Hospital practice (1995)最新文献

{"title":"Assessing the effectiveness of a rural distribution program in reducing time to prothrombin complex concentrate administration in patients taking warfarin.","authors":"Abigail Polzin, Joel Stroman, Riley Schaap, Rebecca Baird, David Sturdevant, Aarabhi Gurumoorthy","doi":"10.1080/21548331.2025.2455930","DOIUrl":"10.1080/21548331.2025.2455930","url":null,"abstract":"<p><strong>Study objectives: </strong>Reversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods, such as fresh frozen plasma (FFP). In many rural facilities, the availability of both FFP and PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal.</p><p><strong>Methods: </strong>This was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) and time to PCC4 administration from outside hospital admission. Active warfarin prescription, transfer to a tertiary facility, and administration of anticoagulation reversal between January 2013 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Linear regressions were performed to determine the effect of the variable and INR reversal methods on the time to INR reversal as well as the time to PCC4 administration. Time-to-event analysis was used to analyze the primary outcome between comparison groups. <i>p</i> values of less than 0.05 were considered significant.</p><p><strong>Results: </strong>Chart review identified 189 patients: 56 within the pre-implementation group and 133 within the post-implementation group. Statistics were compared between these two groups. The post-implementation group had a shorter time to INR reversal (median 9.97 h) compared with the pre-implementation group (median 14.58 h, <i>p</i> = 0.00004). Time to PCC4 administration was also significantly decreased (<i>p</i> = 0.023). No statistically significant differences were found for hospital survival or 30-day mortality.</p><p><strong>Conclusion: </strong>In rural hospitals, increasing availability of PCC4 using air medical transport along with a medication exchange program significantly reduces time to PCC4 administration in warfarin anticoagulated patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient complications and mortality in cirrhotic patients undergoing bariatric surgery: a comprehensive analysis.","authors":"Eun Seo Kwak, Abdulmajeed Alharbi, Ahmad Bosaily, Anas Alsughayer, Amna Igbal, Oscar Salichs, Sadik Khuder, Matthew Fourman, Ragheb Assaly","doi":"10.1080/21548331.2025.2455921","DOIUrl":"https://doi.org/10.1080/21548331.2025.2455921","url":null,"abstract":"<p><strong>Introduction: </strong>Liver cirrhosis, a complex and progressive disease, imposes a significant global health burden, characterized by irreversible liver tissue scarring and various life-threatening complications. Traditionally linked to factors like chronic alcohol consumption and viral hepatitis infections, the rising prevalence of obesity introduces a new dimension to its etiology. As obesity rates continue to climb worldwide, the confluence of liver cirrhosis and bariatric surgery has become an increasingly pertinent and clinically relevant topic of inquiry.</p><p><strong>Methods: </strong>In this study, we aimed to investigate the impact of liver cirrhosis on patients who underwent bariatric surgery, using data from the 2020 National Inpatient Sample (NIS) database. We compared the outcomes of 82,414 patients who had bariatric surgery, stratifying them based on the presence or absence of liver cirrhosis. We assessed baseline demographic characteristics and comorbidities, in-hospital outcomes, and complications related to the surgery.</p><p><strong>Results: </strong>Patients with liver cirrhosis who underwent bariatric surgery demonstrated several distinct trends. On average, they were older (mean age 63 years) and predominantly female (52%) compared to those without cirrhosis (mean age 52, 71% female). Furthermore, comorbidities such as hypertension, diabetes with chronic complications, and alcohol abuse were more prevalent in the cirrhosis group. In terms of outcomes, patients with liver cirrhosis faced significantly higher inpatient mortality rates (4%) compared to those without cirrhosis (1%) with <i>p</i> < 0.001. They also experienced a notably longer average length of hospital stay (2.35 days longer, 95% CI: -3.46 --1.25, <i>p</i> < 0.001) and incurred higher hospitalization costs (add AOR and <i>p</i> value here). Additionally, patients with cirrhosis had increased odds of experiencing acute heart failure (adjusted odds ratio: 1.87, 95% CI: 1.14-2.57, <i>p</i> = 0.01) and requiring blood transfusions (adjusted odds ratio: 1.71,95% CI: 1.13-3.09, <i>p</i> = 0.009). Although the adjusted odds ratio for inpatient mortality was higher in cirrhosis patients (1.58, 95% CI: 0.76-3.30, <i>p</i> = 0.21), it did not reach statistical significance.