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PURPOSE: Patients with heart failure (HF) are at an increased risk of volume overload, which can lead to hospital admission. Use of noninvasive remote patient monitoring (RPM) devices utilizing biometric sensors and weighing scales to track vital signs and body weight has uncertain benefits. At the Baptist Health Louisville (BHLOU) HF Clinic, high-risk patients were given RPM kits. The purpose of this study was to determine whether RPM led to reductions in HF hospitalizations and mortality. METHODS: This single-center, retrospective chart review evaluated adult patients presenting to the BHLOU HF Clinic after a recent hospitalization for HF or need for intravenous diuretics within the past 60 days. The study evaluated patients before and after implementation of RPM kits. The primary endpoints were differences in the rates of 30-day HF hospitalization and 30-day mortality. Secondary endpoints included differences in the number of interventions in 90 days, the 90-day rate of HF hospitalization, and the 90-day rate of mortality. RESULTS: The final analysis included 58 patients in the preimplementation group and 34 patients in the postimplementation group. The rate of 30-day HF hospitalization was 10.3% in the preimplementation group and 0% in the postimplementation group. The rate of 30-day mortality was 3.4% in the preimplementation group and 0% in the postimplementation group. For the secondary endpoints, the number of interventions in 90 days was 3 vs 4, the 90-day rate of HF hospitalization was 22.4% vs 11.8%, and the rate of 90-day mortality was 6.9% vs 5.9% in the preimplementation vs postimplementation group, respectively. CONCLUSION: Implementation of RPM in patients with acutely decompensated HF led to numerically lower 30-day and 90-day rates of HF hospitalization.

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Assigning inpatients to hospital beds impacts patient satisfaction and the workload of nurses and doctors. The assignment is subject to unknown inpatient arrivals, in particular for emergency patients. Hospitals, therefore, need to deal with uncertainty on actual bed requirements and potential shortage situations as bed capacities are limited. This paper develops a model and solution approach for solving the patient bed-assignment problem that is based on a machine learning (ML) approach to forecasting emergency patients. First, it contributes by improving the anticipation of emergency patients using ML approaches, incorporating weather data, time and dates, important local and regional events, as well as current and historical occupancy levels. Drawing on real-life data from a large case hospital, we were able to improve forecasting accuracy for emergency inpatient arrivals. We achieved up to 17% better root mean square error (RMSE) when using ML methods compared to a baseline approach relying on averages for historical arrival rates. We further show that the ML methods outperform time series forecasts. Second, we develop a new hyper-heuristic for solving real-life problem instances based on the pilot method and a specialized greedy look-ahead (GLA) heuristic. When applying the hyper-heuristic in test sets we were able to increase the objective function by up to 5.3% in comparison to the benchmark approach in [40]. A benchmark with a Genetic Algorithm shows also the superiority of the hyper-heuristic. Third, the combination of ML for emergency patient admission forecasting with advanced optimization through the hyper-heuristic allowed us to obtain an improvement of up to 3.3% on a real-life problem.

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OBJECTIVES: The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD: A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS: Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS: Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

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The COVID-19 lockdown had a series of intended and unintended consequences, including reduced infections and changes in activities and behaviours. Some of these changes may have been beneficial to perinatal outcomes; however, other factors such as reduced access to face-to-face healthcare may have contributed negatively to antenatal care. The aim of this audit was to evaluate neonatal admissions in the South-West of England during the COVID-19 pandemic in 2020 and the previous two years 2018-2019. Anonymised birth and neonatal admission rates from January to December 2020 was obtained and compared to data from 2018 to 2019. The results demonstrate a decreasing in neonatal unit admissions between 2018 and 2020, 9.48% of live births in 2018 (95% CI 9.17, 9.80) to 8.89% (95% CI 8.65, 9.13) in 2020 (p = 0.002).Conclusion: There were no significant differences across gestational groups. It is unclear without nationwide data whether our observed trends, decreased neonatal admissions over the past 3 years, are generalisable and related to the COVID-19 pandemic. Future research exploring the impact of lockdowns on behaviour change during pregnancy and support services is warranted to understand the implications of pandemics on pregnancy and preterm birth. What is Known: • The COVID-19 lockdown had a series of intended and unintended consequences; some of which may have been beneficial to perinatal outcomes. • Research suggests that preterm births have not significantly changed overall, but they have decreased in high-income countries. What is New: • In our audit, analysing retrospective data of regional birth and neonatal admission from the South-West of England, we observed a decrease in live birth rates between 2018 and 2020. • A reduction in neonatal unit admissions was observed from 2018 to 2020 with no significant differences across gestational groups. The reduction from 2019 to 2020 was smaller than that from 2018 to 2019 implying that the COVID-19 pandemic in 2020 was not necessarily implicated.

