Review

Authors: Susan M Chapman, Ian K Maconochie

Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a 'threshold' when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children's hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient's specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.

Topics: Child; Clinical Deterioration; Early Warning Score; Emergency Service, Hospital; Facilities and Services Utilization; Forecasting; Hospitalization; Hospitals, Pediatric; Humans; Point-of-Care Systems; Risk Factors

PubMed: 30413488
DOI: 10.1136/archdischild-2018-314807

Meta-Analysis

Authors: Guido M Peters, Laura Kooij, Anke Lenferink...

BACKGROUND

Telehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear.

OBJECTIVE

The aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions.

METHODS

We searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.

RESULTS

We included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI -1.76 to -0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI -1.42 to -0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects.

CONCLUSIONS

Small to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant.

Topics: Bias; Hospitalization; Hospitals; Humans; Length of Stay; Telemedicine

PubMed: 34468324
DOI: 10.2196/25195

Authors: Gabrielle M Gussin, James A McKinnell, Raveena D Singh...

IMPORTANCE

Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections.

OBJECTIVE

To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California.

EXPOSURES

Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP).

MAIN OUTCOMES AND MEASURES

Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs).

RESULTS

Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%).

CONCLUSIONS AND RELEVANCE

A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.

Topics: Aged; Humans; Administration, Intranasal; Anti-Infective Agents, Local; Bacterial Infections; Baths; California; Chlorhexidine; Cross Infection; Drug Resistance, Multiple, Bacterial; Health Facilities; Hospitalization; Hospitals; Infection Control; Iodophors; Nursing Homes; Patient Transfer; Quality Improvement; Skin Care; Universal Precautions

PubMed: 38557703
DOI: 10.1001/jama.2024.2759

Meta-Analysis

Authors: Morteza Arab-Zozani, Mohammad Zakaria Pezeshki, Rahim Khodayari-Zarnaq...

BACKGROUND

Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals.

OBJECTIVE

To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals.

METHODS

This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI).

RESULTS

Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP).

CONCLUSIONS

Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.

Topics: Hospitalization; Hospitals; Humans; Iran; Patient Admission

PubMed: 31704488
DOI: 10.1016/j.vhri.2019.07.011

Authors: Meredith L McMorrow, Heidi L Moline, Ariana P Toepfer...

BACKGROUND

The coronavirus disease 2019 pandemic disrupted respiratory syncytial virus (RSV) seasonality resulting in early, atypical RSV seasons in 2021 and 2022, with an intense 2022 peak overwhelming many pediatric healthcare facilities.

METHODS

We conducted prospective surveillance for acute respiratory illness during 2016-2022 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested respiratory specimens for RSV and other respiratory viruses. We estimated annual RSV-associated hospitalization rates in children aged <5 years and compared hospitalization rates and characteristics of RSV-positive hospitalized children over 4 prepandemic seasons (2016-2020) to those hospitalized in 2021 or 2022.

RESULTS

There was no difference in median age or age distribution between prepandemic and 2021 seasons. Median age of children hospitalized with RSV was higher in 2022 (9.6 months vs 6.0 months, P < .001). RSV-associated hospitalization rates were higher in 2021 and 2022 than the prepandemic average across age groups. Comparing 2021 to 2022, RSV-associated hospitalization rates were similar among children <2 years of age; however, children aged 24 to 59 months had significantly higher rates of RSV-associated hospitalization in 2022 (rate ratio 1.68 [95% confidence interval 1.37-2.00]). More RSV-positive hospitalized children received supplemental oxygen and there were more respiratory virus codetections in 2022 than in prepandemic seasons (P < .001 and P = .003, respectively), but there was no difference in the proportion hypoxemic, mechanically ventilated, or admitted to intensive care.

CONCLUSIONS

The atypical 2021 and 2022 RSV seasons resulted in higher hospitalization rates with similar disease severity to prepandemic seasons.

Topics: Humans; Respiratory Syncytial Virus Infections; Hospitalization; Infant; Child, Preschool; Male; Prospective Studies; Female; COVID-19; Seasons; Hospitals, Pediatric; Infant, Newborn

PubMed: 38841769
DOI: 10.1542/peds.2023-065623

Authors: Henrik Kehlet

Enhanced recovery after surgery was developed based on the question "Why is the patient in hospital?" and is evolving in the context of multimodal perioperative care programmes with documented major benefits with respect to the need for hospitalisation and the risk of complications. Despite being a worldwide success, future challenges to improvements include patient and procedure-specific modification of inflammatory/immunological stress responses, improvement of post-discharge recovery, closing the knowing-doing gap between scientific evidence and clinical practice, and improving research design strategies.

Topics: Humans; Aftercare; Enhanced Recovery After Surgery; Patient Discharge; Hospitalization; Hospitals

PubMed: 36458610
DOI: No ID Found

Authors: JoAnna K Leyenaar, Seneca D Freyleue, Mary Arakelyan...

IMPORTANCE

National analyses suggest that approximately 1 in 5 US hospitals closed their pediatric units between 2008 and 2018. The extent to which pediatric hospitalizations at general hospitals in rural and urban communities decreased during this period is not well understood.

OBJECTIVE

To describe changes in the number and proportion of pediatric hospitalizations and costs at urban teaching, urban nonteaching, and rural hospitals vs freestanding children's hospitals from 2009 to 2019; to estimate the number and proportion of hospitals providing inpatient pediatric care; and to characterize changes in clinical complexity.

