A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated the discharge plan with the patients on admission. Discharge planning on admission and daily briefings involving care coordination and bedside staff reduced the length of stay, improved HCAPHS scores, and reduced 30-day readmissions by fostering better communication and collaboration. A 1-group pretest and posttest were utilized to compare data before care coordination and after care coordination. These findings yielded a length of stay reduction of 2.04 days, a 50% reduction in 30-day readmissions, and HCAPHS communication composite scores above the 50th percentile. The care coordination team exposed various programs and community resources that assisted with medications and durable medical equipment and suggested that companionship alleviated potential anxiety post discharge for those financially and socially burdened. The implications of a patient-centered team-based approach to discharge planning on admission eliminated barriers to discharge, improved patient knowledge of disease management, and provided a positive hospital experience.

No description available.

No description available.

The purpose of this study was to begin testing of a downward cross-level model for studying the ability of older adults to transition from a nursing home after a Medicare Part A reimbursed stay. Transitions are known to be a weak point in the provision of healthcare to older adults and thus far, research has not identified those factors that influence older adult's transitions i.e., from the nursing home after a post acute stay. The theoretical background for this study was supported by Resource Dependency Theory which is a theory that contends that organizations are externally controlled by activities outside the organization such as the "free-market" economic model that predominates the nursing home industry. It was thought that nursing homes may prioritize their need for resident census above the resident's need for discharge. The hypothesis was that both individual resident characteristics and organizational characteristics might influence the ability of older adults to transfer from the nursing home after a Medicare Part A stay. The method of analysis in this study was contextual regression. Individual and facility characteristics were the independent variables and length of stay was the dependent variable. For this project, emphasis was placed on the development of a methodology for using the MDS in this and future research studies. Selection of variables and methods for variable computation were highlighted. Individual and facility characteristics and discharge disposition (level of care) were reported descriptively. Although facility characteristics did not contribute significantly to the model, individual characteristics explained 28% of the variance in the length of stay. Fifteen percent of individuals in the sample died during their Medicare Part A stay and 18% were readmitted to the hospital. The most prevalent diagnoses of the sample were hypertension (35%), falls (34%) and arthritis (32%). Findings suggest that individual characteristics account for only a portion of the length of stay for post acute nursing home residents. Further model testing is needed and should include a larger facility sample size and market characteristics to determine if those factors significantly influence the ability of older adults to transfer after the Medicare Part A stay ends.

Bakgrund Vistelsetiden på akutmottagningen på Centralsjukhuset i Kristianstad har studerats och en skillnad identifierades där män i större utsträckning än kvinnor hade en vistelsetid kortare än fyra timmar. Ingen direkt orsak till skillnaden i vistelsetid kunde urskiljas. Det identifierade fenomenet valdes att bearbetas med genus som begrepp. Syfte Syftet med studien var att undersöka orsaken till varför det är en skillnad i vistelsetid mellan män och kvinnor på akutmottagningen. Metod Metod för datainsamling var kvalitativ intervju. Informanter valdes strategiskt utifrån kriteriet att de arbetade på en akutmottagning, och bestod av olika yrkesprofessioner, kön samt yrkeserfarenhet. Två olika sjukhus i södra Sverige deltog i studien. Totalt inkluderas nio informanter. Semistrukturerade enskilda intervjuer med öppna frågor genomfördes och insamlad data analyserades genom kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat Skillnaden i vistelsetid på akutmottagningen upplevdes bero på att kvinnor söker med ospecifika och diffusa symtom/orsaker eller oro, sökorsaker som upplevdes mer tidskrävande. I motsatts upplevdes män söka med konkreta/specifika symtom eller allvarlig sjukdom/skada, sökorsaker som upplevdes mindre tidskrävande. Skillnaden upplevdes även bero på när i sjukdomsförloppet patienten söker, sociokulturella faktorer, biologiska könsskillnader samt olika kommunikationsmönster. Slutsatser Skillnaden i män respektive kvinnors vistelsetid på akutmottagningen upplevdes inte bero på vårdpersonalens medvetna handlingar, utan på patientens sökorsak, vald tidpunkt för besök, biologiska faktorer, sociokulturella faktorer samt kommunikativa faktorer. / Background The length of stay in the emergency department at Central Hospital in Kristianstad has been studied and a difference was identified where men more often than women had a length of stay less than four hours. No direct reason for the difference in length of stay could be discerned. This identified phenomenon has been selected to be analyzed with gender as a cause of inequality. Aim The aim of this study was to investigate the reason why there is a difference in length of stay between men and women in the Emergency Department. Methods Method of data collection was qualitative interviews. Informants were chosen strategically based on the criterion that they work in an Emergency Department, consist of various professions, sex and work experience. Two different hospitals in southern Sweden participated in the study. It included in total nine informants. Semi-structured individual interviews with open-ended questions were conducted, and the collected data were analyzed through qualitative content analysis by Graneheim and Lundman. Results The difference in length of stay in the emergency department was experienced due to women seeking with non-specific and diffuses symptoms/cause or concerns, reason to seek experienced more time consuming. Contrarily experienced men seek with concrete/specific symptoms or serious illness/injury, reason to seek experienced less time consuming. The difference was experienced also depend on when in the course of the disease the patient is seeking, socio-cultural factors, biological gender differences, and different communication patterns. Conclusions The difference in men and women's length of stay in the Emergency Department is experienced not to depend on nursing staff aware actions, but on the patient´s reason to seek, the selected time for visit, biological factors, socio-cultural factors, as well as communicative elements.

