This article belongs to the Special Issue Nursing Research. ; [Background] In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. ; [Methods] A multicentre prospective observational study design was used. Sampling was conducted between February 2015 and October 2017. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 h were included. Multivariate regression analyses were performed to analyse the data. ; [Results] The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE (Inventario del Nivel de Cuidados Mediante Indicadores de Clasificación de Resultados de Enfermería) scale yielded an adjusted odds ratio [AOR] of 0.987 (95% confidence interval [CI]: 0.97–0.99) and the nurse staffing level (NSL) yielded an AOR of 1.197 (95% CI: 1.02–1.4). ; [Conclusion] Nursing care dependency measured by INICIARE and nurse staffing level was associated with in-hospital mortality. ; This research was funded by Health Ministry of the Andalusian Regional Government, grant number (PI-0045/2016).
The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of in-hospital mortality. Statistical analysis was carried out using SPSS 15. A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P = 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.
Objective: To identify differences in short-term outcomes of patients with coronavirus disease 2019 (COVID-19) according to various racial/ethnic groups.Design: Analysis of Cerner de-identified COVID-19 dataset.Setting: A total of 62 health care facilities.Participants: The cohort included 49,277 adult COVID-19 patients who were hospitalized from December 1, 2019 to November 13, 2020.Methods: We compared patients' age, gender, individual components of Charlson and Elixhauser comorbidities, medical complications, use of do-not-resuscitate, use of palliative care, and socioeconomic status between various racial and/or ethnic groups. We further compared the rates of in-hospital mortality and non-routine discharges between various racial and/or ethnic groups.Main Outcome Measures: The primary outcome of interest was in-hospital mortality. The secondary outcome was non-routine discharge (discharge to destinations other than home, such as short-term hospitals or other facilities including intermediate care and skilled nursing homes).Results: Compared with White patients, in-hospital mortality was significantly higher among African American (OR 1.5; 95%CI:1.3-1.6, P<.001), Hispanic (OR1.4; 95%CI:1.3-1.6, P<.001), and Asian or Pacific Islander (OR 1.5; 95%CI: 1.1-1.9, P=.002) patients after adjustment for age and gender, Elixhauser comorbidities, do-not-resuscitate status, palliative care use, and socioeconomic status.Conclusions: Our study found that, among hospitalized patients with COVID-2019, African American, Hispanic, and Asian or Pacific Islander patients had increased mortality compared with White patients after adjusting for sociodemographic factors, comorbidities, and do-not-resuscitate/palliative care status. Our findings add additional perspective to other recent studies. Ethn Dis. 2021;31(3):389-398; doi:10.18865/ed.31.3.389
Background In armed conflicts, civilian health care struggles to cope. Being able to predict what resources are needed is therefore vital. The International Committee of the Red Cross (ICRC) implemented in the 1990s the Red Cross Wound Score (RCWS) for assessment of penetrating injuries. It is unknown to what extent RCWS or the established trauma scores Kampala trauma Score (KTS) and revised trauma score (RTS) can be used to predict surgical resource consumption and in-hospital mortality in resource-scarce conflict settings. Methods A retrospective study of routinely collected data on weapon-injured adults admitted to ICRCs hospitals in Peshawar, 2009-2012 and Goma, 2012-2014. High resource consumption was defined as >= 3 surgical procedures or >= 3 blood-transfusions or amputation. The relationship between RCWS, KTS, RTS and resource consumption, in-hospital mortality was evaluated with logistic regression and adjusted area under receiver operating characteristic curves (AUC). The impact of missing data was assessed with imputation. Model fit was compared with Akaike Information Criterion (AIC). Results A total of 1564 patients were included, of these 834 patients had complete data. For high surgical resource consumption AUC was significantly higher for RCWS (0.76, 95% CI 0.74-0.78) than for KTS (0.53, 95% CI 0.50-0.56) and RTS (0.51, 95% CI 0.48-0.54) for all patients. Additionally, RCWS had lower AIC, indicating a better model fit. For in-hospital mortality AUC was significantly higher for RCWS (0.83, 95% CI 0.79-0.88) than for KTS (0.71, 95% CI 0.65-0.76) and RTS (0.70, 95% CI 0.63-0.76) for all patients, but not for patients with complete data. Conclusion RCWS appears to predict surgical resource consumption better than KTS and RTS. RCWS may be a promising tool for planning and monitoring surgical care in resource-scarce conflict settings. ; Funding Agencies|Linkoping University
