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EMERGENCY DEPARTMENT: Use of home-based care

Just over half of the 682 emergency physicians who responded to this 2015 survey indicated that they have chosen home-based care options (overseen by a nurse or physician) instead of observation stays or inpatient admissions for elderly patients who visit the emergency department.  This is not a frequent occurrence  – the majority of ED physicians reported doing this for 5 or fewer patients per month.  The most common barrier to home-based care after an ED visit was reported to be the sense of an unsafe or unstable environment at home.  Patients who were recommended most frequently for home-based care had these diseases or conditions:

  • cellulitis
  • urinary tract infection
  • diabetes
  • pneumonia, community acquired

Note: This is a medical journal article reporting the results of a survey.  The authors are with West Health Institute (La Jolla, CA) and UC San Diego Medical Center.

Source: Stuck, A.R., and others. (2017, November). National survey of emergency physicians concerning home-based care options as alternatives to emergency department-based hospital admissions. The Journal of Emergency Medicine, 53(5), 623-628.  Click here for free full text: http://www.jem-journal.com/article/S0736-4679(17)30488-2/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: 7-day and 30-day rates for U.S., 2014

In 2014, the U.S. 7-day readmission rate was 5 percent and the 30-day rate was 14 percent, according to this new report released by the U.S. Agency for Healthcare Research and Quality (AHRQ).  The data are derived from the Healthcare Cost and Utilization Project (HCUP) and are based on all-payer data – not limited to Medicare data.

This Statistical Brief provides data on the most frequent causes of readmission at both of those points in time.  The most frequent causes are similar at 7 days and at 30 days.  Here is the list for 7-day readmissions, in rank order:

  1. Schizophrenia and other psychotic disorders (9 percent)
  2. Alcohol-related disorders (7.5 percent)
  3. Congestive heart failure, nonhypertensive (7.4 percent)
  4. Heart valve disorders (7.3 percent)
  5. Hypertension with complications, secondary hypertension (7.2 percent)

Here is the list for 30-day readmissions, in rank order:

  1. Congestive heart failure (23.2 percent)
  2.  Schizophrenia and other psychotic disorders (22.9 percent)
  3. Respiratory failure; insufficiency; arrest, adult (21.6 percent)
  4. Alcohol-related disorders (21.5 percent)
  5. Deficiency and other anemia (21.2 percent)

This report also provides a breakout of the most common causes of readmission by payer type (Medicare, Medicaid, private insurance and uninsured).

Note: These readmission rate percents represent readmissions per 100 index inpatient stays.

Source: Fingar, K.R., Barrett, M.L., and Jiang, H.J. (2017, October). A comparison of all-cause 7-day and 30-day readmissions, 2014. Statistical Brief, 230.  Click here for free full text: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

FACILITY DESIGN: How healthy is the indoor environment?

…it is estimated that people in developed countries now spend 90 percent of their lives indoors.”

What is known about the effect of microorganisms found indoors on health is reviewed in this technical report published by the National Academies Press.  Among the topics covered are air sources, water sources and building surfaces.  Physical and chemical interventions that may help to reduce problems caused by hazardous microbes are covered.

Source: National Academy of Sciences, Engineering, and Medicine. (2017). Microbiomes of the built environment: A research agenda for indoor microbiology, human health, and buildings. Washington, D.C.: The National Academies Press.  Click here for free full text: https://www.ncbi.nlm.nih.gov/books/NBK458827/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ORTHOPEDICS: 30-day readmission rates for total hip and total knee replacement

The readmission rate for total hip replacement and total knee replacement procedures performed recently on patients in California, Florida and Massachusetts was studied.  Here are the findings for the percent of these patients readmitted within 30 days:

  • 4.29 percent (California during the period 2009 to 2011)
  • 4.7 percent (Florida during the period 2009 to 2013)
  • 3.92 percent (Massachusetts during the period 2009 to 2012)

The authors analyzed the role of infection in these 30-day readmissions, finding that in about one-third of the total hip and total knee arthroplasty patients, infection was listed as the primary or secondary reason for readmission.

Source: A retrospective study. Medicine, 96(38). Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617700/pdf/medi-96-e7961.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PERIOPERATIVE: Enhanced recovery after surgery

Enhanced recovery after surgery (ERAS) refers to redesigned perioperative care, sometimes also referred to as fast-track recovery after surgery.  Among the objectives are to reduce readmissions and avoid opioid abuse.  Changes include early ambulation, multi-modal analgesia and careful attention to nutrition.  The Cleveland Clinic includes ERAS in a list of the top 10 medical innovations for 2018.  The Gramlich article describes how the ERAS guidelines for colorectal surgery were implemented in six Canadian hospitals by the Alberta Health Services.  More information can also be obtained from the ERAS Society.

Sources:

Cleveland Clinic. Top 10 medical innovations.  Click here: http://innovations.clevelandclinic.org/Summit/Top-10-Medical-Innovations.aspx

Gramlich, L.M., and others. (2017). Implementation of enhanced recovery after surgery: A strategy to transform surgical care across a health system. Implementation Science. 12(67). Click here:  https://implementationscience.biomedcentral.com/track/pdf/10.1186/s13012-017-0597-5?site=implementationscience.biomedcentral.com

ERAS Society. Click here: http://erassociety.org/   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGERY: How much vascular surgery is done?

This is an analysis of over 3 million adult inpatient admissions in the state of Maryland during the years 2009 to 2013.

  • 3,157,499 adult admissions to Maryland hospitals 2009-2013
    •    154,004 (5 percent) of the total admissions involved a vascular procedure
      • 54 percent of the vascular procedures were emergent
      • 13 percent of the vascular procedures were urgent
      • 33 percent of the vascular procedures were elective

Patients who were in the emergent or urgent groups were found to have higher mortality rates and hospital resource utilization.

Source: Harris, D.G., and others. (2017, November). Defining the burden, scope, and future of vascular acute care surgery. Journal of Vascular Surgery, 66(5), 1511-1517.  Click here for access to the publisher’s website: http://www.jvascsurg.org/article/S0741-5214(17)31354-X/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org