Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives

Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay

Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity: A Nonrandomized Controlled Trial

Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial.; To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity.; This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022.; After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning.; Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals.; There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time.; In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge.; isrctn.org Identifier: ISRCTN83274049

Self-Care Index and Post-Acute Care Discharge Score to Predict Discharge Destination of Adult Medical Inpatients: Protocol for a Multicenter Validation Study

Delays in patient discharge can not only lead to deterioration, especially among geriatric patients, but also incorporate unnecessary resources at the hospital level. Many of these delays and their negative impact may be preventable by early focused screening to identify patients at risk for transfer to a post-acute care facility. Early interprofessional discharge planning is crucial in order to fit the appropriate individual discharge destination. While prediction of discharge to a post-acute care facility using post-acute care discharge score, the self-care index, and a combination of both has been shown in a single-center pilot study, an external validation is still missing.; This paper outlines the study protocol and methodology currently being used to replicate the previous pilot findings and determine whether the post-acute care discharge score, the self-care index, or the combination of both can reliably identify patients requiring transfer to post-acute care facilities.; This study will use prospective data involving all phases of the quasi-experimental study "In-HospiTOOL" conducted at 7 Swiss hospitals in urban and rural areas. During an 18-month period, consecutive adult medical patients admitted to the hospitals through the emergency department will be included. We aim to include 6000 patients based on sample size calculation. These data will enable a prospective external validation of the prediction instruments.; We expect to gain more insight into the predictive capability of the above-mentioned prediction instruments. This approach will allow us to get important information about the generalizability of the three different models. The study was approved by the institutional review board on November 21, 2016, and funded in May 2020. Expected results are planned to be published in spring 2021.; This study will provide evidence on prognostic properties, comparative performance, reliability of scoring, and suitability of the instruments for the screening purpose in order to be able to recommend application in clinical practice

Bei Eintritt den Austritt bereits im Blick : der PACD am Kantonsspital Aarau

Die Erfassung und Bewertung des «biopsychosozialen Risikos» ermöglicht es, bereits frühzeitigerkennen und entscheiden zu können, ob ein Patient nach einem stationären Aufenthalt aufUnterstützung in einer post-akuten Institution zu Hause angewiesen sein wird. Das KantonsspitalAarau setzt dafür das Einschätzungsinstrument «Post-acute-care-discharge» (PACD) ein

Data from: Improving the post-acute care discharge score (PACD) by adding patients’ self-care abilities: a prospective cohort study

Background: Reducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the post-acute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients. Methods: We included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy. Results: Out of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864–0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics also showed significant improvements with regard to net reclassification index (14.2%, p<0.05) and integrated discrimination improvement (4.83%, p<0.05). Conclusions: Incorporating an early assessment of patients’ actual intrahospital self-care ability to the post-acute care discharge score led to an improved prognostic accuracy for identifying adult, medical and neurological patients at risk for discharge to a post-acute care facility

Verbessert eine pflegegeleitete Versorgung die Selbstpflegefähigkeiten? Eine quasi‐experimentelle Studie

Hintergrund: Die Zunahme von betagten und multimorbiden Patienten erhöht die Anforderungen an Behandlungs- und Prozessabläufe in Akutkrankenhäusern. Seit 2010 bietet das Kantonsspital Aarau (KSA) mit der pflegegeleiteten Versorgung (NLC-KSA) eine innovative Dienstleistung an. Mit den fünf NLC-KSA Pflegeschwerpunkten erhalten Patienten eine individuelle, regelgeleitete Pflege, zur Erhöhung ihrer Selbstständigkeit, Alltags- und Selbstpflegekompe- tenzen. Ziele: Diese Studie beschreibt die demographischen und pflegerischen Merkmale von NLC-KSA Patienten sowie die Unterschiede in den Alltags- und Selbstpflegekompetenzen zwischen NLC-KSA Versorgung und der üblichen Versorgung im Akutkrankenhaus. Methode: Es handelt sich um eine Studie mit quasi-experimen- tellem Design. Aus 1917 Patienten der Kontrollgruppe und 54 Patienten der NLC-KSA Gruppe konnten durch Propensity Score Matching je 45 Patienten pro Gruppe zugeordnet werden. Ergebnisse: Die NLC-KSA Patienten waren älter als die medizinischen Patienten der Gesamtgruppe (Median 78 vs. 70 Jahre). Außerdem hatten sie mehr Einschränkungen hinsichtlich ihrer Alltags- und Selbstpflegekompetenzen (Median Selbstpflegeindex 29 vs. 37) und traten bereits mit erhöhten biopsychosozialen Risiken (Median PACD 12 vs. 6) in das Krankenhaus ein. Im Vergleich zur Kontrollgruppe zeigten NLC-KSA Patienten, die bis zur Hälfte der Gesamtaufenthaltsdauer in NLC-KSA Versorgung waren (n=30), signifikante Ver- besserungen des Selbstpflegeindex (B=4,513, p=0,004) und der Bewegungsfähigkeiten vom Eintritt bis zum Austritt (B=1,055, p=0,038). Schlussfolgerungen: Da es sich bei den NLC-KSA betreuten Patienten um ältere, vulnerable Patienten handelte, profitierten diese insbesondere von einem intensiveren Aufbautraining, der Unterstützung ihres Selbstmanagements und der gezielten Austrittsvorbereitung

The use of nurse-led care intervention to improve self-care abilities subsequently decreasing readmission in multimorbid hospitalized patients ::a quasi-experimental study in a real- world setting

Aim: Nurse-led care aims to optimize the discharge preparation with a focus on in- creasing patients' independency and self-care abilities. This study compared patients' improvements of self-care abilities and frequency of readmission rate between nurse- led care and regular nursing care within the acute hospital setting. Design: A quasi-experimental design within a real-world setting was used for this work. Methods: We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse-led care). After pro-pensity score matching, the study cohort consisted of 612 patients. Results: From admission to discharge, nurse-led care patients showed superior im- provements of total self-care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse-led care were furthermore less frequently readmitted to hospital compared with the control group patients. Patient or public contribution: No patient or public contribution

Steps to Take to Reduce Length of Hospital Stay in Patients With Lower Respiratory Tract Infections: A Prospective Cohort Study

Background: Identification of medical and nonmedical requirements for outpatient treatment and/or early hospital discharge have potential to decrease health care costs. Method: On admission and before discharge, physicians and nurses, patients, and their relatives were interviewed about requirements over five domains (medical, nursing, organizational, and patients’ and their relatives’ preferences) for outpatient management and/or early discharge. Results: From a total of 550 included patients, 136 (24.7%) potential outpatients and 265 (48.2%) potential patients for early discharge were identified. Specific medical and nursing factors and factors related to patients and relatives were identified as being important for initial outpatient treatment and/or early discharge. Conclusion: This survey shows important requirements from the perspective of different heath care workers, patients, and relatives, which could allow initial outpatient treatment and/or early discharge of a large proportion of lower respiratory tract infection (LRTI) patients

Improving the post-acute care discharge score (PACD) by adding patients' self-care abilities: A prospective cohort study

BACKGROUND: Reducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the post-acute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients. METHODS: We included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy. RESULTS: Out of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864-0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics also showed significant improvements with regard to net reclassification index (14.2%, p<0.05) and integrated discrimination improvement (4.83%, p<0.05). CONCLUSIONS: Incorporating an early assessment of patients' actual intrahospital self-care ability to the post-acute care discharge score led to an improved prognostic accuracy for identifying adult, medical and neurological patients at risk for discharge to a post-acute care facility.status: publishe