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Rapid response teams and recommended ward-based management of acute deterioration: a single-centre retrospective cohort study in an inner-city London (UK) teaching hospital

Por: Hadfield · S. · Zentar · M. · McPhail · M. · Helme · E. · Broderick · R. · Logan · F. · Loveridge · R. · Madine · E. · Vining · I. · Wendon · J. · Metaxa · V. · Hadfield · D.
Objectives 

  • To describe the associations between Rapid Response Team (RRT) patient review and other predefined clinical management actions, with risk of in-hospital cardiac arrest and in-hospital mortality in the first unplanned admission (UPA) to the adult intensive care unit (ICU) from the ward environment for each patient.

  • To describe a novel RRT assessment tool for ward-based care for patients who were deteriorating.

  • Design

    A retrospective cohort study.

    Setting

    A large multispecialty, tertiary referral and teaching hospital in England, UK.

    Participants

    The study included 3175 consecutive adult ICU UPAs from hospital wards over a 6-year period (2014–2019).

    Outcome measures

    Ward-based management of deterioration prior to ICU admission was assessed by the RRT, using a scored checklist—the UPA score. Admissions were compared in two groups according to their exposure to an RRT review in the 72 hours before ICU admission. Associations with in-hospital cardiac arrest within 24 hours before ICU admission and all-cause in-hospital mortality were estimated, using unadjusted and adjusted odds ratios (aORs) with 95%CI.

    Results

    RRT review occurred in 1413 (44.5%) admissions and was associated with reduced odds of in-hospital cardiac arrest (aOR 0.51; 95% CI 0.36 to 0.78; p

    Conclusions and relevance

    An RRT review in the 72 hours prior to ICU admission was associated with reduced odds of in-hospital cardiac arrest but did not impact in-hospital mortality. Higher UPA scores were associated with increased incidence of both in-hospital cardiac arrest and in-hospital mortality. In addition, this study describes a novel and adaptable RRT scoring tool (the UPA score) for safety monitoring and quality improvement.

    Cost of physiotherapy non-attendance at a metropolitan hospital in Australia: A time-driven activity-based costing study

    Por: Mohammed Selim · S. · Naicker · S. · Kularatna · S. · Carter · H. E. · Borg · S. · Armstrong · C. · Walkenhorst · M. · Kunst · B. · McPhail · S. M.
    Objectives

    (1) Identify the processes, staff time and labour costs associated with non-attendance at two physiotherapy outpatient clinics using time-driven activity-based costing; (2) estimate labour cost-burden of non-attendance response scenarios.

    Design

    A six-step time-driven activity-based costing method was used, including scenario analyses.

    Setting

    Two tertiary hospital outpatient clinics.

    Participants

    Clinic non-attendance rates were determined from digital administrative records for participating clinics. Interviews and iterative discussions were conducted with 15 administrative and clinical staff to establish process maps and key parameters.

    Primary and secondary outcome measures

    The primary outcome was health service labour cost associated with clinic non-attendance. Four key work processes were identified and costed (2023, A$).

    Results

    Clinic non-attendance rates for the 2018–2021 period were 8% (Clinic 1) and 10% (Clinic 2). Complex triaging cases constituted greater costs than simple triaging cases. Projected annual costs of non-attendance were as high as A$114 827 for a single clinic. The most expensive referral and response scenario was internal referral with non-attendance that was converted to a telephone appointment (mean cost of A$113/appointment).

    Conclusion

    Non-attendance rates at participating clinics were at the lower end of values reported in prior literature; however, substantial healthcare resource waste was still evident. Findings highlighted the extent to which non-attendance at scheduled clinic appointments may not only impact patients’ welfare through lost treatment opportunity, but also carry substantial opportunity cost from wasted hospital resources that could have been allocated to other referred patients. Establishing the effectiveness and cost-effectiveness of interventions to reduce non-attendance remains a priority.

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