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Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate.

ABSTRACT: OBJECTIVES:Anemia, either chronic or newly developed in the hospital as a result of underlying disease and/or phlebotomy, is seen commonly among general medical inpatients, and its impact on the quality and efficiency of care is unknown. METHODS:This study investigated the relation among hemoglobin level, length of stay, and 30-day unplanned readmission rates in a cohort of 314 general medical inpatients 18 years old and older admitted to a teaching hospital during a period of 4 months in a large urban academic medical center, using retrospective chart review of the electronic health record. RESULTS:Anemia was common among this cohort of general medical inpatients (44.6%), and there was a statistically significant decrease in hemoglobin levels during their hospitalization. Anemic patients, as compared with nonanemic patients, had significantly longer mean and median length of stay. More important, the admission hemoglobin level and its change during hospitalization were significant predictors of increased length of stay. For every 1-U increase in admission hemoglobin level, the median length of stay was reduced by 0.5 days. For every 1-U increase in the level of hemoglobin change, the median length of stay was extended by 1.5 days. Likewise, the discharge hemoglobin level predicted the rate of 30-day unplanned readmission. For every 1-U decrease in discharge hemoglobin level, the readmission rate increased by nearly 4%. These relations remained after adjusting for common demographic and clinical variables, including age, sex, nutritional status, and number of comorbidities. CONCLUSIONS:Anemia is common among general medical inpatients and adversely affects their length of stay and 30-day unplanned readmission rate.

SUBMITTER: Lin RJ

PROVIDER: S-EPMC7047646 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate.

Lin Richard J RJ Evans Arthur T AT Chused Amy E AE Unterbrink Michelle E ME

Southern medical journal 20130501 5

<h4>Objectives</h4>Anemia, either chronic or newly developed in the hospital as a result of underlying disease and/or phlebotomy, is seen commonly among general medical inpatients, and its impact on the quality and efficiency of care is unknown.<h4>Methods</h4>This study investigated the relation among hemoglobin level, length of stay, and 30-day unplanned readmission rates in a cohort of 314 general medical inpatients 18 years old and older admitted to a teaching hospital during a period of 4 m ...[more]

PMID: 23644640

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Project description:Unplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing health care costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aimed to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions.We identified all patients undergoing an infrainguinal endovascular intervention in the targeted vascular module of the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2014. Perioperative outcomes were stratified by symptom status (chronic limb-threatening ischemia [CLI] vs claudication). Patients who died during index admission and those who remained in the hospital after 30 days were excluded. Indications for unplanned readmission related to the index procedure were evaluated. Multivariable logistic regression was used to identify preoperative and in-hospital (during index admission) risk factors of 30-day unplanned readmission.There were 4449 patients who underwent infrainguinal endovascular intervention, of whom 2802 (63%) had CLI (66% tissue loss) and 1647 (37%) had claudication. The unplanned readmission rates for CLI and claudication patients were 16% (n = 447) and 6.5% (n = 107), respectively. Mortality after index admission was higher for readmitted patients compared with those not readmitted (CLI, 3.4% vs 0.7% [P < .001]; claudication, 2.8% vs 0.1% [P < .01]). Approximately 50% of all unplanned readmissions were related to the index procedure. Among CLI patients, the most common indication for readmission related to the index procedure was wound or infection related (42%), whereas patients with claudication were mainly readmitted for recurrent symptoms of peripheral vascular disease (28%). In patients with CLI, predictors of unplanned readmission included diabetes (odds ratio, 1.3; 95% confidence interval, 1.01-1.6), congestive heart failure (1.6; 1.1-2.5), renal insufficiency (1.7; 1.3-2.2), preoperative dialysis (1.4; 1.02-1.9), tibial angioplasty/stenting (1.3; 1.04-1.6), in-hospital bleeding (1.9; 1.04-3.5), in-hospital unplanned return to the operating room (1.9; 1.1-3.5), and discharge other than to home (1.5; 1.1-2.0). Risk factors for those with claudication were dependent functional status (3.5; 1.4-8.7), smoking (1.6; 1.02-2.5), diabetes (1.5; 1.01-2.3), preoperative dialysis (3.6; 1.6-8.3), procedure time exceeding 120 minutes (1.8; 1.1-2.7), in-hospital bleeding (2.9; 1.2-7.4), and in-hospital unplanned return to the operating room (3.4; 1.2-9.4).Unplanned readmission after endovascular treatment is relatively common, especially in patients with CLI, and is associated with substantially increased mortality. Awareness of these risk factors will help providers identify patients at high risk who may benefit from early surveillance, and prophylactic measures focused on decreasing postoperative complications may reduce the rate of readmission.