</p><p><strong>Conclusion: </strong>This study highlights the substantial impact of liver cirrhosis on post-bariatric surgery outcomes. Patients with cirrhosis who undergo bariatric surgery face higher inpatient mortality rates and a greater risk of complications, particularly acute heart failure and the need for blood transfusions. The longer hospital stays and increased costs further emphasize the challenges in managing this unique patient population. These findings emphasize the need for careful patient selection, risk assessment, and a multidisciplinary approach when considering bariatric surgery for individuals with both liver cirrhosis and obesity.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of patient demographics and outcomes in teaching and non-teaching hospitals in Iran.","authors":"Niusha Shahidi Sadeghi, Mohammadreza Maleki, Hassan Abolghasem Gorji, Soudabeh Vatankhah, Bahram Mohaghegh, Ali Behmanesh","doi":"10.1080/21548331.2025.2455931","DOIUrl":"10.1080/21548331.2025.2455931","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates the differences in patient demographics and outcomes between teaching and non-teaching hospitals in Iran. By analyzing these differences, it aims to provide useful information for policymakers to optimize resource allocation, improve patient care, and balance educational and service delivery goals in teaching hospitals.</p><p><strong>Materials and methods: </strong>In this cross-sectional investigation, both teaching and non-teaching general hospitals were examined. A comprehensive analysis was carried out on 13 non-teaching and 25 teaching hospitals with homogeneity, utilizing Health Information System (HIS) data comprising 10,611,647 records through census sampling in 2019. Before employing the logistic regression models to clarify the relationship between a binary dependent variable (distinguishing teaching or non-teaching hospitals) and independent variables, we utilize the Recursive Feature Elimination (RFE) technique to select the most crucial predictor variables.</p><p><strong>Findings: </strong>the optimal logistic regression model revealed that the teaching status of hospitals played a crucial role as an indirect predictor for variables including referral patients, length of stay (<24 hours), patients with partial improvement, and those who received less than 3 services. It also emerged as a direct predictor for variables such as length of stay (>30 days), patients receiving more than the mean services, death rate, and patients with complete improvement. Moreover, the teaching status had an indirect impact on variables like outpatient cases, length of stay (>30 days), and paraclinical services, while directly predicting variables such as patients with supplementary insurance and vulnerable groups insurance type, rehabilitation services, clinic wards, and length of stay (between 4-30 days).</p><p><strong>Conclusion: </strong>In Iranian teaching hospitals, we observed an increase in patient numbers, extended length of stay, a rise in both the quantity and complexity of services, and more intricate patient admissions. It appears that small teaching hospitals in Iran have transitioned from being referral centers to functioning as outpatient centers with active clinics.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of transition from use of alteplase to tenecteplase in the treatment of acute ischemic stroke in a large system of community hospitals.","authors":"Adam Hasse, Kimberly Korwek, Jeffrey Guy, Russell E Poland","doi":"10.1080/21548331.2024.2438592","DOIUrl":"10.1080/21548331.2024.2438592","url":null,"abstract":"<p><strong>Objective: </strong>Pharmacologic thrombolytic treatment for acute ischemic stroke has primarily been managed by intravenous alteplase. Tenecteplase is a variant that has been shown to be non-inferior to alteplase in clinical trials. In this study, we present a real-world assessment of patient outcomes with the facility-wide transition to the use of tenecteplase versus altepase for acute ischemic stroke in a large system of community hospitals in the United States.</p><p><strong>Methods: </strong>This retrospective analysis assessed adult patients who received either alteplase or tenecteplase between 1 April 2020 and 31 March 2023. Propensity matching was used to estimate the covariate-adjusted association with outcomes of discharge expired/hospice, intracranial hemorrhage and readmission to a facility in the same healthcare system within 30, 60, or 90 days.