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INTRODUCTION: Major trauma centres have improved morbidity and mortality for moderate and severely injured patients. Less injured patients may be treated in facilities less resourced for trauma care. In these units, understanding the variations in injury presentation and treatment over time allows service delivery to be tailored to demand. This study set out to describe seasonal variations in trauma over a 10-year period at a level III trauma unit. MATERIALS AND METHODS: Patient demographics, admission frequency, site of injury, season of admission, management, complications, onward transfers, and length of stay were extracted on consecutive patients admitted with traumatic injuries between January 2009 and December 2018 and recorded on a prospectively maintained database. Analysis was undertaken to determine if there were reproducible patterns in trauma presentation across seasons, based on the patient's age and gender, type of injury, management and length of stay. RESULTS: There were 13,007 'first admissions' over 10 years, with a mean (SD) age of 55.6 (27.7) years. Admissions were higher in summer (27%) and lower in winter (23.6%) and patients were on average younger in the summer (52.8 years) and older in winter (59.2 years). The proportion of female and male patients remained relatively constant across seasons (CV=6% and 8%, respectively). There was seasonal variation in the incidence of forearm (36%) elbow (19%), and multi-sites injuries (17%) compared with hip and wrist injuries (CV=5% for both). A lower proportion of patients underwent operations in summer (72%) compared with other seasons with winter having the highest at 77%. More patients aged less than 60 years stayed in hospital during winter than summer (13.2% vs. 11.6-12.4%) although often for a day. Patients aged 60 years stayed longer in spring and winter. CONCLUSION: The results of this study demonstrate trends in the admission and management of trauma patients to a level III trauma unit. Some of the patterns in admission, treatment and length of stay had not been identified previously. The results can be used to enhance patient care and minimise health care costs by reducing unwarranted variations and enabling service delivery to match the demand in all trauma units.

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PURPOSE: Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings. METHODS: Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used. RESULTS: 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences. CONCLUSIONS: Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.

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OBJECTIVE: Drug therapeutic failures (TFs) are included in pharmacovigilance reporting, as some authors consider them a type of adverse drug reaction. Given their high frequency in Colombia, we studied their importance as a cause of admission to an intensive care unit (ICU). METHODS: This was a cross-sectional observational study. Clinical records of patients who arrived at the emergency service of a third-care level university hospital were reviewed. Information was collected by a resident in clinical toxicology, and each case was validated and analyzed by a research team using the algorithm proposed by Vaca González and Schumock and Thornton criteria for preventability to evaluate the existence of possible medication errors. FINDINGS: In total, 697 clinical records were evaluated and 18 patients presented TFs (2.6%, 95% confidence interval 1.5%-4.1%) as the cause of admission to the ICU. The most frequent TFs were seizures (56%) and hypertension (28%). The most commonly associated medications were valproic acid (28%) and losartan (28%). Ten cases (56%) were associated with drug misuse and the same number of cases was preventable, according to Schumock and Thornton criteria. CONCLUSION: This is the first study assessing TFs as a cause of admission to the ICU in the Colombian population. The frequency of TFs in our study was similar to that described in the literature; being the most common cause the inappropriate drug use, particularly for drugs with complex kinetics, such as antiepileptic drugs.

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OBJECTIVE: Existing data examining mortality rates following inpatient hospital admissions in the UK are either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess mortality rates in patients admitted to complex care (CC) wards managed by geriatricians at Southmead hospital, Bristol. METHODS: Data were collected by the trust's audit department and analysed by the authors. All patients admitted to the four CC wards from July to December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge and date of death if applicable. RESULTS: 2673 patients were admitted to CC wards from July to December 2017. 42.72% of patients were men, and mean age of patients was 82.46 years. Mean length of stay was 16.68 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were: (1) 1 month: 11.34% (303 patients); (2) 3 months: 21.59% (577 patients); (3) 6 months: 30.15% (806 patients); (4) 12 months: 38.53% (1030 patients). 12-month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% in 85-89 years, 50.27% in 95-99 years, 66.67% in 100-104 years) but was similar in those aged 65-69 and 70-74 years (29.41% and 28.18%, respectively). CONCLUSIONS: An improved understanding of mortality rates in patients requiring an admission under geriatricians may aid clinicians' ability to prognosticate. Appreciating that over a third of these patients are potentially in the last year of life provides further impetus to begin advance care planning discussions during inpatient admissions.

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Self-admission to inpatient treatment is a novel approach that aims to increase agency and autonomy for patients with severe psychiatric illness and a history of high utilization of inpatient care. By focusing on brief, preventive hospital admissions in times of increased risk of relapse, self-admission seeks to reduce the need for prolonged episodes of inpatient treatment. Participants are generally satisfied with the model, which is not surprising given that self-admission programs allocate a scarce resource-hospital beds-to a select group. However, the patients targeted by these programs are not necessarily those in most need of hospital admission, which may compromise the commonly accepted 'principle of need' in allocation of public healthcare resources. In light of the current lack of consistent evidence of the usefulness and cost-effectiveness of the model, several aspects need to be further studied in order to guide any large-scale implementation of self-admission in psychiatry.

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BACKGROUND: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. AIM: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. DESIGN: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. PARTICIPANTS/SETTING: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. RESULTS: Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care. CONCLUSION: Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.

