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PubMed2004

Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States.

OBJECTIVE: To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness. DESIGN: Retrospective cohort study based on claims data from the US Medicare programme. PARTICIPANTS: Cohorts receiving most of their hospital care from 77 hospitals that appeared on the 2001 US News and World Report "best hospitals" list for heart and pulmonary disease, cancer, and geriatric services. MAIN OUTCOME MEASURES: Use of healthcare resources in the last six months of life: number of days spent in hospital and in intensive care units; number of physician visits; percentage of patients seeing 10 or more physicians; percentage enrolled in hospice. Terminal care: percentage of deaths occurring in hospital; percentage of deaths occurring in association with a stay in an intensive care unit. RESULTS: Extensive variation in each measure existed among the 77 hospital cohorts. Days in hospital per decedent ranged from 9.4 to 27.1 (interquartile range 11.6-16.1); days in intensive care units ranged from 1.6 to 9.5 (2.6-4.5); number of physician visits ranged from 17.6 to 76.2 (25.5-39.5); percentage of patients seeing 10 or more physicians ranged from 16.9% to 58.5% (29.4-43.4%); and hospice enrollment ranged from 10.8% to 43.8% (22.0-32.0%). The percentage of deaths occurring in hospital ranged from 15.9% to 55.6% (35.4-43.1%), and the percentage of deaths associated with a stay in intensive care ranged from 8.4% to 36.8% (20.2-27.1%). CONCLUSION: Striking variation exists in the utilisation of end of life care among US medical centres with strong national reputations for clinical care.

Aged↗

PubMed2002

[Obstetrical inpatient care and hospitalization risks in hospitals of Brazil].

OBJECTIVE: To analyze variations in early neonatal mortality, stillbirth rates, and a set of indicators collected from obstetric hospitals affiliated to the Brazilian National Unified Health System (SUS) for their monitoring through the Hospital Data System (SIH/SUS) and Live Births Data System (SINASC). METHODS: One-hundred and thirty five hospitals in the state of Rio de Janeiro were assessed in 1997. Factor analysis was conducted using principal components. Score distribution for the first two components were established, which allowed to classify hospitals according to maternal risk profile and care outcomes. RESULTS: Hospitals affiliated to SUS were responsible for 77.8% of all deliveries in the state of Rio de Janeiro and 23% of them performed fewer than 100 deliveries a year. Among hospitals of extreme high maternal risk and low performance, there were several units considered as referral centers for high-risk pregnancy. It was also observed that 5% of hospital units with low complexity infrastructures showed a profile of high maternal risk and questionable care outcomes. CONCLUSIONS: The Hospital Information Data System affiliated to the National Unified Health System has proven to be an important information source for monitoring hospital stillbirth and early neonatal mortality rates as well as for planning surveillance actions for health services providing obstetric and/or neonatal care.

Adolescent↗

PubMed2002

Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals.

The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.

Adverse Drug Reaction Reporting Systems↗

PubMed2002

A comparison of the surgical caseloads of selected companion animal hospitals and a veterinary academic hospital in South Africa.

Educational institutions should be aware of the frequency of surgical procedures in private practice, to assist both the student and the lecturer in evaluating the relative importance of procedures and to structure training programmes accordingly. The surgical caseload for 1 year at a veterinary academic hospital and 13 private companion animal hospitals registered with the South African Veterinary Council were compared. Surgical records were entered into a spreadsheet and sorted according to 96 selected surgical procedures to facilitate comparisons. Surgical procedures were in turn grouped according to date, species, degree of difficulty and frequency of occurrence. Feline procedures were more commonly performed in private hospitals. The academic hospital's caseload was dominated by major and advanced procedures while the private hospitals carried out more minor procedures. At the private hospitals more general surgery, and ear, nose and throat surgery as well as dental procedures were performed, while at the academic hospital more ophthalmic, orthopaedic, thoracic and neurosurgical procedures were carried out. The most commonly performed procedures at the academic hospital differed from those at the private hospitals. No seasonal trends were evident.