Class of 2009 Abstract / OBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.

Class of 2009 / OBJECTIVES: To determine and characterize the relative impact of patient demographics on hospital inpatient charges, length of stay, and inpatient mortality in patients with ovarian cancer from 2002-2005. METHODS: A retrospective database analysis of AHRQ’s Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample databases was conducted spanning from January 1, 2002, to December 31, 2005.Data were collected regarding age, race, payer status, median household income, location of hospital (urban/rural), comorbidities, procedures, total charges, length of stay, and inpatient mortality. Multivariate and gamma regression methods were utilized to examine incremental risks associated with length of stay, total charges, and inpatient mortality, after controlling for all other variables. RESULTS: Overall, data from 246,012 hospital admissions were obtained. The average length of stay of patients was 6.58 days (SD = 7.22), the average number of diagnoses was 7.18 (SD = 3.36), the average number of procedures performed was 2.71 (SD = 2.66). A total of 14,485 (5.9%) patients died during hospitalization. The average total charge was $29,698 (SD = $42,951). The IRR was 0.886 (95%CI, -0.105 to -0.04) for patients who were Hispanic, and 1.089 (95%CI, 0.017–0.153) for patients who were Black compared to patients who were white. When compared to patients who lived in large, metropolitan areas, the IRR was 0.88 (95%CI, -0.146 to - 0.109) for patients located in smaller, metropolitan areas, and the IRR was 0.74 (95%CI, -0.335 to -0.268) for patients located in non- urban areas. CONCLUSIONS: Patient demographics were found to have associations, both directly and indirectly, with length o

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while the patient was still hospitalized. The purpose of the project was to develop an evaluation plan to determine whether the pilot centralized denials management unit could overturn an additional 5% or more of the concurrent denials compared with the current individual hospital-based denials management approach. The quantitative evaluation plan will guide review of data collected from one organization to determine payer trends on the types of denials received and reasons for the denials. Understanding the pattern of denials is expected to uncover opportunities for denials coordinators in the dedicated centralized management unit to challenge payers based on contract language or medical necessity. If the centralized denials management unit is shown to reduce denials, it will be considered for expansion corporate wide. The social change expected through a successful denials management unit program is that the hospitals in the system will recover payment for services rendered and will be able to continue to provide quality care in the communities they serve.

Abstract Background and Objectives: Since 1894, open appendectomy (OA) has been the treatment of choice for acute appendicitis. In 1981 Semm performed the first laparoscopic appendectomy (LA). More than 2 decades later, the benefits of LA are still controversial. The goal of the present investigation was to compare the effectiveness of LA and OA based on a large administrative (The Bureau of National Health Insurance, BNHI) Research Database. The source of data analyzed was the administrative claims data from the BNHI Research Database. Methods: The objective of this retrospective study was based on the ICD-9-CM procedure code of 4701 (Laparoscopic appendectomy, LA) and 4709 (Open appendectomy, OA) respectively from a database of 20 million insurance population, Separate analyses were performed for uncomplicated (ICD-9-CM, 540.9) and complicated (presence of appendiceal perforation or abscess; ICD-9-CM 540.0 and 540.1) appendicitis. Exclusive criteria were: (1) Average length of stay exceeds 3 S.D. (n=1,262). (2) Gender unmentioned (n=243). All these data will analyze in multiple dimensions including length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic (LA) and open appendectomy (OA) based on The Bureau of National Health Insurance (BNHI) database. Results: We enrolled 11,118 patients underwent LA and 47,725 patients underwent OA during 2004 to 2007. The prevalence of LA increases gradually from 6.97 per 100,000 populations in 2004 to 21 per 100,000 populations in 2007. The prevalence of OA decreases gradually from 57.5 per 100,000 populations in 2004 to 44.86 per 100,000 populations in 2007. Patients underwent LA (3.25¡Ó1.51day) have significant lower length of hospital stay than OA (3.57¡Ó1.49 day) (p<0.001). We also found the trend that the annual medical expenditure of LA increases gradually but OA decreases gradually. In general, LA spends higher medical expenditure than OA. With respect to medical expenditure, higher length of hospital stay and co-morbidity are associated with more medical expenditure significantly. Conclusions: LA is the current developing trend of surgical treatments for appendicitis. LA can reduce length of hospital stay significantly. OA can reduce the medical expenditure in Taiwan. In our opinion, the results represent the native data in Taiwan and are very important for a good administration of public resources distribution.