</p><p><strong>Results: </strong>Among 12,766 patients, gross mortality was 7.6% (<i>n</i> = 285) with tenecteplase and 8.2% (<i>n</i> = 739) with alteplase (<i>p</i> = 0.314); intracranial hemorrhage was 2.4% with either. The propensity match analysis found that the relative risk of mortality/hospice for patients given tenecteplase versus alteplase was 0.993 (95% CI: 0.848-1.162, <i>p</i> = 1.000). When limited to five facilities with the highest volume of thrombolytic use, there were no significant differences in outcomes. While the time from emergency department arrival to thrombolytic administration (door-to-needle) was shorter among patients receiving tenecteplase, there was no significant difference in the odds of mortality based on door-to-needle time.</p><p><strong>Conclusion: </strong>In alignment with previous studies, these findings demonstrate the lack of potential harm with a transition from alteplase to tenecteplase in clinical practice for acute ischemic stroke patients treated in community hospitals.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of trauma team physicians toward patients with bleeding in Saudi Arabia: a cross-sectional study.","authors":"Abdulaziz Mohammad Al-Sharydah, Faisal Ahmad Katbi, Razan Essam AlHarbi, Faisal Al-Ghamdi, Saleh AlShreadah","doi":"10.1080/21548331.2024.2442299","DOIUrl":"10.1080/21548331.2024.2442299","url":null,"abstract":"<p><strong>Objectives: </strong>Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients.</p><p><strong>Methods: </strong>A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding. The surveys were administered in person to 135 TT physicians.</p><p><strong>Results: </strong>Among them, 38.52% had five or more years of independent practice, and 87.41% routinely encountered patients with bleeding patients. Physicians who routinely treated patients with bleeding patients exhibited higher median scores, in line with current management standards (<i>p</i> = 0.634). Tertiary care physicians and academic- and military-affiliated physicians exhibited higher median scores (<i>p</i> =  <0.001 and <i>p</i> < 0.006, respectively). Amongst TT physicians, 47.41% preferred EAE for unstable pelvic ring fractures with active bleeding, while 68.15% favored splenectomy for unstable patients with grade V splenic injuries. For traumatic aortic injuries, 67.42% considered TEVAR/EVAR safer options. Notably, 84.44% viewed an INR > 3 as a contraindication for EAE in hemodynamically stable patients. General surgeons scored the highest in management decision-making, followed by neurosurgeons (<i>p</i> = 0.001). Orthopedics, emergency medicine, intensive care (ICU), and anesthesia specialists exhibited similarly high median scores for appropriate management approaches (<i>p</i> = 0.003). Overall, general surgeons, orthopedic surgeons, and ICU specialists exhibited the highest median correct responses, adhering to the current standard of practice (<i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>To address the potentially life-threatening condition of traumatic bleeding, raising awareness of the appropriate management and referral patterns for EAE is crucial.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct costs of severe hypoglycemia events in individuals with diabetes mellitus: a perspective from the Colombian health system - a single-center study.","authors":"Natalia A Rojas-Henao, Michael Garcia-Rivera, Ana C Hernandez-Herrera, Juliana Díaz-Giraldo, Carlos E Builes-Montaño","doi":"10.1080/21548331.2024.2439775","DOIUrl":"10.1080/21548331.2024.2439775","url":null,"abstract":"<p><strong>Background and aims: </strong>Diabetes mellitus is one of the more prevalent chronic diseases globally, and healthcare expenditures for diabetes care are on the rise. Intensive diabetes treatment has been associated with reducing the risk of chronic complications. However, hypoglycemia, the most common adverse effect, poses a significant risk to individuals' lives and is linked to high costs for healthcare systems.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study to determine direct costs by identifying emergency room visits due to hypoglycemia events using diagnostic codes during January 2017 to June 2019. Direct costs were calculated using billed data from the payer and information on outpatient treatment regimens. Differences in median costs were estimated based on length of stay and type of outpatient treatment.</p><p><strong>Results: </strong>Data from 101 patients and the same number of events were included. Women represented (62.4%) of the patients, the median age was 70 (IQR 59.5-80). Blood glucose levels at admission ranged from 12 mg/dL to 67 mg/dL. Most patients were on insulin for outpatient treatment. The median cost of care per hypoglycemia episode was US $345.35 (IQR US $202-727.8), and the cost per episode was higher in patients treated with regimens that included sulfonylureas.