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PubMed2000

The clinical applications of Mini-Mental State Examination in geropsychiatric inpatients.

OBJECTIVE: This study investigated the association between Mini-Mental State Examination (MMSE) scores and diagnosis, computerized tomographic scans or electroencephalogram findings in geropsychiatric inpatients (age > or = 65). METHOD: We analyzed the MMSE records of patients sixty-five and older who had been hospitalized in our psychiatric ward during a nine-year period. Case data were collected by review of chart records. RESULTS: In these patients, MMSE scores were significantly different among the seven diagnostic groups included. Demented patients had the lowest MMSE scores. Patients who had abnormal findings on computerized tomographic scans or electroencephalogram had lower MMSE than patients with normal findings. CONCLUSION: Our findings suggest that the MMSE is a useful screening instrument for organicity in the geropsychiatric inpatients. However, because of the lower average MMSE score in geropsychiatric inpatients, the optimal cut-offpoint of MMSE for dementia should be lower than those used in other populations.

Aged↗
PubMed2006

Inpatient radiology utilization: trends over the past decade.

OBJECTIVE: The objective of our study was to assess patterns of use of radiology services for inpatients at our institution between 1993 and 2002. MATERIALS AND METHODS: We retrospectively reviewed the administrative data about adult inpatients for fiscal years 1993-2002 in a 721-bed tertiary care institution. Examinations were coded according to imaging technique: conventional (plain films and fluoroscopy), sonography, nuclear medicine, CT, or MRI. We assessed workload trends using relative value units (RVUs). Linear regression analysis was used to assess the significance of trends for the number of examinations and RVUs per case-mix-adjusted admission (CMAA). RESULTS: There was a significant decrease in the total number of examinations per CMAA (p < 0.001). This was due to significant decreases in the use of conventional studies (p < 0.001) and sonograms (p < 0.001), despite significant increases in the number of nuclear medicine (p = 0.046), CT (p < 0.001), and MRI (p < 0.002) examinations per CMAA. The RVUs per CMAA increased significantly (p < 0.01) during the study period. CONCLUSION: Newer imaging technologies (nuclear medicine, CT, and MRI) are replacing older ones in the evaluation of inpatients. Despite the significant decrease in the total number of imaging examinations per CMAA, we observed a significant increase in RVUs per CMAA during the 10-year study period. Understanding the impact of this change in practice on the quality of care would be useful in justifying the increasing use of these new technologies, and decreasing their inappropriate use should be a priority in efforts that focus on controlling imaging expenditures.

Adult↗
PubMed2005

Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff.

OBJECTIVE: We studied a systematic program to reeducate our medical house officers on how to manage inpatient hyperglycemia without the use of sliding-scale insulin (SSI). RESEARCH DESIGN AND METHODS: Patients admitted to the general medical service with diabetes or a blood glucose >140 mg/dl were included. HbA(1c) was measured in all patients, and therapy was modified if the HbA(1c) was >7.0%. For each 24 h on call, two house officers were responsible for all glucose management for their team's patients and rounded with a teaching endocrinologist twice daily for 2 weeks. Oral agent or insulin therapy was modified using blood glucoses and HbA(1c). All patients who required insulin therapy were treated with basal and bolus insulin, usually NPH and regular, adjusted twice daily. RESULTS: During 8 weeks, 88 patients were identified and 16 house officers were instructed. The mean duration of diabetes was 10.4 years. Mean HbA(1c) level was 8.7%, and 48% of patients had HbA(1c) >8%. All patients with HbA(1c) >7% had diabetes therapy intensified. Overall 80% had their diabetes therapy changed by discharge. Compared with 98 historical control subjects, significantly fewer study patients had episodes of hyperglycemia, and a subgroup followed for 12 months showed a decrease in HbA(1c) from 10.1 to 8%. CONCLUSIONS: Medical history, blood glucose, and HbA(1c) testing can effectively identify patients with inpatient hyperglycemia. Using direct ward-based teaching and a widely disseminated pocket set of guidelines, house officers can be taught to effectively and safely manage inpatient hyperglycemia without the use of SSI.

