Unplanned readmissions in younger and older adult patients: the role of healthcare-related adverse events

BACKGROUND: Readmissions are a burden for patients and increase healthcare costs. In Europe, factors associated with readmissions have not yet been extensively investigated. This study aimed to discover factors associated with readmissions in both young and older adult internal medicine patients. Furthermore, we explored the role of healthcare-related adverse events (AEs) in readmissions. METHODS: All patients admitted through the emergency department to the internal medicine department in the last 2 weeks of each month (2011) were included. Information on index admissions and readmissions, defined as an unplanned admission within 30 days after discharge, was obtained from the electronic patient record system. Demographic, clinical, and organizational factors were evaluated for their association with readmissions. RESULTS: Of all patients (n = 940), 17.3 % were readmitted; 16.9 % of the younger (<65 years, n = 485), and 17.8 % of the older patients (≥65 years, n = 455). Dependency in activities of daily living (ADL) was the only factor associated with readmissions in both all ages (OR 2.43) and in older patients (OR 3.19), while age was associated with readmissions in younger patients (OR 1.03 per year). AEs leading to 35.4 % of all index admissions were not associated with readmissions. CONCLUSIONS: Readmissions are common in medical patients, and, thus, remain a reason for concern in terms of patient safety and quality of care. AEs, responsible for to the index admission, were not associated with readmissions. ADL dependency was the only factor associated with readmission in patients of all ages and older patients, indicating that determining which patients are at risk for readmissions is not easy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40001-016-0230-0) contains supplementary material, which is available to authorized users

MOESM1 of Unplanned readmissions in younger and older adult patients: the role of healthcare-related adverse events

Additional file 1: Table S1. (Part of) Standard information obtained by nurses at admission

Bedside palliative care and geriatric consultations:adherence rate in hospitalised patients

ObjectivesThis study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics influence adherence rates.MethodsThis retrospective cohort study was performed in the Maastricht University Medical Center+ in the Netherlands and included hospitalised patients who received a consultation by the PCT or the GCT. Baseline data on consultations were collected for the total population and for the GCT and PCT separately. The adherence rate of the recommendations was evaluated by checking evidence of implementation. The nature of recommendations given (solicited or unsolicited) was documented per domain (somatic, psychological/cognitive, social, spiritual, functional, and existential). The association with adherence was evaluated for solicited and unsolicited recommendations separately. Exploration of potentially associated factors was performed using OpenEpi.ResultsOverall, 507 consultations of individual patients were performed (n=131) by the GCT and (n=376) by the PCT. Most recommendations given were solicited (865/1201=72%). Over 80% of both solicited and unsolicited recommendations were implemented in the majority of domains. No potentially modifiable factors associated with the adherence of the advices were found.ConclusionsThe overall adherence rate of the GCT and PCT consultations was high. In addition, in certain domains, many recommendations were unsolicited. However, also the majority of these recommendations were implemented

The Effect of a Smartphone App with an Accelerometer on the Physical Activity Behavior of Hospitalized Patients:A Randomized Controlled Trial

Inactive behavior is common in hospitalized patients. This study investigated the effectiveness of using a smartphone app with an accelerometer (Hospital Fit) in addition to usual care physiotherapy on increasing patients' physical activity (PA) behavior. A randomized controlled trial was performed at Maastricht University Medical Centre. Patients receiving physiotherapy while hospitalized at the department of Pulmonology or Internal Medicine were randomized to usual care physiotherapy or using Hospital Fit additionally. Daily time spent walking, standing, and upright (standing/walking) (min) and daily number of postural transitions were measured with an accelerometer between the first and last treatment. Multiple linear regression analysis was performed to determine the association between PA behavior and Hospital Fit use, corrected for functional independence (mILAS). Seventy-eight patients were included with a median (IQR) age of 63 (56-68) years. Although no significant effects were found, a trend was seen in favor of Hospital Fit. Effects increased with length of use. Corrected for functional independence, Hospital Fit use resulted in an average increase of 27.4 min (95% CI: -2.4-57.3) standing/walking on day five and 29.2 min (95% CI: -6.4-64.7) on day six compared to usual care. Hospital Fit appears valuable in increasing PA in functionally independent patients

Barriers and enablers to physical activity behaviour in older adults during hospital stay:a qualitative study guided by the theoretical domains framework

BACKGROUND: Older adults admitted with an acute medical illness spent little time active during hospitalisation and this has been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity behaviour. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach. This study aimed to explore barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF). METHODS: A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted with an acute medical illness, and healthcare professionals (nurses, physicians, physiotherapists) were recruited using purposive sampling. Semi-structured interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity behaviour during hospitalisation were identified and coded using the TDF. RESULTS: Meaning saturation was determined after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. The ‘Environmental Context and Resources’ domain in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients. CONCLUSIONS: The large number of identified barriers and enablers highlights the complexity of influencing older adults’ physical activity behaviour during hospitalisation. This overview of barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults’ physical activity levels. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02887-x