</p><p><strong>Conclusions: </strong>The management of patients admitted to the emergency department with a diagnosis of hypoglycemia places a significant burden on the Colombian healthcare system, primarily due to the associated hospitalization costs. Patients treated with regimens that included sulfonylureas incurred higher costs per episode. Prevention, patient education, and individualized treatment approaches could help alleviate the burden of hypoglycemia on both patients and the healthcare system.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of type 2 diabetes mellitus on mortality and recurrence of clostridioides difficile infection.","authors":"Cristina Martínez Cuevas, María Del Carmen Rebollo Nájera, Jessica Abadía Otero, Miriam Gabella Martín, Mónica de Frutos Serna, José María Eiros Bouza, Luis Corral Gudino, José Pablo Miramontes González","doi":"10.1080/21548331.2024.2440305","DOIUrl":"10.1080/21548331.2024.2440305","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. The infection is associated with a high mortality rate and risk of recurrence. We assessed risk factors for death or recurrent CDI (CDI) in patients with diabetes mellitus (DM).</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single institution from 2019 to 2020. CDI was defined as a positive toxin assay for C. difficile. CDI was defined as a repeat positive toxin assay within ≤ 60 days of stopping CDI treatment. Logistic regression models were used to identify risk factors for CDI-related mortality, recurrence, and the combined outcome of mortality and recurrence.</p><p><strong>Results: </strong>Of the 252 enrolled patients with CDI, 19% had DM. Only 49% of patients with DM fully recovered after the first CDI occurrence, whereas 69% of patients without diabetes fully recovered (<i>p</i> = 0.021); 23% of patients with DM vs. 17% of patients without DM had recurrences (<i>p</i> = 0.200); and 23% of patients with DM vs. 15% of patients without DM died (<i>p</i> = 0.169). DM was associated with mortality (OR 2.75, 95% CI 0.94-8.06) and the combined outcome (OR 2.10, 95% CI 1.05-4.18). Nosocomial transmission, immunosuppression, CKD, and age were associated with mortality.</p><p><strong>Conclusions: </strong>Diabetes is associated with a worse prognosis in patients with CDI. Prevention efforts should be optimized in patients with diabetes by reducing CDI transmission and avoiding nonessential medications, such as PPIs or antibiotics when they are not necessary. [Figure: see text].</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of proactive care model for patients with chronic kidney disease stage 4-5 to clinical outcomes and quality of life: an action research.","authors":"Malinee Jitnuk, Waree Jullaket, Ausanee Wanchai","doi":"10.1080/21548331.2024.2437977","DOIUrl":"10.1080/21548331.2024.2437977","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease often struggle to control clinical symptoms and need help from the healthcare team. This study aimed to develop a proactive care model for stage 4-5 chronic kidney disease patients and investigate its effectiveness on their clinical outcomes and quality of life in Thailand.</p><p><strong>Methods: </strong>The study was a comprehensive, collaborative effort conducted in North Thailand involving a multidisciplinary team of healthcare professionals. This team, which included physicians, professional nurses, pharmacists, and nutritionists from the Chronic Kidney Disease Clinic at a secondary hospital, worked together to develop and implement a proactive care model for stage 4-5 chronic kidney disease patients. The research instruments used were a proactive care model for CKD stages 4-5 patients, the clinical outcomes assessment form, and the Kidney Disease Quality of Life Short Form. Quantitative data were analyzed using descriptive statistics, Chi-Square, and dependent t-tests, while qualitative data were analyzed using content analysis.</p><p><strong>Results: </strong>The proactive care model for patients with chronic kidney disease stage 4-5 consists of 1) a multidisciplinary team providing chronic kidney disease standards, 2) providing knowledge and counseling for behavior change, and 3) supporting self-management of patients with chronic kidney disease. After the experiment, mean systolic blood pressure, diastolic blood pressure, and mean potassium were significantly lower than before, and Hematocrit significantly increased. In contrast, glomerular rate, fasting blood sugar, and hemoglobin A1C did not change after the intervention compared to before (<i>p</i> > .05). After the experiment, patients' overall quality of life significantly increased.