Adult↗
PubMed1998

[Extreme decrease of serum total cholesterol and other lipid levels in elderly inpatients].

In this study 112 elderly inpatients (55 men, 57 women) were recruited. 1. Twelve elderly inpatients (5 men, 7 women) aged 82.5 +/- 7.4 years (M +/- SD) were investigated during 3 periods of dietary intake: good intake (period I), tube nutrition (period II) and fasting with intravenous fluid infusion (period III). Calorie, protein, carbohydrate, fat and cholesterol intakes were greater in period I than in periods II and III. Serum total and LDL cholesterols were lowest in period III, when serum HDL cholesterol, triglyceride and total protein were lower in period III than in period I. 2. One hundred elderly inpatients (50 men, 50 women) were divided into 4 groups according to type of decreased serum lipid and a control group. Serum total cholesterol only was decreased in group I, both serum total and HDL cholesterols were decreased in group II, both serum total cholesterol and triglyceride were decreased in group III, all 3 lipids were decreased in group IV and lipid levels did not change in the control group. There were 5 patients in group I, 28 patients in group II, 20 patients in group III, 27 patients in group IV and 20 patients in the control group. The patient's age ranged from 80.3 to 88.4 years and body mass index ranged from 14.7 to 18.4 kg/m2. Serum total protein decreased significantly in groups II-IV, to 5.6 to 5.7 g/dl. Serum total protein, and total cholesterol correlated positively (r = 0.525, p < 0.01), as did Calorie ingestion and serum total cholesterol levels (r = 0.554, p < 0.001). Therefore, severe hypocholesterolemia was accompanied by malnutrition and a decrease in Calorie or cholesterol intake. Serum total cholesterol levels during observation decreased most in group IV, followed by group II similar to serum HDL cholesterol levels. The amount of nutrient intake was smallest in group IV resulting in an extreme lowering of all 3 serum lipid levels.

Aged↗
PubMed1998

[Basic activities of daily living of elderly inpatients].

Basic activities of daily living (ADL) together with communication ability (visual, auditory and speech) and frequency of bedside visits by a nurse were assessed in 672 elderly inpatients staying on a certain day in Tokyo Metropolitan Geriatric hospital, which is a specialized general hospital for geriatrics but not a long-stay chronic care hospital. Diseases were divided into seven groups: neurological (N), circulatory (C), respiratory (P), bone and joint (B), malignant (M), dementia (D) and other disorders (O). The purpose of the study was to clarify the functional state of elderly inpatients and to correlate the Barthel indices (BAI) of ADL with disease group, communication ability, frequency of bedside visits, age and gender. Multivariate analysis revealed a significant association of BAI with frequency of bedside visits by a nurse, communication ability, disease group and age. Scores in patients of N and D groups were significantly decreased compared with other diseases in many items composing the BADL. Patients of B group showed significantly decreased scores in mobility, stairs and bathing, while patients of P group had decreased scores for stairs and bathing. Bathing and stairs were the most difficult activities in the BADL. BAI were linearly correlated with transfer. When independence of feeding was lost, the patients were almost totally dependent. The functional state should be assessed in geriatric inpatients where the quality of life of the patients must take priority over other considerations in the decision making for interventions. The BAI is easy to use and reliable and is probably a suitable tool evaluating the BADL in a comprehensive geriatric assessment.

Activities of Daily Living↗
PubMed2006

Influence of hospice use on hospital inpatient mortality: a state-level analysis.

This study tests the hypothesis that high hospice enrollment is associated with lower Medicare inpatient mortality. The results show that Medicare inpatient mortality in a state can be explained by hospice enrollment and a host of demographic and market environment variables. An increase in hospice population by 100 individuals is associated with a reduction of 28 inpatient deaths, ceteris paribus. The results suggest, among other things, that opportunities exist for greater expansion of hospice capacity in low-use states to reduce deaths in the expensive hospital setting and improve the quality of end-of-life care for terminally ill patients.

