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Critical Care (London, England) Dec 2016Epidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk of mortality. This systematic review and meta-analysis aimed to determine whether ICU discharge time was associated with hospital mortality.
METHODS
The PubMed, Embase, and Scopus databases were searched to identify cohort studies that investigated the effects of discharge from the ICU on weekends and at night on hospital mortality, with adjustments for the disease severity at ICU admission or discharge. The primary meta-analysis focused on the association between nighttime ICU discharge and hospital mortality. The secondary meta-analysis examined the association between weekend ICU discharge and hospital mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.
RESULTS
We included 14 studies that assessed outcomes for nighttime versus daytime discharges among 953,312 individuals. Of these 14 studies, 5 evaluated outcomes for weekend versus weekday discharges (n = 70,883). The adjusted OR for hospital mortality was significantly higher among patients discharged during the nighttime, compared to patients discharged during the daytime (OR 1.31, 95% CI 1.25-1.38, P < 0.0001), and the studies exhibited low heterogeneity (I = 33.8%, P = 0.105). There was no significant difference in the adjusted ORs for hospital mortality between patients discharged during the weekend or on weekdays (OR 1.03, 95% CI 0.88-1.21, P = 0.68), although there was significant heterogeneity between the studies in the weekday/weekend analysis (I = 72.5%, P = 0.006).
CONCLUSIONS
Nighttime ICU discharge is associated with an increased risk of hospital mortality, while weekend ICU discharge is not. Given the methodological limitations and heterogeneity among the included studies, these conclusions should be interpreted with caution, and should be tested in further studies.
Topics: Critical Illness; Hospital Mortality; Humans; Intensive Care Units; Odds Ratio; Outcome Assessment, Health Care; Patient Discharge; Time Factors
PubMed: 27903270
DOI: 10.1186/s13054-016-1569-x -
Current Problems in Cardiology Oct 2022With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be... (Meta-Analysis)
Meta-Analysis Review
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Patient Discharge; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34571105
DOI: 10.1016/j.cpcardiol.2021.100998 -
Thrombosis Research Jul 2017Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse... (Review)
Review
Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n=3036) or discharged early (n=535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, <2% for thromboembolic recurrences or major bleedings and <3% for deaths with no evidence in favour of one selection strategy or another. Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatment may be considered as the first line management for hemodynamically stable PE patients, subject to the respect of simple eligibility criteria and on the condition that a specific procedure for outpatient care is developed in advance.
Topics: Ambulatory Care; Disease Management; Humans; Outpatients; Patient Discharge; Pulmonary Embolism
PubMed: 28525830
DOI: 10.1016/j.thromres.2017.05.001 -
Heart, Lung & Circulation Jan 2022Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource... (Review)
Review
OBJECTIVE
Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource availability of each centre, until the recent unifying guidelines published by the European Society for Vascular Surgery (ESVS). This paper aimed to amalgamate the published experience in managing PAGI and their outcomes.
METHODS
PubMed, Scopus and Cochrane Library databases were searched systematically. All primary studies besides single-patient case reports were included. Data extracted included study and patient characteristics, type of index surgery, type of microorganisms involved, definitive treatment modality, and any outcome measures reported.
RESULTS
Of the 20 studies included, 157 of the 290 PAGI patients underwent complete graft explantation and replacement, 106 underwent graft-preservation interventions (debridement and/or irrigation), and 25 had antibiotics alone. Adjunctive interventions included graft coverage, vacuum-assisted closure, use of infection-resistant graft materials, and lifelong suppressive therapy. In-hospital mortality was 20.8% (n=60), with postoperative sepsis and multiorgan failure (n=24) being the most common cause. Recurrent infection occurred in 10 post-discharge patients. Post-discharge mortality rate was 11.4% (n=33), with cardiac complications and stroke being the most common cause in surgically-treated and medically-treated patients, respectively.
CONCLUSIONS
Given the risk of mortality, the management approach of PAGI highly depends on the fitness of the patient. We believe that early referral to specialised aortic centres is essential to plan for optimal management strategies and improve patient outcomes. Further studies are also required to parse out the most effective adjunctive interventions to maximise patient outcomes.
Topics: Aftercare; Aorta; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Patient Discharge; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome
PubMed: 34602347
DOI: 10.1016/j.hlc.2021.07.026 -
Endocrine Practice : Official Journal... Apr 2021The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length... (Review)
Review
OBJECTIVE
The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length of stay. We aimed to highlight the variability in care during these transitions and point out areas where research is needed.
METHODS
A PubMed search was performed with a combination of search terms that pertained to diabetes, hyperglycemia, hospitalization, locations in the hospital, discharge to home or a nursing facility, and diabetes medications. Studies with at least 50 patients that were written in the English language were included.