Italy was one of the nations most affected by SARS-CoV-2. During the pandemic period, the national government approved some restrictions to reduce diffusion of the virus. We aimed to evaluate changes in in-hospital mortality and its possible relation with patient comorbidities and different restrictive public health measures adopted during the 2020 pandemic period. We analyzed the hospital discharge records of inpatients from public and private hospitals in Apulia (Southern Italy) from 1 January 2019 to 31 December 2020. The study period was divided into four phases according to administrative restriction. The possible association between in-hospital deaths, hospitalization period, and covariates such as age group, sex, Charlson comorbidity index (CCI) class, and length of hospitalization stay (LoS) class was evaluated using a multivariable logistic regression model. The risk of death was slightly higher in men than in women (OR 1.04, 95% CI: 1.01–1.07) and was lower for every age group below the > ; 75 years age group. The risk of in-hospital death was lower for hospitalizations with a lower CCI score. In summary, our analysis shows a possible association between in-hospital mortality in non-COVID-19-related diseases and restrictive measures of public health. The risk of hospital death increased during the lockdown period.
The direct impact of hospital accreditation on patients' clinical outcomes is unclear. The purpose of this study was to evaluate whether mortality within 30 days of hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), and hemorrhagic stroke (HS) differed before and after hospital accreditation. This study targeted patients who had been hospitalized for the three diseases at the general hospitals newly accredited by the government in 2014. Thirty-day mortality rates of three years before and after accreditation were compared. Mortality within 30 days of hospitalization for the three diseases was lower after accreditation than before (7.34% vs. 6.15% for AMI; 4.64% vs. 3.80% for IS; and 18.52% vs. 15.81% for HS). In addition, hospitals that meet the criteria of the patient care process domain have a statistically lower mortality rate than hospitals that do not. In the newly accredited Korean general hospital, it was confirmed that in-hospital mortality rates of major cardiovascular diseases were lower than before the accreditation.
IMPORTANCE: Beginning in 2013, New York State implemented regulations mandating that hospitals implement evidence-based protocols for sepsis management, as well as report data on protocol adherence and clinical outcomes to the state government. The association between these mandates and sepsis outcomes is unknown. OBJECTIVE: To evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adult patients hospitalized with sepsis in New York State and in 4 control states (Florida, Maryland, Massachusetts, and New Jersey) using all-payer hospital discharge data (January 1, 2011-September 30, 2015) and a comparative interrupted time series analytic approach. EXPOSURES: Hospitalization for sepsis before (January 1, 2011-March 31, 2013) vs after (April 1, 2013-September 30, 2015) implementation of the 2013 New York State sepsis regulations. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day in-hospital mortality. Secondary outcomes were intensive care unit admission rates, central venous catheter use, Clostridium difficile infection rates, and hospital length of stay. RESULTS: The final analysis included 1 012 410 sepsis admissions to 509 hospitals. The mean age was 69.5 years (SD, 16.4 years) and 47.9% were female. In New York State and in the control states, 139 019 and 289 225 patients, respectively, were admitted before implementation of the sepsis regulations and 186 767 and 397 399 patients, respectively, were admitted after implementation of the sepsis regulations. Unadjusted 30-day in-hospital mortality was 26.3% in New York State and 22.0% in the control states before the regulations, and was 22.0% in New York State and 19.1% in the control states after the regulations. Adjusting for patient and hospital characteristics as well as preregulation temporal trends and season, mortality after implementation of the regulations decreased significantly in New York State relative to the ...