Hospices↗
PubMed2003

Passive therapeutic gardens. A study on an inpatient geriatric ward.

A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed.

Aged↗
PubMedDate not supplied

Financial implications of glycemic control: results of an inpatient diabetes management program.

OBJECTIVE: (1) To determine the financial implications associated with changes in clinical outcomes resulting from implementation of an inpatient diabetes management program and (2) to describe the strategies involved in the formation of this program. METHODS: The various factors that influence financial outcomes are examined, and previous and current outcomes are compared. RESULTS: Associations exist between hyperglycemia, length of stay, and hospital costs. Implementation of an inpatient diabetes management program, based on published guidelines, has been shown to increase the use of scheduled medications to treat hyperglycemia and increase the frequency of physician intervention for glucose readings outside desired ranges. Results from implementing this program have included a reduction in the average glucose level in the medical intensive care unit through use of protocols driven to initiate intravenous insulin once the glucose level exceeds 140 mg/dL. Additionally, glucose levels have been reduced throughout the hospital, primarily because of interactions between diabetes nurse care managers and the primary care team. Associated with these lower glucose levels are a decreased prevalence of central line infections and shorter lengths of stay. The reduction in the length of stay for patients with diabetes has resulted in a savings of more than 2 million dollars for the year and has yielded a 467% return on investment for the hospital. CONCLUSION: Improved blood glucose control during the hospitalization of patients with known hyperglycemia is associated with reduced morbidity, reduced hospital length of stay, and cost savings. The implementation of an inpatient diabetes management program can provide better glycemic control, thereby improving outcomes for hyperglycemic patients while saving the hospital money.

Blood Glucose↗
PubMed2004

Adverse drug events caused by medication errors in medical inpatients.

PRINCIPLES: In view of growing concern in recent years regarding medication errors as causes of adverse drug events (ADEs), we explore the frequency and characteristics of error-associated ADEs in medical inpatients. METHODS: All patients with ADEs or ADErelated hospital admission in a cohort of medical inpatients identified by "event monitoring" (SAS/CHDM database, Br J Clin Pharmacol 2000:49:158-67) were evaluated independently by two experienced physicians. ADEs were first divided into ADEs occurring during cohort stay (incident ADE) and ADE present prior to/at admission. ADEs were then grouped as error-associated ADEs (eADEs: indication error, missed contraindication, wrong dosage regimen or inadequate surveillance) and adverse drug reactions (ADRs: indication established, no contraindications, appropriate dosage regimen and adequate surveillance). RESULTS: Among the 6383 patients analysed (100%), 481 (7.5%) experienced at least one incident ADE. Incident ADRs occurred in 457 (7.2%). Incident eADEs were recorded in 28 patients, corresponding to an eADE incidence of 0.4% (95% CI: 0.2, 0.7). Error types were missing/inappropriate indication (4 cases), missed contraindications (9), relative overdoses (8), absolute overdoses (3) and inadequate clinical surveillance (4). The responsible drugs included antithrombotics (6), cardiovascular drugs (5), antibiotics (5), hypnotics (4) and non-steroidal anti-inflammatory drugs (3). ADE-related hospital admissions were observed in 262 patients (4.1%); 183 (2.9%) were classified as ADRs and 79 (1.2%) as eADEs. CONCLUSIONS: Incident eADEs were observed in 1 out of 250 patients and accounted for approximately 6% of ADEs. In contrast, eADEs accounted for 30% of ADE-related hospital admissions. Hence, in medical inpatients, eADEs represented a small fraction of total incident ADEs, whereas they contributed significantly to hospital admissions.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Coping during inpatient stroke rehabilitation: an exploratory study.