Animals↗

PubMed1997

The GP-hospital interface: attitudes of general practitioners to tertiary teaching hospitals.

OBJECTIVE: To assess general practitioner (GP) perceptions of liaison with two local tertiary teaching hospitals. DESIGN: Questionnaire-based survey of GP attitudes. SETTING: Melbourne and North West Melbourne Divisions of General Practice, in July and September 1994. PARTICIPANTS: All GPs (587) practising in the Divisions (identified from Health Insurance Commission lists of consultations charged at GP rates). OUTCOME MEASURES: Degree of agreement on a 5-point Likert scale to statements about GP-hospital liaison, and relevant open comments. RESULTS: 350 GPs (60%) responded, including 84% of vocationally registered GPs; 68% of the 350 were in full-time practice and 70% had been in practice for over 10 years. GPs had no clear strategy for obtaining admission of semi-urgent patients to public hospitals. For patients needing urgent admission, almost a third of GPs sometimes resorted to sending them to the emergency department without first telephoning. Most GPs agreed that hospitals did not notify them of patient admission (84%), major changes in patient condition, including death (87%), and patient discharge (75%). Most would interrupt a consultation to discuss a patient with hospital staff (92%). About half agreed they had poor access to outstanding results, and 65% were concerned that proposed early-discharge practices would be detrimental to patient care. CONCLUSIONS: The survey identified considerable GP dissatisfaction with hospital-GP communication and GP willingness to be more involved in liaison and communication with hospitals about patient care. Changes in hospital organisation and hospital staff attitudes are needed to allow this.

Attitude of Health Personnel↗

PubMed1991

Hospital CEOs' priorities and perceptions regarding industry issues and the Virginia Hospital Association's activities.

Based on a survey of Virginia hospital CEOs, it was revealed that four industry issues are causing a high degree of concern, namely Medicare/Medicaid reimbursement policies, personnel shortages, indigent care, and increased operating expenses. Each of these issues will be discussed regarding the VHA's activities to devise possible solutions. Regarding Medicare, the VHA has worked closely with the American Hospital Association in their federal advocacy efforts encouraging members to write, call, and visit their Congressional representatives to persuade them to pass legislation increasing the Medicare budget. Regarding Medicaid, which is administered by each state and in Virginia involves a 50/50 sharing of the funding between the federal and state governments, the VHA has challenged what it believes to be an illegal hospital reimbursement system through the federal judicial system. While the process is continuing, the VHA is encouraged by the U.S. Supreme Court's decision (July 1990) affirming hospitals' and all other health care providers' right, to pursue via the judicial process their allegation that a state is violating federal law by setting inadequate and inequitable Medicaid reimbursement rates to hospitals. In order to address the personnel shortages issue, the VHA has actively addressed recruitment and retention challenges by establishing a Health Manpower Resource Center and hiring a full-time director. This office targets high school students, second-career adults, and current health care professionals through communication and education programs. The area of indigent care represents one of the VHA's most notable achievements to date. This entails the recent Virginia legislation creating the Indigent Care Trust Fund. This fund's initial amount is some $15 million and represents an approximate 60/40 contribution ratio involving both the State of Virginia and hospitals in Virginia. A formula has been developed for each hospital in Virginia to assess how sensitive they are to indigent care patients, which includes patients who are either in households whose annual income is below the federal poverty level and/or patients who do not have health care insurance. Those Virginia hospitals who are less sensitive to indigent care will contribute to this fund, while those who have more exposure to indigent care patients will be reimbursed from it. Legislation will be proposed to the state legislature to broaden the contributory base to the Indigent Care Trust Fund by requiring employers who do not currently offer health care insurance to their employees to also contribute to the fund. Reimbursements from the fund to Virginia hospitals are scheduled to begin in FY 1991.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude of Health Personnel↗

PubMed1999

[Borderline between emergencies and hospitalization in the analysis of hospital mortality].

