of patients waiting/hour in the waiting room increased by 8% (95% confidence interval [CI] = 1.08-1.09). The number of patients waiting for a room/hour was 2.28 times higher for middle than for high acuity. The number of patients in waiting room slightly decreased as hospital occupancy increased (95% CI = 0.997-0.997). CONCLUSION: Number of patients in ED waiting room are directly related to boarding times and hospital occupancy. ED waiting room times should be considered as not just an ED operational issue, but an aspect of hospital throughput.
Smalley CM; Simon EL; Meldon SW; Muir McKinsey R; Briskin I; Crane S; Delgado F; Borden BL; Fertel BS
Journal Of The American College Of Emergency Physicians Open
2020
2020-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/emp2.12100" target="_blank" rel="noreferrer noopener">10.1002/emp2.12100</a>
The relationship between psychiatric medication and course of hospital stay among intoxicated trauma patients
acute; brain-injury; chronic alcohol-abuse; comorbidity; cost; disorders; Emergency Medicine; ethanolism; general hospitals; hospitalization; inpatients; intoxication; Length of Stay; pneumonia; prevalence; Psychiatry; trauma
Introduction The purpose of this study was to determine whether trauma patients requiring psychiatric medication who were admitted with positive alcohol or drug screen require more pain medications or sedation resulting in longer length of stay. Methods Data were retrospectively collected from 1997 through 2003 on patients with positive alcohol or drug screen who also received psychiatric medication during their hospital stay in a trauma center. Patients were matched by age, injury severity score, and injury to controls who had negative alcohol and toxicology screens and no psychiatric medication. An additional group consisted of positive alcohol or drug-screen trauma patients without psychiatric medication during hospitalization. Each group had 25 patients. Results No significant differences between the three groups regarding comorbidities or pain-medication doses given per day were found. The patients with positive alcohol and with psychiatric medication were more likely to have respiratory complications such as pneumonia or respiratory failure requiring ventilator support (36 versus 4%, P=0.005), to develop other infections (8 versus 0%), or other complications (26 versus 4%, P=0.0007) compared with the controls. A significant difference in hospital length of stay between the group with positive toxicity and psychiatric medication and that with negative toxicity and psychiatric medication (mean: 12.8 and 5.5 days, respectively; P=0.01) was found. Conclusion Psychiatric medication and positive drug or alcohol screens are associated with longer length of stay and increased respiratory complications. Factors influencing these outcomes need more clarification and prospective studies.
Muakkassa F F; Marley R A; Dolinak J; Salvator A E; Workman M C
European Journal of Emergency Medicine
2008
2008-02
Journal Article
<a href="http://doi.org/10.1097/MEJ.0b013e3280b17ea0" target="_blank" rel="noreferrer noopener">10.1097/MEJ.0b013e3280b17ea0</a>
Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database.
*aortic stenosis; *costs and cost analysis; *length of stay; *Patient Readmission/economics; *readmission; *rehospitalization; *transcatheter aortic valve implantation; *transcatheter aortic valve replacement; 80 and over; Aged; Aortic Valve Stenosis/diagnosis/economics/*surgery; Comorbidity; Databases; Factual; Female; Hospital Costs; Humans; Length of Stay; Male; Patient Discharge; Postoperative Complications/etiology; Risk Factors; Skilled Nursing Facilities; Time Factors; Transcatheter Aortic Valve Replacement/*adverse effects/economics; Treatment Outcome; United States
BACKGROUND: Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS: Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay \textgreater5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), \textgreater4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS: Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
Kolte Dhaval; Khera Sahil; Sardar M Rizwan; Gheewala Neil; Gupta Tanush; Chatterjee Saurav; Goldsweig Andrew; Aronow Wilbert S; Fonarow Gregg C; Bhatt Deepak L; Greenbaum Adam B; Gordon Paul C; Sharaf Barry; Abbott J Dawn
Circulation. Cardiovascular interventions
2017
2017-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1161/CIRCINTERVENTIONS.116.004472" target="_blank" rel="noreferrer noopener">10.1161/CIRCINTERVENTIONS.116.004472</a>
Transfer of DNR orders to the ED from extended care facilities.
*Advance Directives; *Critical Illness; *Health Services for the Aged; *Skilled Nursing Facilities; 80 and over; 80 and Over; Advance Directives; Aged; Coding – Administration; Coding – Standards; Critical Illness; Do-not-resuscitate; Emergency Medical Services – Administration; Emergency Medical Services/*organization & administration; Emergency Service; EMS; Extended care facilities; Female; Forms and Records Control/*organization & administration/standards; Health Services for the Aged; Hospital; Human; Humans; Length of Stay; Male; Medical Records – Statistics and Numerical Data; Medical Records/*statistics & numerical data; Middle Age; Middle Aged; Ohio; Outcome Assessment; Outcome Assessment (Health Care); Patient Advocacy; Physicians; Prospective Studies; Resuscitation Orders; Skilled Nursing Facilities
PURPOSE/OBJECTIVE: With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay. METHODS: We prospectively enrolled patients presenting from ECFs to the ED, blinding the treating team to the purpose. We did a chart review for the presence of a DNR form, demographic data and acknowledgement of the DNR forms. RESULTS: Fifty patients were enrolled in this study. The mean age was 77.6years and 56% were female. Twenty-eight percent had a DNR order transported to the ED, but 68% had a DNR preference noted in their ECF notes. Registration only noted an advanced directive on 32% of patients (p=0.09). Eighteen percent had a DNR noted by the ED physician (p=0.42). Sixteen percent of patients had a DNR order written by an ED physician while 28% had a DNR order written by a non-ED physician during their inpatient evaluation. Thirty percent had a palliative care consult while in the hospital, but there was no significant association between DNR from the ECF and these consults. CONCLUSIONS: Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.
McQuown Colleen M; Frey Jennifer A; Amireh Ahmad; Chaudhary Ali
The American journal of emergency medicine
2017
2017-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2017.02.007" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.02.007</a>