The emotional impact of surviving a stroke has not received the same attention as physical aspects. This is particularly true regarding how stroke survivors cope during inpatient rehabilitation. This study examined the coping strategies used by stroke survivors undergoing inpatient rehabilitation and the relationships between demographic or clinical variables and coping behaviors. This case series examined 16 acute stroke survivors via standardized assessments and a medical records review completed during the first week of inpatient rehabilitation. Stroke survivors used combinations of multiple coping strategies. All stroke survivors used a higher number and frequency of adaptive rather than maladaptive strategies. Women used a higher number of adaptive strategies. Stroke survivors with depression used maladaptive coping strategies more frequently, whereas those presenting with a greater number and severity of comorbidities used adaptive coping strategies more frequently. Stroke survivors with higher levels of coping self-efficacy used the strategies of active coping and positive reframing more frequently. Based on these results, it is recommended direct-care providers place greater emphasis on objectifying the emotional consequences of stroke. Further research is recommended regarding understanding the relationship between coping and outcomes.

Adaptation, Psychological↗
PubMed2006

Safety of paracentesis in inpatients.

INTRODUCTION: Prior research has suggested that paracentesis is free from complications such as acute renal failure (ARF) providing albumin is administered. Actual safety of paracentesis > 1,000 ml was assessed at a tertiary care hospital. METHODS: 300 inpatient paracenteses performed between 12/99 and 4/04 were identified by coding records, of which 40 procedures were excluded due to lack of pre- or post-procedure lab values. Charts were reviewed for serum creatinine (Scr) before and after procedures, ascites volume, and clinical outcomes. RESULTS: 44 deaths occurred after 260 paracenteses (16.9%). Among 33 patients with ARF, 13 (39.4%) died. Only 31/227 patients without ARF (13.7%) died (p < 0.001). Serum creatinine (Scr) > 1.6 mg/dl prior to paracentesis predicted a 22.5% rate of ARF, compared to 8% for Scr < 1.0 (p = 0.002). ARF increased as volume increased (9.9%, 12.4%, and 14.9%, for volumes of < 2,300, 2,300 - 3,200, and > 3,200 ml) but this trend did not have statistical significance (p = 0.426). ARF occurred in 11/69 (15.9%) of patients receiving albumin, compared to 22/191 (11.5%) of patients who did not (p = 0.462). CONCLUSIONS: Paracentesis in inpatients has significant rates of ARF and death. Scr > 1.6 prior to paracentesis predicts an increased rate of ARF. Development of ARF is associated with an increased rate of death. No advantage was demonstrated with administration of albumin. Pre- and post-paracentesis labwork should be routine in inpatients.

Acute Kidney Injury↗
PubMed1991

Medicare program; changes to the inpatient hospital prospective payment system and fiscal year 1992 rates--HCFA. Final rule.

We are revising the Medicare inpatient hospital prospective payment system to implement necessary changes arising from legislation and our continuing experience with the system. In addition, in the addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare inpatient hospital services. We are also setting forth the new target rate percentages for determining rate-of-increase limits for hospitals and hospital units excluded from the prospective payment system. This final rule also responds to the comments we received concerning changes to hospital payments made in a January 7, 1991 final rule with comment. These changes include midyear changes to the inpatient hospital prospective payment system that implemented several provisions of section 4002 of the Omnibus Budget Reconciliation Act of 1990. In addition, this final rule responds to comments received concerning changes in the procedures and criteria of the Medicare Geographic Classification Review Board (MGCRB) that were set forth in a June 4, 1991 final rule with comment period.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Prospective payment system for inpatient hospital capital-related costs--HCFA. Final rule.

We are revising the Medicare payment methodology for hospital inpatient capital-related costs for hospitals paid under the prospective payment system. As required by section 1886(g) of the Social Security Act, we are replacing the reasonable cost-based payment methodology with a prospective payment methodology for hospital inpatient capital-related costs. Under this prospective payment methodology, a predetermined amount per discharge will be made for Medicare inpatient capital-related costs.

Capital Expenditures↗
PubMed1992

Measuring inpatient and outpatient costs: a cost-function approach.

