by PWeekly | Oct 25, 2016 | Articles, Emergency Medicine, Hospital Medicine, Surgery
With hospital readmission rates following surgery being increasingly used as a marker of quality of care and used in pay-for-performance metrics, efforts to reduce these rates has become a focus for physicians, hospital administrators, and policy makers. Patients undergoing emergency general surgery (EGS) are at high risk for medical errors and complications following surgery. Previous research has shown that about half of all patients undergoing EGS will have a postoperative complication, and postoperative complications have been closely linked to hospital readmission. According to Joaquim M. Havens, MD, there is a great need to closely examine readmission rates in EGS because of the uniqueness of these patients. “Data are needed to identify the patterns of readmissions in this population,” he says. However, studies on readmission rates in surgical patients can be limited by the restricted number of procedures being examined, the exclusive age categories that are included, and the lack of distinction of EGS patients from other surgical patients. Readmission rates and outcomes can also vary significantly by patient age, procedure type, and surgical specialty. Characterizing EGS Patients In a study published in JAMA Surgery, Dr. Havens and colleagues sought to define hospital readmission rates, identify risk factors, and describe patterns of readmission among EGS patients. The analysis also aimed to account for variations in patients’ age groups and diagnoses. The investigators used hospital discharge records from a statewide database in California and identified the five most commonly performed EGS procedures in each of 11 EGS diagnosis groups. Data were collected on patient demographics, comorbidities, length of stay, complications, and discharge disposition and examined within the context of 30-day...
by admin | Apr 14, 2014 | Articles, Hospital Medicine, Infectious Disease, Recent Features, Slider, Surgery
In hospital settings, specialists are often consulted when managing patients with complex conditions, offering evidence-based recommendations on diagnosis and treatment plans. Infectious disease (ID) specialists are typically consulted when patients have one or more infectious conditions that are severe and require intensive monitoring. “ID specialists can assist hospitals in the inpatient setting by recommending appropriate antibiotic choices, duration of therapy, and route of delivery,” says Steven K. Schmitt, MD. “They can also help monitor patients to minimize adverse drug reactions.” Studies indicate that when an ID specialist is involved in patient care and the physician in charge follows ID recommendations, patients are more likely to receive a correct diagnosis. ID specialist involvement has also been associated with shorter lengths of stay (LOS), receipt of more appropriate therapies, fewer complications, and reduced use of antibiotics overall. However, data regarding the impact of ID specialists on hospital LOS and costs have been mixed. Many studies have been constrained by small sample size and chart review methodology, which limits the ability to generalize conclusions. As a result, it has been difficult to draw meaningful conclusions about the value of ID specialty interventions. Robust Data In a study published in Clinical Infectious Diseases, Dr. Schmitt and colleagues sought to generate robust data on the impact of ID consultation on spending and outcomes using a national Medicare claims database. Researchers looked at patients hospitalized with at least one of 11 serious but commonly treated infections. These included bacteremia, Clostridium difficile, central line-associated bloodstream infections, bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections. Outcomes of a...
by admin | Feb 10, 2014 | Articles, Emergency Medicine, Hospital Medicine, Pulmonology/Critical Care, Recent Features, Slider, Surgery
Throughout the United States, reducing the rates of hospital readmissions has become a top priority, as evidenced by CMS planning to include surgical procedures in the expansion of the penalty program. “The hospital readmissions reduction program is predicated on the notion that decreasing the frequency with which patients return to hospitals can improve care and lower costs,” says Thomas C. Tsai, MD, MPH. “However, using medical readmission rates as a measure of hospital quality has been controversial.” Hospitals vary substantially in their medical readmission rates, but these data generally do not correlate with the measures that are often used to identify high-quality hospitals, such as mortality. This raises the question of whether or not medical readmission rates actually measure hospital quality or if they instead reflect other factors that are unrelated to hospital care. The relationship between readmission rates and surgical care may be different than that of medical readmissions. Most patients undergo non-urgent major surgery when they’re clinically stable. As a result, surgical readmissions are more likely to result from complications of care received during index hospitalizations. “Clinicians have relatively little information on the types of hospitals that perform well or poorly with regard to surgical readmission rates,” says Dr. Tsai, “but we hypothesized that hospitals excelling in surgical care would generally have fewer readmissions.” A Comprehensive Analysis In a study published in the New England Journal of Medicine, Dr. Tsai and colleagues sought to determine the patterns of surgical readmissions among Medicare patients across a set of major procedures in a national sample of hospitals. The study team combined information from Medicare claims, the American Hospital Association...
by admin | Sep 16, 2013 | Articles, Emergency Medicine, Hospital Medicine, Infectious Disease, Pulmonology/Critical Care, Recent Features, Slider
In the United States, community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality due to infection and most often strikes the elderly and individuals with comorbidities. The 30-day mortality rate for Medicare patients admitted to the hospital for CAP is about 12% and has not changed significantly in decades (Table 1). CAP has been shown to increase long-term mortality to as high as 40% within 1 year of admission. The infection is one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge. Estimates show that the cost of treating CAP exceeds $17 billion per year. Hospitalizing Patients With Community-Acquired Pneumonia “The decision on whether or not hospitalization is necessary for CAP is critical because there are multiple consequences,” says Thomas M. File, Jr., MD, MSc. “Hospitalizations can influence the cost of care, the intensity of diagnostic testing, and the selection of antimicrobial agents.” There are several advantages to outpatient treatment of CAP—when used appropriately—including cost, patient preference, faster convalescence, and fewer nosocomial complications. Hospitalization decisions should be based on several factors, including (among others): age over 50; significant underlying coexisting conditions; elevated blood urea nitrogen levels; and the presence of altered mental status or significant abnormalities in vital signs. “Readmission for CAP patients recently discharged after hospitalization represents an important, expensive, and often preventable adverse outcome,” Dr. File says. “The risk of readmission can be modified by the quality and type of care that is provided. Improving CAP readmission rates is the joint responsibility of hospitals and clinicians.” He adds that measuring readmission rates can help...
by admin | Sep 13, 2013 | Articles, Emergency Medicine, Hospital Medicine, Recent Features, Slider
Efforts to improve the care experience for ED patients have the potential for wide-ranging benefits, including more effective continuity of care, reduced need for follow-up visits, and higher staff morale. Recent studies suggest that several types of interventions can be effective tools to enhance ED patient satisfaction. “In some analyses, telephone and email follow-up by healthcare providers has been shown to improve patient satisfaction rates,” says Pankaj B. Patel, MD. “The benefits of higher patient satisfaction range from better patient compliance with discharge instructions to higher staff morale. Contacting patients after they leave the ED may also improve transitions of care and help reduce unnecessary return visits to the ED.” Given that emergency care is often rushed, it has been hypothesized that ED patients may have even more to gain from timely post-visit contact with healthcare providers, especially among the elderly. “The potential for improving follow-up communication with elderly ED patients is particularly important because of their rising population,” Dr. Patel says. “It behooves EDs to identify opportunities that can help improve continuity of care and opportunities to increase patient satisfaction. In turn, there is also an opportunity to enhance patient outcomes for the long term.” In-Depth Analysis of Patient Satisfaction The direct effect of post-visit patient contact by ED physicians has not been studied extensively. Dr. Patel and David R. Vinson, MD, published an article in Annals of Emergency Medicine detailing results of their study that examined the impact of post-visit email or phone contact on patient satisfaction. “Prior to our investigation, our study team was contacting patients by email or by telephone shortly after their ED visit,”...
