The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations.

Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment

Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people

YesBackground The patient transition from a hospital to a post-discharge healthcare setting has potential to disrupt continuity of medication management and increase the risk of harm. “Connect with Pharmacy” is a new electronic web-based transfer of care initiative employed by Leeds Teaching Hospitals NHS Trust. This allows the sharing of discharge information between the hospital and a patient’s chosen community pharmacy. Objective We investigated whether the timely sharing of discharge information with community pharmacies via “Connect with Pharmacy” reduced hospital readmission rates in older patients. Method To evaluate intervention efficacy, hospital admission data was retrospectively collected. For primary analysis, admission rates were tracked 6-months prior (baseline) and 6-months post-intervention. Secondary measures included effect on total length of stay if readmitted, emergency department attendance and duration, and impact of polypharmacy. Main outcome measure The rate of non-elective hospital readmissions, 6-months post-intervention. Results In the sample (n = 627 patients; Mean age = 81 years), emergency readmission rates following the intervention (M = 1.1, 95% CI [0.98, 1.22]) reduced by 16.16% relative to baseline (M = 1.31, 95% CI [1.21, 1.42]) (W = 54,725; p < 0.001). There was no reduction in total length of stay. Subsidiary analysis revealed a post-intervention reduction in number of days spent in hospital lasting more than three days (χ2 = 13.37, df = 1, p < 0 .001). There were no statistically reliable differences in the remaining secondary measures. Conclusion The results showed a reduction in readmissions and potential post-intervention length of stay, indicating there may be further benefits for our older patients’ experiences and hospital flow

Fatores de atraso na alta hospitalar em hospitais de ensino

OBJETIVO Analisar os motivos de atraso na alta hospitalar de pacientes internados em enfermarias de clínica médica. MÉTODOS Foram analisados 395 prontuários de pacientes consecutivos das enfermarias de clínica médica de dois hospitais públicos de ensino: Hospital das Clínicas da Universidade Federal de Minas Gerais e Hospital Odilon Behrens. Foi utilizado o Appropriateness Evaluation Protocol para definir o momento a partir do qual as anotações do prontuário permitiam concluir que a permanência no hospital não mais era adequada. O intervalo entre esse momento e a data da alta hospitalar efetivada definiu o total de dias de atraso na alta hospitalar. Foi utilizado, sistematicamente, instrumento para categorizar os motivos de atraso da alta hospitalar, tendo sido realizada análise de frequências. RESULTADOS O atraso na alta hospitalar ocorreu em 60,0% das 207 internações do Hospital das Clínicas e em 58,0% das 188 internações do Hospital Odilon Behrens. O atraso por paciente foi em média de 4,5 dias no primeiro e 4,1 dias no segundo, o que corresponde à taxa de ocupação de 23,0% e 28,0% em cada hospital, respectivamente. Os principais motivos de atraso nos dois hospitais foram, respectivamente: espera para realização de exames complementares (30,6% e 34,7%) ou para liberação dos laudos dos exames (22,4% e 11,9%) e os relacionados à responsabilidade médica (36,2% e 26,1%), compreendendo a demora na discussão do caso clínico e na tomada de decisão clínica e dificuldades nas interconsultas, respectivamente (20,4% e 9,1%). CONCLUSÕES Foi constatado percentual elevado de atraso na alta hospitalar nos dois hospitais. O atraso foi devido principalmente a fatores relacionados a processos, que podem ser melhorados por intervenções da equipe assistencial e dos gestores. O impacto na média de permanência hospitalar e na taxa de ocupação foi expressivo e preocupante, num cenário de relativa escassez de leitos e longas esperas por internação

Acute care inpatients with long-term delayed-discharge: evidence from a Canadian health region

<p>Abstract</p> <p>Background</p> <p>Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.</p> <p>Methods</p> <p>Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.</p> <p>Results</p> <p>ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1^st 2009 and April 1^st, 2011. ALC patients with the identified characteristics had unique clinical profiles.</p> <p>Conclusions</p> <p>A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.</p