RESULTS
With the exception of transitioning from intravenous insulin infusion to subcutaneous insulin and perhaps admission to the regular floors, few studies pointedly focused on transitions of care, leading us to extrapolate recommendations based on data from disparate areas of care in the hospital. There is evidence at every stage of care, starting from the entry into the hospital and ending with discharge home or to a facility, that patients benefit from having protocols in place guiding overall care.
CONCLUSION
Pockets of care exist in hospitals where methods of effective diabetes management have been studied and implemented. However, there is no sustained continuum of care. Protocols and care teams that follow patients from one physical location to the other may result in improved clinical outcomes during and following a hospital stay.
Topics: Hospitalization; Humans; Hyperglycemia; Inpatients; Insulin; Patient Discharge
PubMed: 33529732
DOI: 10.1016/j.eprac.2021.01.016 -
Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis.Archives of Orthopaedic and Trauma... Aug 2022This systematic review aimed to assess the safety and efficacy of outpatient joint arthroplasty (OJA) pathways compared to inpatient pathways. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review aimed to assess the safety and efficacy of outpatient joint arthroplasty (OJA) pathways compared to inpatient pathways.
MATERIALS AND METHODS
An electronic literature search was conducted to identify eligible studies. Studies comparing OJA with inpatient pathways-following hip and/or (partial) knee arthroplasty-were included. Included studies were assigned-based on OJA definition-to one of the following two groups: (1) outpatient surgery (OS); outpatient defined as discharge on the same day as surgery; and (2) semi-outpatient surgery (SOS); outpatient defined as discharge within 24 h after surgery with or without an overnight stay. Methodological quality was assessed. Outcomes included (serious) adverse events ((S)AEs), readmissions, successful same-day discharge rates, patient-reported outcome measures (PROMs) and costs. Meta-analyses and subgroup analyses by type of arthroplasty were performed when deemed appropriate.
RESULTS
A total of 41 studies (OS = 26, SOS = 15) met the inclusion criteria. One RCT and 40 observational studies were included, with an overall risk-of-bias of moderate to high. Forty studies were included in the meta-analysis. Outpatients (both OS and SOS) were younger and had a lower BMI and ASA class compared to inpatients. Overall, no significant differences between outpatients and inpatients were found for overall complications and readmission rates, and improvement in PROMs. By type of arthroplasty, only THAs in OS pathways were associated with fewer AEs [OR = 0.55 (0.41-0.74)] compared to inpatient pathways. 92% of OS patients were discharged on the day of surgery. OJA resulted in an average cost reduction of $6.797,02.
CONCLUSION
OJA pathways are as safe and effective as inpatient pathways in selected populations, with a potential reduction of costs. Considerable risk of bias in the majority of studies emphasizes the need for further research.
Topics: Ambulatory Surgical Procedures; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Outpatients; Patient Discharge; Patient Readmission; Postoperative Complications; Retrospective Studies
PubMed: 33587170
DOI: 10.1007/s00402-021-03811-5 -
JBI Database of Systematic Reviews and... Aug 2015Patients' satisfaction with hospital services is an important indicator in demonstrating that nursing care meets their expectations. Hospitals are responsible for... (Review)
Review
BACKGROUND
Patients' satisfaction with hospital services is an important indicator in demonstrating that nursing care meets their expectations. Hospitals are responsible for providing safe and quality care to patients during their hospitalization and ensuring patients receive continued care post‑discharge. Interventions such as nurse leader rounding and post-discharge telephone calls could potentially enhance patients' hospital stay, meeting their expectations and needs in a timely manner.
OBJECTIVES
The objective of this review was to synthesize the best available evidence on the effectiveness of nurse leader rounding and post-discharge telephone calls in patient satisfaction of nursing and hospital services.
TYPES OF PARTICIPANTS
The review included studies of adult patients (aged 18 years or older) who had been admitted to hospital. Studies undertaken in outpatient settings were excluded. TYPES OF INTERVENTION(s): The interventions studied were nurse leader rounding and post-discharge telephone calls. There was no comparator. TYPES OF STUDIES: This review considered studies with experimental designs, including randomized controlled trials, non-randomized controlled trials, quasi-experimental designs, and before and after studies. It also considered studies with analytical and descriptive epidemiological designs, including prospective and retrospective cohort studies, case control studies, analytical cross‑sectional studies, case series, and individual case reports. TYPES OF OUTCOMES: The primary outcome was patients' satisfaction with nursing and hospital services.
SEARCH STRATEGY
A search for published and unpublished English language studies from 2003 to 2013 was conducted in seven major electronic databases. They were Cochrane Central Register of Controlled Trials, Scopus, Web of Science, MEDLINE, CINAHL, Embase, PsycINFO and Mednar. A three-step search strategy was used, developing MeSH terminology and keywords to search and retrieve all relevant literature for the review.