Project description:ObjectivesThe aim of this systematic review was to describe and analyse the performance statistics of validated risk scores identifying elderly inpatients at risk of early unplanned readmission.Data sourcesWe identified potentially eligible studies by searching MEDLINE, EMBASE, COCHRANE and Web of Science. Our search was restricted to original studies, between 1966 and 2018.Eligibility criteriaOriginal studies, which internally or externally validated the clinical scores of hospital readmissions in elderly inpatients.Data extraction and synthesisA data extraction grid based on Strengthening the Reporting of Observational Studies in Epidemiology and Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis statements was developed and completed by two reviewers to collect general data. The same process was used to extract metrological data of the selected scores.Quality assessment of the included studiesAssessment of the quality and risk of bias in individual studies was performed by two reviewers, using the validated Effective Public Health Practice Project quality assessment tool.ParticipantsElderly inpatients discharged to home from hospital or returning home after an accident and emergency department visit.ResultsA total of 12 studies and five different scores were included in the review. The five scores present area under the receiving operating characteristic curve between 0.445 and 0.69. Identification of Senior At Risk (ISAR) and Triage Risk Screening Tool (TRST) scores were the more frequently validated scores with ISAR being more sensitive and TRST more specific.ConclusionsThe TRST and ISAR scores have been extensively studied and validated. The choice of the most suitable score relies on available patient data, patient characteristics and the foreseen clinical care intervention. In order to pair the intervention with the appropriate clinical score, further studies of external validation of clinical scores, identifying elderly patients at risk of early unplanned readmission, are needed.Prospero registration numberCRD42017054516.

Project description:BackgroundExisting readmission reduction solutions tend to focus on complementing inpatient care with enhanced care transition and postdischarge interventions. These solutions are initiated near or after discharge, when clinicians' impact on inpatient care is ending. Preventive intervention during hospitalization is an underexplored area that holds potential for reducing readmission risk. However, it is challenging to predict readmission risk at the early stage of hospitalization because few data are available.ObjectiveThe objective of this study was to build an early prediction model of unplanned 30-day hospital readmission using a large and diverse sample. We were also interested in identifying novel readmission risk factors and protective factors.MethodsWe extracted the medical records of 96,550 patients in 205 participating Cerner client hospitals across four US census regions in 2016 from the Health Facts database. The model was built with index admission data that can become available within 24 hours and data from previous encounters up to 1 year before the index admission. The candidate models were evaluated for performance, timeliness, and generalizability. Multivariate logistic regression analysis was used to identify readmission risk factors and protective factors.ResultsWe developed six candidate readmission models with different machine learning algorithms. The best performing model of extreme gradient boosting (XGBoost) achieved an area under the receiver operating characteristic curve of 0.753 on the development data set and 0.742 on the validation data set. By multivariate logistic regression analysis, we identified 14 risk factors and 2 protective factors of readmission that have never been reported.ConclusionsThe performance of our model is better than that of the most widely used models in US health care settings. This model can help clinicians identify readmission risk at the early stage of hospitalization so that they can pay extra attention during the care process of high-risk patients. The 14 novel risk factors and 2 novel protective factors can aid understanding of the factors associated with readmission.