BACKGROUND: The analysis of hospital mortality rate as a measure of care quality is usually restricted to death occurred at hospital wards, and no consideration is given to deaths occurred at the Emergency Department. Therefore, the information from a fundamental hospital area goes without analysis. METHODS: The following characteristics of decreased individuals at the Emergency Department (n = 79) and hospital wards (n = 280) in the Costa del Sol Hospital (Marbella, Málaga, Spain) during 1997 were compared: age, sex, main diagnosis at admission, main diagnosis specificity, and number of secondary diagnoses. A reevaluation of hospital mortality rates was made after data from ED deaths had been added. RESULTS: The addition of deaths occurred at the ED meant a relevant increase in hospital mortality rates: 57% for heart failure, 30% for stroke, and 25% for myocardial infarction. Twenty percent of deaths at the ED had non-specific diagnosis versus 5% at wards (p < 0.0001; 95%CI: 6.03; 24.15). Deaths at the ED had 2.9 +/- 1.3 secondary diagnoses versus 4.9 +/- 2.0 in deaths at hospital wards (p < 0.0001; 95%CI: 1.6; 2.4). CONCLUSIONS: Deaths at the ED make up a relevant proportion of the total deaths and should be incorporated to the hospital mortality analysis. Deficiencies in the collection of clinical information were observed in this ED. Therefore, adjustments for severity--an essential issue for comparing mortality rates between centers--might be precluded.

Aged↗

PubMed2001

[Relationship between in-hospital mortality rate and patient volume for total hip arthroplasty in the Rhône-Alpes public hospitals].

BACKGROUND: Comparisons between hospitals using surgical volume, among other criteria can be made using large hospital databases. A relationship between hospital volume and care results, particularly mortality, is assumed to justify the use of activity volume as a comparison criterion. We aimed to assess a relationship between hospital volume and mortality after total hip replacement using the data available in the French Diagnosis Related Groups (Programme de Médicalisation des Systèmes d'Information, PMSI). We also searched for a threshold associated with mortality. METHODS: We included all stays with a surgical procedure for total hip replacement in public hospitals in the Rhône-Alpes region in France in 1997 (n=5521). We examined the relationship between mortality and the number of procedures per hospital and assessed activity threshold using logistic regression. RESULTS: Using the number of procedures as the continuous variable, we observed a relationship with mortality (OR=0.94 [0.91; 0.96] for an increase in activity of 100 total hip replacements). We found no evidence of an activity threshold. The reason for performing total hip replacement (OR=6.36 [2.78; 14.55] for trauma compared with rheumatology diseases) and patient age (OR=1.76 [1.31; 2.36] for a 10-year increase in age) were strongly related to mortality. CONCLUSIONS: PMSI only collects in-hospital mortality, limiting the impact of our findings. The relationship between mortality and hospital volume is significant, but too small and consequently of little use. We found no activity threshold. It would be difficult to recommend surgical volume as a criterion for comparing hospitals.

Activities of Daily Living↗

PubMed2004

Comparison of pediatric emergency patients in a tertiary care hospital vs a community hospital.

This study was conducted to compare the profile of patients attending the pediatric emergency services of a tertiary care teaching and referral hospital, Chandigarh, and a community level hospital in Ambala district, Haryana. Records of children (<or=12 years) attending emergency services over a period of one year; from 1st March 1999 to 28th February 2000, at both the health facilities were analyzed for demographic details, diagnostic categories, monthly trends of illnesses and mortality pattern. Five hundred ninety six children attended the Community Hospital's emergency service while 8301 children were seen at the pediatric emergency service of the tertiary care hospital during the same period. The most common morbidities at both the centers were diarrhea and respiratory infections (58% at community hospital, 45% at tertiary care hospital respectively). Neonatal illnesses and CNS diseases were other important morbidities. There was a significant use of emergency facilities for management of trivial complaints. At tertiary care hospital 26% of AR1 cases had upper respiratory infections, while 70% of diarrhea cases seen were without dehydration. At both the hospitals neonatal deaths formed the major proportion of all the deaths. We concluded that diarrhea and AR1 continue to be the most important reasons for utilization of pediatric emergency service at a primary as well as a tertiary care hospital.