DESIGN, SETTING, AND PARTICIPANTS

This study is a retrospective cross-sectional analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative data set of US pediatric hospitalizations among children younger than 18 years. Data were analyzed from February to June 2023.

EXPOSURES

Pediatric hospitalizations were grouped as birth or nonbirth hospitalizations. Hospitals were categorized as freestanding children's hospitals or as rural, urban nonteaching, or urban teaching general hospitals.

MAIN OUTCOMES AND MEASURES

The primary outcomes were annual number and proportion of birth and nonbirth hospitalizations and health care costs, changes in the proportion of hospitalizations with complex diagnoses, and estimated number and proportion of hospitals providing pediatric care and associated hospital volumes. Regression analyses were used to compare health care utilization in 2019 vs that in 2009.

RESULTS

The data included 23.2 million (95% CI, 22.7-23.6 million) weighted hospitalizations. From 2009 to 2019, estimated national annual pediatric hospitalizations decreased from 6 425 858 to 5 297 882, as birth hospitalizations decreased by 10.6% (95% CI, 6.1%-15.1%) and nonbirth hospitalizations decreased by 28.9% (95% CI, 21.3%-36.5%). Concurrently, hospitalizations with complex chronic disease diagnoses increased by 45.5% (95% CI, 34.6%-56.4%), and hospitalizations with mental health diagnoses increased by 78.0% (95% CI, 61.6%-94.4%). During this period, the most substantial decreases were in nonbirth hospitalizations at rural hospitals (4-fold decrease from 229 263 to 62 729) and urban nonteaching hospitals (6-fold decrease from 581 320 to 92 118). In 2019, birth hospitalizations occurred at 2666 hospitals. Nonbirth pediatric hospitalizations occurred at 3507 hospitals, including 1256 rural hospitals and 843 urban nonteaching hospitals where the median nonbirth hospitalization volumes were fewer than 25 per year.

CONCLUSIONS AND RELEVANCE

Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.

Topics: Child; Humans; Cross-Sectional Studies; Retrospective Studies; Rural Population; Hospitalization; Hospitals, General

PubMed: 37656457
DOI: 10.1001/jamanetworkopen.2023.31807

Review

Authors: Paula Adam-Castelló, Eva María Sosa-Palanca, Luis Celda-Belinchón...

Nurses carry out holistic assessments of patients during hospital admission. This assessment includes the need for leisure and recreation. Different intervention programmes have been developed to meet this need. The aim of this study was to investigate hospital leisure intervention programmes described in the literature in order to determine their effects on patient health and highlight the strengths and weaknesses of the programmes as reported by health professionals. A systematic review of articles in English or Spanish published between 2016 and 2022 was carried out. A search was performed in the following databases: CINAHL COMPLETE, PubMed, Cochrane Library and Dialnet and the Virtual Health Library and Web of Science resources. A total of 327 articles were obtained, of which 18 were included in the review. The methodological quality of the articles was assessed using the PRISMA, CASPe and STROBE scales. A total of six hospital-based leisure programmes were identified, including a total of 14 leisure interventions. The activities developed in most of the interventions effectively reduced the levels of anxiety, stress, fear and pain in patients. They also improved factors such as mood, humour, communication, wellbeing, satisfaction and hospital adaptation. Among the main barriers to implementing hospital leisure activities is the need for more training, time and adequate spaces for them develop. Health professionals consider it beneficial for the patient to develop leisure interventions in the hospital.

Topics: Humans; Health Personnel; Hospitals; Hospitalization; Leisure Activities; Personal Satisfaction

PubMed: 36833961
DOI: 10.3390/ijerph20043268

Authors: Sayaka Yamazaki, Nanako Tamiya, Kaori Muto...

This study aims to determine the approximate number of hospitalizations of persons without family and the medical challenges they encounter in hospitals across Japan. Self-administered questionnaires were mailed to 4,000 randomly selected hospitals nationwide to investigate the actual conditions and problems, decision-making processes, and use of the government-recommended Guidelines for the hospitalization of, and decision-making support for, persons without family. To identify the characteristics of each region and role of hospitals, chi-square tests were used to make separate group comparisons by hospital location and type. Responses were received from 1,271 hospitals (31.2% response rate), of which 952 hospitals provided information regarding the number of admissions of persons without family. The mean (SD) and median number of hospitalizations (approximate number per year) of patients without family was 16 (79) and 5, respectively. Approximately 70% of the target hospitals had experienced the hospitalization of a person without family, and 30% of the hospitals did not. The most common difficulties encountered during the hospitalization were collecting emergency contact information, decision-making related to medical care, and discharge support. In the absence of family members and surrogates, the medical team undertook the decision-making process, which was commonly performed according to manuals and guidelines and by consulting an ethics committee. Regarding the use of the government-recommended Guidelines, approximately 70% of the hospitals that were aware of these Guidelines responded that they had never taken any action based on these Guidelines, with significant differences by region and hospital type. To solve the problems related to the hospitalization of persons without family, the public should be made aware of these Guidelines, and measures should be undertaken to make clinical ethics consultation a sustainable activity within hospitals.

Topics: Humans; Japan; Hospitalization; Patient Discharge; Hospitals

PubMed: 37267321
DOI: 10.1371/journal.pone.0276090

Meta-Analysis

Authors: J McPeake, M Bateson, F Christie...

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Topics: Critical Care; Critical Illness; Hospitalization; Hospitals; Humans; Patient Readmission

PubMed: 34967011
DOI: 10.1111/anae.15644