METHODOLOGICAL QUALITY
Two reviewers appraised the methodological quality of the studies independently, using the Joanna Briggs Institute's standardized critical appraisal instruments.
DATA EXTRACTION
Data was extracted from the studies using the standardized data extraction tool. The authors of primary studies were contacted for missing information or data.
DATA SYNTHESIS
Statistical pooling was not possible due to the included studies being descriptive study design. Therefore, the data was presented in narrative summary.
RESULTS
Three studies were included in the review. The evidence was weak to suggest that nurse leader rounding and post-discharge telephone calls were effective in enhancing patients' satisfaction.
CONCLUSIONS
The interventions on nurse leader rounding and post-discharge telephone calls had increased patients' satisfaction of nursing and hospital services.
Topics: Adult; Hospitalization; Humans; Nurse Administrators; Patient Discharge; Patient Satisfaction; Telephone
PubMed: 26455854
DOI: 10.11124/jbisrir-2015-2013 -
Cardiovascular Revascularization... Oct 2021The passage of the Hospital Readmissions Reduction Program (HRRP) has been associated with been associated with decreased risk-standardized readmission rates for heart... (Review)
Review
BACKGROUND
The passage of the Hospital Readmissions Reduction Program (HRRP) has been associated with been associated with decreased risk-standardized readmission rates for heart failure (HF) patients. However, some quantitative analyses have shown association between HRRP and increased mortality for hospitalized HF patients. Qualitative information on what hospital programs were actually implemented can help us understand if this trend is a causal effect of the law or an unrelated trend.
PURPOSE
To perform a systematic literature review to synthesize evidence on what clinical programs American hospitals implemented in response to HRRP.
METHODS
Following PRISMA guidelines, we conducted a systematic review in April 2020 that included a search of PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Literature (CINAHL) for studies related to hospital strategies to reduce HF readmissions.
RESULTS
Of 20 included articles, 8 were qualitative (survey and interviews), 3 were systematic reviews, 5 were single site quality improvement (QI) initiatives, 2 were plans for ongoing randomized control trials (RCTs), one was a plan for a future RCT and one was an observational analysis. We found that interventions hospitals undertook in response to HRRP to reduce HF readmissions fell into four categories: inpatient care, discharge, transitional care and data collection/administration. The majority of interventions were related to transitional care, most commonly scheduling follow up appointments within 7-14 days of discharge, performing post-discharge phone calls and partnering with community physicians.
CONCLUSIONS
We did not find any published evidence of practices that could mechanistically be linked to harm to HF patients enacted by hospitals in response to HRRP. For example, no programs encouraged emergency department providers to discharge patients from emergency departments. We found QI initiatives, improved discharge planning and increased post-discharge follow up.
Topics: Benchmarking; Heart Failure; Hospitals; Humans; Patient Discharge; Patient Readmission; United States
PubMed: 33339772
DOI: 10.1016/j.carrev.2020.12.015 -
International Journal For Quality in... Jul 2020Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges.
DATA SOURCES
PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019.
STUDY SELECTION
Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies.
DATA EXTRACTION
Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate.
RESULTS OF DATA SYNTHESIS
There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity.
CONCLUSION
In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
Topics: Aftercare; Emergency Service, Hospital; Humans; Length of Stay; Mortality; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Quality Assurance, Health Care; Time Factors
PubMed: 32453404
DOI: 10.1093/intqhc/mzaa060 -
Resuscitation Mar 2021To evaluate the optimal timing and doses of epinephrine for Infants and children suffering in-hospital or out-of-hospital cardiac arrest. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the optimal timing and doses of epinephrine for Infants and children suffering in-hospital or out-of-hospital cardiac arrest.
METHODS
We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) for human randomized clinical trials and observational studies including comparative cohorts. Two investigators reviewed relevance of studies, extracted the data, conducted meta-analyses and assessed the risk of bias using the GRADE and CLARITY frameworks. Authors of the eligible studies were contacted to obtain additional data. Critically important outcomes included return of spontaneous circulation, survival to hospital discharge and survival with good neurological outcome.
RESULTS
We identified 7 observational studies suitable for meta-analysis and no randomized clinical trials. The overall certainty of evidence was very low. For the critically important outcomes, the earlier administration of epinephrine was favorable for both in-hospital and out-of-hospital cardiac arrest. Because of a limited number of eligible studies and the presence of severe confounding factors, we could not determine the optimal interval of epinephrine administration.
CONCLUSIONS
Earlier administration of the first epinephrine dose could be more favorable in non-shockable pediatric cardiac arrest. The optimal interval for epinephrine administration remains unclear.
Topics: Child; Epinephrine; Humans; Infant; Out-of-Hospital Cardiac Arrest; Patient Discharge
PubMed: 33529645
DOI: 10.1016/j.resuscitation.2021.01.015