Child, Preschool↗

PubMed2006

Otago rural hospitals study: what do utilisation rates tell us about the performance of New Zealand rural hospitals?

AIM: To provide a description of the role and function of Otago Province's three main rural hospitals, utilising analysis of hospital discharge data for the period July 2001 to June 2002. METHODS: Calculation of hospitalisation rates based on analysis of information contained in the National Minimum Dataset (Hospital Events); Census data from Statistics New Zealand; and local knowledge of hospital utilisation by geographical district. RESULTS: A comparison between the rural Otago population and New Zealand (as a whole) show age-standardised hospitalisation rates of 19,847 vs 19,930 per 100,000, and a mean length of hospital stay of 4.5 days vs 6.8 days respectively. Patients aged over 75 years account for 49% of the work of rural Otago hospitals calculated by total bed days; 9% of patients account for 28% of the total discharges. CONCLUSIONS: Results show that Otago's rural hospitals (when compared to the New Zealand average) provide an efficient and appropriate service for their communities when judged by hospitalisation rates, mean length of stay, and patient groups cared for. There are serious difficulties encountered in using the National Minimum Dataset to analyse the workload of a rural hospital. An agreed methodology to overcome these difficulties is needed as they have significant implications for service planning and resource allocation for rural hospitals in New Zealand.

Adolescent↗

PubMedDate not supplied

[Hospital utilization in Brazil and effect of the measures to reduce hospitalizations].

The purpose of this paper is to discuss the increase and variation of hospital discharges in Brazil. In addition, the effects of recent governmental measures aiming at reducing the accelerated rate of use of in-patient facilities is discussed. A new case-based hospital reimbursement method, introduced late in 1983, was one of these measures, which seemed to have contributed to increase and not to decrease hospitalization. On the other hand, there has been a shift in hospital discharges from the private to the public sector. It is shown that there is a large difference in hospital workload between private and public institutions. While private hospitals in Brazil operate strongly in the specialties of internal medicine, public hospitals are treating more surgical patients. Consequently it seems that private hospitals are treating less complicated cases and public hospitals the most complicated ones.

Brazil↗

PubMed2005

Hospital development plans: a new tool to break ground for strategic thinking in Tanzanian hospitals.

Tanzanian hospitals suffer from underfunding and poor management. In particular, planning and strategic thinking need improvement. Cultural values such as subordination, risk aversion, and high time preference, together with a long history of socialist government, result in lack of responsibility, accountability, and planning. This has been addressed by the health sector reform with its focus on decentralization, strengthened by the introduction of basket funding facilitated by the Comprehensive Council Health Plans. As a consequence of this the next logical step is to improve the authority of regional and district hospitals in the use of their resources by introducing hospital development plans. These strategic plans were introduced as tools of strategic planning in 2001 by the Kreditanstalt für Wiederaufbau in close collaboration with the Tanzanian Ministry of Health, binding the release of rehabilitation funds to presentation of a strategic hospital plan. This study examines the rationale and content of hospital development plans. Initial experiences are discussed. The quality of presented plans has steadily improved, but there is a tendency for hospitals with a close connection to development partners to present well prepared reports while other hospitals have severe problems fulfilling the requirements. For many hospitals it is in fact the first time that they have had to define their functions and future role, thus breaking ground for strategic thinking.

Budgets↗

PubMedDate not supplied

Trust between managers and physicians in community hospitals: the effects of power over hospital decisions.