The increasing demand for greater clinical accountability requires development of convenient tools to measure healthcare safety and quality, which are able to provide information contemporaneously. The purpose of this paper is to describe the development of the Hospital Mortality Project, a quality assurance initiative designed to encourage and facilitate clinical accountability for hospital mortality by all clinical departments and clinicians. The project was carried out in two stages. Part 1: After registration of in-hospital patient deaths (1 May 2004 to 31 December 2007), the consultant in charge of patient care was notified and requested to assign the death to a predefined category. This categorisation leads to further investigation as appropriate. Part 2: Hospital administrative data from 1 April 1997 to 31 December 2007 were used to assess a defined index, the Hospital Mortality Index (HMI), which was the expressed in the form of an Attribute Control Chart ( p-CHART) and then used as a performance indicator for hospital departments and clinicians. Summary data are reported to the clinical departments and to the hospital executive via the Quality Improvement Committee on quarterly basis. The clinical review was complete for 2,990 of 3,132 (95%) inpatient deaths till 31 December 2007, while a further 142 (5%) deaths are still in the process of being reviewed as of 7 April 2008. The median age of all the cases was 78 years (IQR 67-86) of which 1,657 (53%) were male. The Poisson regression analysis showed that since 1997 departments with a minimum of 100 deaths in total showed no clinically significant change in HMI over time. The Hospital Mortality Project provides a simple and efficient tool to analyse data for clinical managers to facilitate accountability.
BACKGROUND: Fractional excretion of sodium (FENa), the reflection of sodium (Na) handling by the kidney during natriuresis, is influenced by exo- and endogenous factors that have a powerful impact on renal function. We performed this study to define the correlation between FENa and worsening renal function (WRF) and assess the value of FENa in the length of hospital stay and in-hospital mortality in the patients with acute decompensated heart failure (ADHF). METHODS: This prospective observational study was performed in two tertiary governmental heart centers located in Ahvaz, Iran, from March 2019 to March 2020. Any individual suffering from ADHF who had no renal failure, received only loop diuretics, and was on a low Na diet was eligible for recruitment in this study. The urine sample used to calculate FENa was a 24-hour sample. RESULTS: Over the one year, 56 patients met the inclusion criteria. The total study population had a mean age of 61.46 ± 14.22 years with the dominance of women (51.8%). The mean age of men and women was 58.59 ± 14.35 and 64.13 ± 13.80 years, respectively. During hospitalization, 13 (23.2%) patients experienced WRF. In patients who experienced WRF during hospitalization, FENa of 2%: 2.30 ± 0.92 days, P = 0.02). There was no significant relation in terms of in-hospital death across different categories of FENa (P = 0.69). CONCLUSION: Our data suggested that FENa less than 1% was associated with WRF and could be associated with a longer hospitalization period. We did not find any association between FENa and in-hospital mortality. Further studies with a larger number of patients are required to determine the cut-off value.
Dept. of Public Health/諛뺤궗 ; Ischemic stroke, hemorrhagic stroke, and acute myocardial infarction (AMI) are diseases that occur during the so-called golden hour. These diseases need timely treatment and quick response to reduce mortality. Although the government has made efforts to improve survival, 30-day in-hospital mortality rates due to stroke and AMI are high. This study aimed to identify and compare factors that affect 7-day, 30-day, and in-hospital mortality in patients who had a stroke and have AMI who are admitted via the emergency department. This study used the Korean National Health Insurance claims data from 2002 to 2013. The study sample included 7,693 patients who had an ischemic stroke, 2,828 patients who had a hemorrhagic stroke, and 4,916 patients with AMI who were admitted via the emergency departments of a superior general hospital and general hospital, did not transfer to another hospital or come from another hospital, and were aged �돟20 years. This study was analyzed by using Cox�셲 proportional hazards frailty model. 