Project description:PURPOSE:Analyze associations between patients' characteristics and treatment factors with 30-day unplanned readmissions in hospitalized otolaryngology patients in the German Diagnosis Related Group (D-DRG) system. METHODS:A retrospective cohort study was performed on 15.271 otolaryngology admissions of 12.859 patients in 2015 in Thuringia, Germany. The medical records of the 1173 cases (7.6%) with readmission within 30-days were analyzed in detail. RESULTS:The 30-day readmission was planned in 747 cases (4.9%) and was unplanned in 422 cases (2.8%). The median interval between primary and next inpatient treatment was 11 days. The principal diagnosis was the same as during the primary index treatment in 72% of the cases. The most frequent reasons for readmission were: Need for non-surgical therapy (31.2%), need for further surgery (26.3%), post-surgical complaints (16.9%), and recurrence of primary complaints (10.7%). The multivariate analysis revealed that discharge due to patient's request against medical advice was a strong independent factor with high risk for unplanned readmission (Odds Ratio [OR] = 9.62]; confidence interval [CI] = 2.69-34.48). Surgery at index admission (OR = 3.33; CI = 1.86-5.96) was the second important independent risk factor for unplanned readmission. Unplanned readmission had more frequently a non-surgical treatment at readmission than a surgical treatment (OR = 3.92; CI = 2.24-6.84) and needed more frequently further diagnostics (OR = 2.34; CI = 1.34-4.11). The following index International Classification of Diseases (ICD) categories had the highest risk for unplanned readmission: Injury, poisoning and certain other consequences of external causes, ICD: S00-T98 (OR = 66.67; CI = 15.87-333.33), symptoms, signs, abnormal findings, ill-defined causes, not otherwise classified, ICD: R00-R99 (OR = 62.5; CI = 11.76-333.33), blood forming organ diseases, ICD: D50-D90 (OR = 21.276; CI = 3.508-125), and eye/ ear diseases, ICD: H00-H95 (OR = 12.66; CI = 4.29-37.03). CONCLUSIONS:The causes of unplanned 30-day readmission in German otolaryngology inpatients are multifactorial. Specific patient and treatment characteristics were identified to be targeted with health care interventions to decrease unplanned readmissions.

Project description:BackgroundUnplanned hospital readmissions are a major source of morbidity among dialysis patients, in whom the risk of hospital readmission is exceptionally high. The contribution of dialysis facility staffing to hospital readmission has been largely overlooked.MethodsUsing annual data of dialysis patients from the United States Renal Data System from 2010 to 2013, we assessed dialysis facilities with a significantly worse (SW) and facilities with a nonsignificant (NS) standardized readmission ratio (SRR). SRR estimates were risk adjusted for patient factors, past year comorbidities, and index hospitalization characteristics. Facility staffing variables were compared between 2 exposure groups: facilities with SW and NS SRRs. Four measures of staffing, including patient-to-staffing ratio, were compared between SW and matched NS facilities.ResultsAbout 136,000-148,000 dialysis patients with 269,000-319,000 index hospital discharges were used to identify facilities with SW and facilities with NS SRR annually. Approximately 3-4% of facilities were identified as having SW SRR among > 5,000 facilities annually. The percent of nurses-to-total staff was significantly lower in 2010 for SW facilities than in matched NS facilities (42.5 vs. 45.6%, p = 0.012), but this disparity was attenuated by 2013 (44.8 vs. 44.7%, p = 0.949). There was a higher patient-to-nurse ratio for SW facilities than for NS facilities (mean 16.4 vs. 15.2, p = 0.038) in 2010 as well, and the disparity was reduced by 2013. The trends were similar for patient-to-total staff and patient-to-registered nurse, but not statistically significant.ConclusionsThis study found that dialysis facilities with SW 30-day readmission rates had lower proportions of nurses-to-total staff and higher patient-to-nurse ratios, but this disparity improved in recent years. Additional research is warranted focusing on how evidence-based staffing at dialysis facilities can contribute to reduction of hospital readmission, and this knowledge is needed to inform clinical practice guidelines and policy decisions regarding optimal dialysis patient staffing.

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Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate.

Publications

Anemia in general medical inpatients prolongs length of stay and increases 30-day unplanned readmission rate.

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