Trust is a key element of effective work relationships between managers and physicians. Despite its importance, little is known about the factors that promote trust between these two professional groups. We examine whether manager and physician power over hospital decisions fosters manager-physician trust. We expect that with more power, managers and physicians will have greater control to enforce decisions that benefit the interests of both groups. Subsequently, they may gain confidence that their interests are supported and have more trust for each other. We test proposed hypotheses with data collected in a national study of chief executive officers and physician leaders in community hospitals in 1993. Findings indicate that power of managers and physicians over hospital decisions is related to manager-physician trust. Consistent with our expectations, physicians perceive greater trust between the two groups when they hold more power in four separate decision-making areas. Our hypotheses, however, are only partially supported in the manager sample. The relationship between power and trust holds in only one decision area: cost/quality management. Our findings have important implications for physician integration in hospitals. A direct implication is that physicians should be given the opportunity to influence hospital decisions. New initiatives, such as task force committees with open membership or open forums on hospital management, allow physicians a more substantial involvement in decisions. Such initiatives will give physicians more "voice" in hospital decision making, thus creating opportunities for physicians to express their interests and play a more active role in the pursuit of the hospital's mission and objectives.

Decision Making, Organizational↗

PubMed1978

[Hospital legislation in the Federal Republic of Germany and its effects on psychiatric hospitals (author's transl)].

The article discusses the hospital laws of several land governments enacted subsequent to the hospital financing law of the Federal Government, in respect of the influence exercised by these laws on the internal structure of the hospital. The fact that the laws apply to all kinds of hospitals, and hence also to big psychiatric hospitals, is considered a disadvantage for psychiatric care. Such care is obviously hampered, on the one hand, by the legislative demand for departmentalization of the individual fields according to specialist subjects, representing a setup which is opposed to the realization of patient care in accordance with the requirements of the communities and citizens who expect to be cared for on an individual and not on a schematic basis, whereas, on the other hand, the new structures of management stipulated by the law do not provide for the inclusion of representatives of the new groups of professions now engaged in psychiatric activities. The model of regrouping the hospital structure into sectors instead of medical specialist departments, is presented and contrasted with the proposed model. It is recommended to arrange for representation of the non-medical and non-nursing professions in the managing boards, as well as to take into account the sociotherapeutico-rehabilitative interests as forming part of the conceptual approach to care in psychiatric hospitals, via special hospital committees.

Economics, Hospital↗

PubMed1996

Smoking prevalence in neighborhood and hospital controls: implications for hospital-based case-control studies.

It is widely believed that the prevalence of smoking among hospital patients is greater than that of the general population because many conditions for which patients are hospitalized are caused by or associated with smoking, and that this increased prevalence may bias results of case-control studies of tobacco-related diseases. For this reason, many authors have suggested excluding from the control series patients hospitalized for tobacco-related illnesses. The present study investigated potential selection bias for hospital compared to neighborhood controls in studying tobacco-related diseases. The 709 cases from six U.S. cities had tobacco-related cancers or myocardial infarction. They were individually matched to one hospital control and to one neighbor. After excluding patients with tobacco-related diseases, hospital controls were less often current smokers and more often former smokers than neighborhood controls. Among male ever smokers, hospital controls tended to smoke more cigarettes per day than neighborhood controls. Compared with the U.S. population, there was an overrepresentation of smokers in neighborhood controls rather than an under-representation of smokers in hospital controls. Relative risk estimates varied according to type of control. Choosing between hospital and neighborhood controls in case-control studies should be dictated by criteria related to the study hypothesis, participation, or cost. In particular, exclusion of hospital controls with diseases known to be tobacco-related seems to be a successful strategy for reducing selection bias.

Adult↗

PubMed1996

Surgical wound infections diagnosed after discharge from hospital: epidemiologic differences with in-hospital infections.