500 (6.5%) patients were dead of 7,693 patients with ischemic stroke, 569 (20.1%) patients were dead of 2,828 patients with hemorrhagic stroke, and 399 (8.1%) patients were dead of 4,916 patients with AMI. The analysis of the association between patient characteristics and mortality, clinical factors were associated with 7-day mortality such as age, sex, hypertension, and diabetes in all three diseases. Non-clinical factors such as individual household income and health insurance type were associated with 30-day mortality and in-hospital mortality. In the analysis of the association between treatment characteristics and mortality, performing PCI was associated with reducing adjusted hazard ratio (aHR) for 7-day, 30-day and in-hospital mortality (aHR,0.40; 95% CI,0.29-0.54; aHR, 0.35; 95% CI, 0.23-0.55; aHR, 0.43; 95% CI, 0.27-0.67, respectively) among AMI patients. In patients with AMI and ischemic stroke, the adjusted hazard ratio of patient who utilized intensive care unit service was high for 7-day, 30-day and in-hospital mortality comparing to those who did not utilize intensive care unit service. There was a weekend effect in AMI and ischemic stroke. In patients with hemorrhagic stroke, the risk of mortality for patients who received surgical interventions such as trephination and craniotomy was high than those who received medical interventions such as administration of mannitol and intravenous antihypertensive agents to control intracranial pressure (eg., for 30-day mortality; aHR, 2.42; 95% CI, 1.36-4.32 for patients who received mannitol; aHR, 3.30; 95% CI, 1.80-6.04 for patients who received trephination; aHR, 5.27; 95% CI, 2.49-11.17 for patients who received craniotomy). In the analysis of the association between hospital characteristics and mortality, characteristic of funding source and number of patients per one nurse was associated with reducing risk of mortality for 7-day, 30-day and in-hospital mortality in patients with ischemic stroke. In all three diseases, greater volume was associated with reducing the risk of mortality, and greater transferred rated was associated with increasing the risk of mortality in patients with hemorrhagic stroke. These findings suggest that focus should be on preventing hypertension in stroke and preventing diabetes in AMI. Health-care providers should make efforts to provide consistent care like that provided on weekdays. Especially health policy makers and health-care providers should seek ways to obtain personal resources that can provide highly technical interventions such as percutaneous coronary intervention (PCI). At the same time, ways that can reflect the real hospital context have been developed to improve the quality of hospital care. �꽌濡�: �떖�뇤�삁愿�吏덊솚�� �쟾泥댁궗留앹쓽 �궗遺꾩쓽 �씪�쓣 �옄移섑븯�뒗 吏덊솚�쑝濡쒖꽌, �뼢�썑 �븳援��쓽 怨좊졊�솕瑜� 媛먯븞�븷 �븣, 吏덈퀝遺��떞�� �뜑�슧 而ㅼ쭏 寃껋쑝濡� �삁�긽�맂�떎. �뇤議몄쨷怨� 湲됱꽦�떖洹쇨꼍�깋利앹쑝濡� �씤�븳 �궗留앹쓣 以꾩씠怨좎옄, �젙遺��� �쓽猷뚭린愿��쓽 �걡�엫�뾾�뒗 �끂�젰�쓣 �빐�솕�쓬�뿉�룄 遺덇뎄�븯怨�, �뿬�쟾�엳 蹂묒썝 �궡 �궗留앸쪧�씠 �넂�떎. �뿰援щぉ�쟻: Algebra Effectiveness Model瑜� �쟻�슜�븯�뿬 �뇤議몄쨷怨� �떖洹쇨꼍�깋利� �솚�옄�뿉�꽌 �솚�옄�슂�씤,. ; open
Ascites is among the most common complications of liver cirrhosis and is associated with a high mortality rate. The present retrospective study aimed to evaluate the potential correlation between in-hospital mortality of liver cirrhosis and volume of ascites. Patients with liver cirrhosis who were admitted to the General Hospital of Shenyang Military Region (Shenyang, China) between June 2012 and June 2014 and underwent axial abdomino-pelvic computed tomography (CT) scans were retrospectively reviewed. The volume of ascites was approximated using a five-point method, and diagnostic accuracy was expressed by the area under the receiver operating characteristic curves (AUROCs) with 95% confidence intervals (CIs). Of the 177 patients reviewed in the present study, 117 (61.10%) exhibited ascites on CT scans, and the in-hospital mortality rate was 4.52% (8/177). Child-Pugh and model for end-stage liver disease (MELD) scores were significantly increased in the presence of ascites (P300 ml (n=72), the AUROCs of the Child-Pugh score, MELD score, and ascites volume for predicting in-hospital mortality were 0.939 (95% CI, 0.856–0982), 0.952 (95% CI, 0.873–0.988), and 0.782 (95% CI, 0.668–0.871), respectively. These AUROCs did not differ significantly. In conclusion, quantification of ascites may aid to predict the in-hospital mortality rate of cirrhotic patients.