</p><p><strong>Conclusions: </strong>This study demonstrated that the proactive care model for Chronic Kidney Disease stage 4-5 patients significantly improved clinical outcomes and profoundly impacted quality of life. Therefore, all components of the proactive care model should be applied, including working as a multidisciplinary team and helping patients adjust their behaviors and manage their health.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global strategies to reduce elective surgery waiting times for sustainable health outcomes: a systematic review.","authors":"Dimuthu Rathnayake, Mike Clarke, Viraj Jayasinghe","doi":"10.1080/21548331.2024.2435802","DOIUrl":"https://doi.org/10.1080/21548331.2024.2435802","url":null,"abstract":"<p><strong>Objective: </strong>Long waiting times for elective surgery reflect not just backlog issues but systemic inefficiencies that disrupt the smooth flow of patients through the surgical care pathway. This systematic review adopts a holistic approach to summarize global policies, strategies, and interventions aimed at reducing elective surgery wait times.</p><p><strong>Method: </strong>A comprehensive electronic search was performed in PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library from December 2019 to January 2020 and updated in April 2022. Eligible studies, published after 2013, focused on waiting lists for major elective surgeries in adults, excluding cancer-related surgeries. Both randomized and non-randomized studies and systematic reviews were included. Study quality was assessed using ROBINS-I, AMSTAR 2, and CASP tools, as appropriate. The review was registered in PROSPERO (CRD42019158455) and reported using a PRISMA flow diagram.</p><p><strong>Results: </strong>From 7543 records, 92 articles met the inclusion criteria. Evidence was categorized into seven strategic areas: referral management, patient prioritization, preventing scheduled surgery cancellations, perioperative time management, quality improvement methods for surgical care pathways, and waiting time targets for hospitals. Strategies such as referral management, patient prioritization, and preventing cancellations had the most significant impact on reducing waiting times, while perioperative time management and waiting time targets proved less effective.</p><p><strong>Conclusion: </strong>The review highlights that targeted interventions at different stages of the surgical care pathway yield variable impacts on overall waiting times. While individual measures had limited effects, combining multiple short-term strategies may be more beneficial, particularly for health systems recovering from the COVID-19 pandemic.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct oral anticoagulant assay utilization and associated bleeding events: a multi-center cohort study.","authors":"Brandon Stretton, Joshua Kovoor, Stephen Bacchi, Aashray Gupta, Suzanne Edwards, Jir Ping Boey, Samuel Gluck, Benjamin Reddi, Guy Maddern, Mark Boyd","doi":"10.1080/21548331.2024.2433937","DOIUrl":"10.1080/21548331.2024.2433937","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of evidence regarding direct oral anticoagulant (DOAC) assay plasma concentrations and their association with bleeding events or transfusion requirements. This multicenter study aimed to characterize the use and plasma levels of DOAC assays of anticoagulated patients who present to emergency with a bleeding event and their association with bleeding severity.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study of consecutive emergency bleeding presentations with a DOAC assay over a five-year period was conducted. Linear regressions were performed for continuous outcomes, binary logistic regression for categorical outcomes.</p><p><strong>Results: </strong>There were 86 patients on a DOAC, who presented with a major bleeding event, and had a DOAC assay performed. Assays were performed within a median time of 4.8 hours (IQR = 9,14.4) from presentation and had a median result of 122.9 ng/ml(IQR = 42,160). DOAC assay plasma level was not significantly associated with type or severity of bleed however, for every 10 unit increase in DOAC assay plasma level, the odds of administering reversal increases by 4% (OR = 1.04, 95%CI:1.00-1.08).</p><p><strong>Conclusion: </strong>A wide range of plasma levels can be expected in patients who present with bleeding events. Higher DOAC plasma levels do not necessarily confer a worse bleeding event or increased transfusion requirements; however, it is associated with an increased likelihood of anticoagulant reversal administration.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}