In this article, the authors estimate a multiple-output cost function for a sample of 2,235 hospitals during the period 1984-88 to disaggregate total costs into inpatient and outpatient components. The results suggest that outpatient cost growth is roughly proportional to that of inpatient cost, despite much higher relative growth in revenues and utilization on the outpatient side. The stability in the outpatient/inpatient cost ratio implies that the increase in the outpatient-to-inpatient utilization ratio was offset by a decline in their relative unit costs.

Cost Allocation↗
PubMed1997

Inpatient and ambulatory patient satisfaction with nursing care.

This study reports on the development and psychometric testing of inpatient and ambulatory patient satisfaction scales designed to measure patient satisfaction using the standards of nursing practice within a medical center. The surveys were administered to patients 4-6 weeks after discharge from the hospital or following a clinic visit. A total of 619 inpatient and 955 ambulatory patient questionnaires were analyzed. Factor analyses suggest there exist four scales for inpatient satisfaction anf five scales for outpatient satisfaction with high reliability and reasonable validity.

Health Care Surveys↗
PubMed1999

[Rationale of inpatient care--towards a new payment system].

German statutory health insurance is introducing a system of lump sum payments for hospital care in the framework of a sectorial budget. All hospital cases covered by a major regional health insurance fund (AOK Magdeburg) and completed in 1995 to 1997 (590,000 cases and 7.6 million hospital days, resp.) were analysed to find out changes in the main parameters of inpatient care. The number of hospital cases per 10,000 insured persons continues to increase even after age-adjustment. The increase was 3.1% from 1996 to 1997. Hence the objective "outpatient treatment ranks before inpatient treatment" has not been achieved. The number of hospital days per 10,000 insured patients also increased. Hence the concept of "controlled touch down" (i.e. reaching the prospectively negotiated number of hospital days exactly) has not succeeded. After taking age into account, the number of hospital days slightly and for the first time decreased in 1997 compared to 1996. The average level of hospital stay (LOS) is decreasing, but still high. The proportion of cases with hospital stays exceeding the "Length of Stay Guidelines" was more than 30% in 1997. The pattern of the three parameters (number of cases, hospital days, and LOS) indicate that hospitals manage bed occupancy rates in the first place and that the indications for inpatient treatment are getting softer. Between 1996 and 1997 there has been a 17.5% increase in the total number of cases reimbursed by lump sums. In some categories of the fee schedule the increase is considerably greater. Such changes in performance make it difficult for both contracting parties to assess the "necessary" amount of cases and procedures to be covered by lump sum payments. In a considerable proportion of cases covered by lump sum renumeration, the LOS is longer than the calculated average on which costing is based. In spite of this, however, most hospitals gain more income from lump sum payment than they would if their per diem rates were applied. The proportion of cases with the LOS exceeding the upper compensation limit is low. Between hospitals, the average LOS in the same categories of the fee schedule differs by a factor of 1.5 to 2. There is no consistent indication of adverse risk selection. If the present payment system is maintained until the end of 1999 (or even 2001 as preferred by some), German hospitals will have an opportunity to continue with their development of organisation and costing, to improve their structure of services as well as their negotiating power and- the full compensation scheme having been abandoned in favour of prospective budgets- to net rationalization profits.

Germany↗
PubMed1988

Characterizing hospital inpatients: the importance of demographics and attitudes.

To compete effectively, hospital administrators must understand inpatients who are involved in hospital-choice decisions more clearly. To this end, a methodology is presented to measure and assess the importance of inpatients' personal attributes in predicting hospital selection. Empirical results show that demographic characteristics are poor--but attitudes are useful--segmentation variables that delineate differences between two particular hospitals' inpatients. More generally, the survey method and statistical procedures outlined are applicable (with slight modification) to markets with a greater number of competitors.

Decision Making↗
PubMed2000

Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

PURPOSE/OBJECTIVES: To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. DESIGN: Descriptive, correlational, and random sampling. SETTING: Three community-based institutions in southeast Louisiana. SAMPLE: 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. METHODS: Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. FINDINGS: Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. CONCLUSIONS: Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. IMPLICATIONS FOR NURSING PRACTICE: Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

Adult↗