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BACKGROUND: Interest has increased in programs offering self-admission to inpatient treatment for patients with severe psychiatric illness, whereby patients who are well-known to a service are afforded the opportunity to admit themselves at will for a brief period of time. The aim of the present study was to examine patient experiences of practical considerations during the start-up phase of a self-admission program in an eating disorder service. METHODS: Sixteen adult participants in a self-admission program at a specialist eating disorders service were interviewed at 6 months about their experiences during the implementation phase. A qualitative content analysis approach was applied in order to identify recurring themes. RESULTS: Six subcategories regarding implementation and logistics of self-admission were identified: "Start-up problems", "Problems associated with reserving a bed", "Lack of staff continuity", "Not enough emphasis on long-term goals", "Too demanding in terms of freedom and responsibility", and "Suggestions for alternative models". CONCLUSIONS: Practical recommendations can be offered for the implementation of future self-admission programs, such as thoroughly informing all participants about the rationale behind self-admission with particular emphasis on patient accountability, establishing a waiting list procedure for occasions when all designated beds are occupied, and assigning an individual contact staff member responsible for each self-admitted patient. TRIAL REGISTRATION: The study protocol is retrospectively registered at ClinicalTrials.gov as ID: NCT02937259 .

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The aim of the present study was to explore patients' experiences of participating in a self-admission program at a specialist eating disorders clinic. Sixteen adult program participants with a diagnosis of anorexia nervosa were interviewed at 6 months about their experiences in the self-admission program. A qualitative content analysis approach was applied to identify recurring themes. Four themes were identified: Agency and Flexibility, Functions, Barriers, and Applicability. Participants used self-admission to boost healthy behaviors, to prevent deterioration, to forestall the need for longer periods of hospitalizations, and to get a break from overwhelming demands. Quick access to brief admissions provides a safety net that can increase feelings of security in everyday life, even for patients who do not actually make use of the opportunity to self-admit. It also provided relief to participants' relatives. Furthermore, participants experienced that self-admission may foster agency and motivation. However, the model also requires a certain level of maturity and an encouraging environment to overcome barriers that could otherwise hinder optimal use, such as ambivalence in asking for help. Informants experienced that self-admission could allow them to gain greater insight into their disease process, take greater responsibility for their recovery, and transform their health care from crisis-driven to proactive. By offering a shift in perspective on help-seeking and participation, self-admission may potentially strengthen participants' internal responsibility for their treatment and promote partnership in treatment.

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AIMS: This study aimed to determine the occurrence of adverse drug reactions (ADRs) that caused admission to the intensive care unit (ICU) of a university hospital. METHODS: Clinical records were reviewed for patients meeting the inclusion criteria who were admitted to the ICU between September and December 2012. Suspected cases of ADRs were documented. Nine researchers later evaluated causality using the Naranjo Algorithm, preventability using the Schumock and Thornton criteria, and clinical classification based on the dose-time-susceptibility system. RESULTS: In total, 96 patients presented 108 cases of ADR (13.8%, 95% confidence interval 11.2-16.4%) as the cause of admission. The most frequent ADRs were bradyarrhythmias and upper gastrointestinal bleeding (12%). Therapeutic failure accounted for 20%. The most commonly associated medications were acetylsalicylic acid (16%) and losartan (10%). Forty-six cases were categorized as possible, and only one as definite. According to the dose-time-susceptibility classification, in 82% of the cases, the dosage was collateral (within the therapeutic range), and 90% were independent of time; the factors most associated with susceptibility to ADRs were comorbidities (42%) and age (49%). Forty-four percent of the ADRs were considered possibly preventable. CONCLUSIONS: ADRs contribute significantly to ICU admissions, and a significant number of ADRs are preventable. National studies are needed to assess their incidence and to establish classification standards to reduce their clinical impact.

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OBJECTIVES: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. METHODS: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization's International Classification of Diseases (ICD) coding system. RESULTS: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56-65-year-old age group (19.4%) and the majority of patients were admitted for one week or less (86.4%). Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%), followed by diseases of the circulatory (16.4%), digestive (16.4%) and genito-urinary (13.8%) systems. The most common diseases were cardiovascular disease (16.4%), malaria (11.3%), gastritis/peptic ulcer disease (9.8%), urinary tract infections (7.2%) and diabetes mellitus (6.9%). The mortality rate was 4.7%. CONCLUSION: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital.

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PURPOSE:The characteristics of hospitalized patients in neonatal intensive care units (NICUs), including hospitalization costs (HC) and National Health Insurance (NHI) status were studied. METHODS:We gathered the following data from 7 hospitals in Korea during 2006: the distribution of patients according to birth weight (BW), and the duration of the hospital stay according to BW and HC. RESULTS:The patients who were admitted to the NICU consisted of high-risk neonates, including low birth weight or premature neonates, which comprised 50% of all neonates admitted to the NICU. The duration of hospitalization was 75-90 days for neonates with BW 25% of the total HC. For this matter, additional NHI is needed.

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