BACKGROUND: The purpose of this study was to study postoperative infections detected in hospital and after discharge and to identify risk factors for such infections. METHODS: A prospective cohort study was used, with follow-up of 30 days after hospital discharge, on 1483 patients admitted to the general surgery service of a tertiary care hospital. The main outcome measure was surgical wound infection (SWI). Relative risks, crude and multiple risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals (CIs) were estimated. RESULTS: During follow-up 155 patients showed evidence of nosocomial infection, 134 in hospital and 21 at home, yielding a cumulative incidence of 10.5%. According to several variables (age, American Society of Anesthesiologists score, serum albumin, the SENIC and National Nosocomial Infections Surveillance indexes of intrinsic patient risk, length of hospital stay, etc.) there were no differences between patients with postdischarge SWI and uninfected patients; however, differences were detected between postdischarge SWI and in-hospital SWI, as well as between patients with in-hospital SWI and patients without infections. The analysis of risk factors showed that most predictors for in-hospital SWI did not behave in the same manner for postdischarge SWI. Stepwise logistic regression analysis identified cancer (odds ratio = 4.5, 95% CI = 1.7 to 12.2, p = 0.003) and surgeon performing the operation (for medium risk, OR = 4.4, 95% CI = 0.9 to 21.3, p = 0.059; for high risk, OR = 3.0, 95% CI = 0.7-13.3, p = 0.144) as independent risk factors for postdischarge SWI. CONCLUSIONS: There were important epidemiologic differences between in-hospital SWI and postdischarge SWI; most risk factors for in-hospital SWI are not predictors for postdischarge SWI.

Analysis of Variance↗

PubMed2005

Primary health care and hospital interactions: effects for hospital length of stay.

AIMS: Norwegian healthcare services are divided between primary and secondary care providers. A growing problem is that every third patient of 75 years of age or more experiences an extended stay in a somatic hospital while waiting to be sent to primary healthcare services. The interaction between these two levels of healthcare services is analysed to examine the effect on a patient's length of stay in hospital. METHODS: Recent studies have asserted that research on length of stay in hospital should include influential factors such as system variation and system characteristics, in addition to standardizing for case-mix. New organizational routines are identified in 50 Norwegian somatic hospitals. A multivariate linear regression is used in both a static and a dynamic model to explain variations in hospital length of stay and in additional length of stay (5% of stays are defined as outliers). RESULTS: The study shows that newly specialized structures constructed to enhance the interaction between the two levels have had no effect. Length of stay is dependent on the capacity of the primary healthcare provider and on the share of elderly in the hospital catchment area, the type of patients, the procedure performed, and the characteristics of the hospital. CONCLUSION: Variation in length of stay between hospitals is primarily explained by the capacity of primary healthcare providers. However, some support is found in the dynamic model that introduces the proposition that a hospital-owned hotel would decrease the length of stay of patients in hospital.

Aged↗

PubMed2005

Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke.

OBJECTIVE: To determine the interval between symptom onset and hospital arrival and its relationship to baseline clinical characteristics, use of thrombolysis, and in-hospital outcomes in patients with acute ischemic stroke admitted to the 11 hospitals in the Buffalo metropolitan area and Erie County. METHODS: The medical records of 1,590 patients were reviewed to determine the severity of the neurologic deficits (NIH Stroke Scale [NIHSS]), in-hospital mortality, favorable outcome (modified Rankin Scale score of < or = 2 at discharge), and strata of time interval between symptom onset and hospital arrival. RESULTS: The time interval between symptom onset and hospital arrival was 0 to 3 hours in 337 (21%) patients, 3 to 6 hours in 177 (11%) patients, 6 to 24 hours in 301 (19%) patients, > 24 hours in 420 (26%) patients, and undetermined in 355 (22%) patients. IV (n = 23) and intra-arterial (n = 4) thrombolysis was used in 27 (8%) of the 337 patients that presented within 3 hours of symptom onset. In 1,235 patients with known time interval between symptom onset and hospital arrival, an association (p = 0.008) was observed between strata of increasing time interval and higher proportion of favorable outcomes at discharge. The initial NIHSS score was higher with decreasing interval between symptom onset and hospital arrival (p < 0.0001). CONCLUSIONS: A small proportion of patients who present within 3 hours of symptom onset receive thrombolytic therapy. The observation that patients with more severe neurologic deficits and subsequently worse in-hospital outcomes appear to present early after symptom onset to the hospital may have implications for clinical studies.

Acute Disease↗