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PubMed2004

A questionnaire survey of ECT practice in university hospitals and national hospitals in Japan.

Although electroconvulsive therapy (ECT) is being performed in many hospitals in Japan, there is little information on its present practice. We surveyed ECT practice to improve the practice of ECT in Japan. A mail questionnaire survey of ECT practice was conducted between 1997 and 1999 in Japan. Of 84 university hospitals and 37 national hospitals, 86 respondents (71%) were obtained. ECT was performed in 56 hospitals (65%). Details of ECT practice were further surveyed in 46 hospitals. The number of patients per year receiving ECT varied according to hospitals from 0.5 to 120. Unmodified ECT was still used in two thirds of the hospitals. Modified ECT was mainly performed in an operating room. Unilateral ECT was seldom used. Japan is an under-developed country for ECT and the practice of ECT must be improved.

Depressive Disorder↗

PubMed1985

Perinatal mortality distributed by type of hospital in the Central Hospital District of Helsinki, Finland.

In Finland as in many other countries, perinatal mortality is higher in those institutions having a higher level of care. To explain this phenomenon, mortality by weight groups was studied in different hospitals in the Central Hospital District of Helsinki in Finland in 1977-81. Among infants weighing less than 2 500 g, perinatal mortality was higher in the local hospital than in the university hospital, the higher mortality being due to the higher rate of stillborn infants. Among babies weighing over 2 500 g, the mortality was lower in local hospitals than in the university hospital. Further studies to explain the higher mortality of infants weighing over 2 500 g in the university hospital are needed.

Birth Weight↗

PubMed2004

US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era.

STUDY OBJECTIVES: We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade. SETTING/PATIENTS: The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997. MEASUREMENT: We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality. RESULTS: Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend < 8 h as the optimal time window for initiation of antibiotics to treat CAP was lower. For both PCP and CAP, variations in processes of care and lengths of in-hospital stays, but not mortality rates, were noted at VA, public, private not-for-profit hospitals, and for-profit hospitals. CONCLUSIONS: This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of the epidemic, it will be important to monitor whether variations in processes of care for various HIV-related clinical diagnoses among different types of hospitals persist.

AIDS-Related Opportunistic Infections↗

PubMed2005

Comparing the stigma of mental illness in a general hospital with a state mental hospital: a Singapore study.

The stigma faced by psychiatric patients associated with the type of psychiatric facilities is controversial. This study was conducted to compare the stigma faced by patients with schizophrenia and non-schizophrenia psychiatric disorders in the outpatient departments of a state mental hospital with those in a general hospital in Singapore. A cross-sectional study involving two groups of outpatients in a state mental hospital (n=300) and in a university general hospital (n=300) were assessed with a 12-item stigma scale. Components of the scale assessed included social rejection, negative media perception, shame and social discrimination. Among schizophrenia patients, state mental hospital patients had significantly lower stigma scores compared to their counterparts in the general hospital. For other mental illnesses, the reverse was true: state mental hospital patients had significantly higher stigma scores compared to their counterparts in the general hospital. Stigma was also associated with a younger age and being employed though not by gender. The stigma faced by psychiatric patients is complex and may have institutional and disorder-specific elements. Possible reasons for this are discussed.

Adolescent↗

PubMed1995

The impact of mandated in-hospital coverage on primary cesarean delivery rates in a large nonuniversity teaching hospital.

OBJECTIVE: Our purpose was to determine whether attending physician call status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN: Data for the study year, during which in-hospital attending coverage was in place, were compared with those of the previous year, during which in-hospital attending coverage of residents was not in place. Birth records were analyzed retrospectively for physician and patient factors. RESULTS: For the year before in-hospital coverage the institutional total cesarean rate was 24.9%, with a primary cesarean section rate of 17.6%. In the first year of coverage the total cesarean delivery was 21.7%, with a decrease in the primary rate to 15.3%. The resident service primary cesarean delivery rate was 10.6% during the study year, which was unchanged from 10.9% the prior year and did not contribute to the overall decrease. Conversely, the private service primary cesarean rate decreased from 18.0% in the prestudy year to 13.4% when the attending physician was on call in the hospital but remained higher at 17.5% when the attending physician was on call not in the hospital. CONCLUSIONS: In-hospital attending physician coverage lowered individual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private service and were unaffected by the initiation of in-hospital coverage.

Adult↗

PubMed1998

A comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease: resource intensity, hospital costs, and survival. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

PURPOSE: Both generalist and pulmonologist physicians care for patients with severe chronic obstructive pulmonary disease (COPD). We studied patients hospitalized with severe COPD to explore whether supervision of care by pulmonologists is associated with greater costs or better survival. SUBJECTS AND METHODS: We studied 866 adults with severe COPD enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a prospective study at five academic medical centers. Patients were admitted to the hospital or transferred to an intensive care setting for treatment of severe COPD, defined by hypoxia (PaO2 <60 mm Hg) and hypercapnia (PaCO2 >50 mm Hg) or hypercapnia alone if on supplemental oxygen. Resource intensity was measured using a modified version of the Therapeutic Intervention Scoring System and estimated hospital costs. To account for differences in the patient case mix, propensity scores were developed to represent each patient's probability of having a pulmonologist as attending physician and each patient's probability of being in an intensive care unit (ICU) at study admission. RESULTS: Of the 866 patients studied, 512 had generalists and 354 pulmonologists as their attending physicians. The median patient age was 70 years; 52% were male; 14% died within 30 days. After adjusting for baseline differences in patient characteristics, there were no differences in resource intensity and hospital costs in those treated by pulmonologists or generalists. Adjusted average resource intensity scores for the entire hospitalization were 16.5 for pulmonologists and 17.0 for generalists (P = 0.34). Estimated hospital costs were the same ($6,400) for patients treated by pulmonologists and generalists (P = 0.99). Patients with pulmonologists as attending physicians did not experience better survival. Comparing patients of pulmonologists to patients of generalists, the adjusted hazard ratio for 30-day mortality was 1.6 (95% confidence interval: 0.98, 2.5); the hazard ratio for 180-day mortality was 1.2 (0.9, 1.7). CONCLUSIONS: Our findings suggest that for patients hospitalized with exacerbation of severe COPD, those with pulmonologist attending physicians do not have higher hospital resource use or better survival than those with generalist attending physicians.

Adult↗

PubMed2004

User fees at a public hospital in Cambodia: effects on hospital performance and provider attitudes.

User-fee programs have been introduced at health care facilities in many developing countries. Difficulties have been encountered, however, especially at public hospitals. This report describes the effects of user fees introduced in April 1997 at a public hospital, the National Maternal and Child Health Center (NMCHC) of Cambodia, on patient utilization, revenue and expenditure, quality of hospital services, provider attitudes, low-income patients, and the government, by reviewing hospital data, patient and provider surveys, and provider focus group discussions.Before the introduction of user fees, the revenue from patients was taken directly by individual staff as their private income to compensate their low income. After the introduction of user fees, however, revenue was retained by the hospital, and used to improve the quality of hospital services. Consequently, the patient satisfaction rate for the user-fee system showed 92.7%, and the number of outpatients doubled. The average monthly number of delivery of babies increased significantly from 319 before introduction of the system to 585 in the third year after the user-fee introduction, and the bed occupancy rate also increased from 50.6% to 69.7% during the same period. As patient utilization increased, hospital revenue increased. The generated revenue was used to accelerate quality improvement further, to provide staff with additional fee incentives that compensated their low government salaries, and to expand hospital services. Thus, the revenue obtained user fees created a benign cycle for sustainability at NMCHC. Through this process, the user-fee revenue offered payment exemption to low-income users, supported the government financially through user-fee contributions, and reduced financial support from donors. Although the staff satisfaction rate remained at 41.2% due to low salary compensation in the third year of user-fee implementation, staff's work attitude shifted from salary-oriented to patient-oriented-with more attention to low-income users.

Attitude of Health Personnel↗

PubMedDate not supplied

Analysis of hospital ability to provide trauma services: a comparison between teaching and community hospitals.

HYPOTHESIS: Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH). METHODS: A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiography (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry. RESULTS: With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS, and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p less than .01). CONCLUSIONS: In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability can be performed in other communities to help guide trauma center designation.

Emergency Medical Services↗

PubMedDate not supplied

[Determinations of hospitalization from psychiatric ER from S. Gerardo hospital in Monza: epidemiological cross-sectional study].

OBJECTIVE: The study aims to identify the predicting factors of hospitalization in patients who come in Emergency Room with psychiatric symptoms. METHOD: Cross-sectional study using data collected by E.R. of S. Gerardo Hospital in Monza from 1st of June 1995 to 31 May 1997. Inclusion criteria were age older than 18 and the need for psychiatric evaluation. The influence on disposition decision of demographic, clinical and service variables were assessed. MAIN OUTCOME MEASURES: Data were collected by a questionnaire designed for the study and administered by a trained psychiatrist. Statistical analysis was performed by univariate analysis and logistic regression. RESULTS: 2076 cases were evaluated. Univariate analysis yielded higher odds of hospitalization for patients between 39 and 48 years of age, unmarried, unemployed, affected by schizophrenia, mood disorders or personality disorders. A linear trend was reported between hospitalization and severity of illness, siucide risk and aggressiveness. While anxiety proved to be a protective factor, hallucination, delusion, lack of insight, psychomotor inhibition, agitation, confusion, destructive behaviour, odd behaviour, abnormal consciousness and previous hospitalization increase inpatient disposition. On Monday and Friday higher frequency of hospitalization was observed. Logistic regression confirm the role of age, symptoms, aggressive behaviour, severity of illness, suicide risk, and among services variables, days of the week. CONCLUSION: Clinical variables proved to be the main predictors of hospitalization, and an important role is played by the availability of outpatients services: hospitalization was more frequent in the days closer the week-end, when the outpatient services are closed.

Adult↗

PubMed1986

Financial charges of hospitalized motorcyclists at the Massachusetts General Hospital.

We studied 47 hospitalized motorcyclists admitted through the Massachusetts General Hospital emergency room during a 1-year period. Four factors were studied: 1) hospitalization charges, 2) hospitalization lengths, 3) medical insurance profiles, and 4) patterns of injuries. The mean hospitalization charges were +15,114. The total hospital charges for this group of patients were nearly +700,000. These figures excluded the costs of subsequent admissions, surgeons' fees, rehabilitation, vocational training, legal suits, and loss of wages. Sixteen per cent of the charges were uncollectable. Forty-six per cent of the patients were uninsured. The average hospitalization was 22 days. The mean age was 22 years and 90% of patients were less than 30 years old. Eighty-five per cent of the patients sustained at least one fracture. Lower extremity fractures occurred in 60%, open fractures in 55%, and tibia fractures occurred in 33% of the patients. Associated head, chest, or abdominal injuries occurred in 40% of the patients. Patients with multiple fractures, open fractures, and grade 3 open tibia fractures had substantially higher hospital bills.

Accidents, Traffic↗

PubMed1987

Hospital-physician relations under hospital prepayment.

Fundamental changes now occurring in the field of health services may make it increasingly difficult to develop or maintain satisfactory hospital-physician relations. This paper examines the nature of hospital-physician relations following the introduction of an experimental hospital prepayment program that capped budgets in nine hospitals for a 5-year period. Results from longitudinal analyses based on data from key physicians, hospital administrators, and board members indicate generally positive "effects" on hospital-physician relations, except for increased strain in the system. In most respects, there were no adverse effects on the work relations of physicians, in the perceived quality of medical care, or in the institutional performance of physicians at the nine participating hospitals after the introduction of prepayment. Moreover, to some extent, the prepayment program appears to have been effective in controlling hospital costs and is perceived by the principal participants to have been successful.

Clinical Competence↗

PubMed2001

Rotavirus-associated medical visits and hospitalizations in South America: a prospective study at three large sentinel hospitals.

BACKGROUND: Knowledge of the impact of rotavirus-associated disease on the health care systems of South America can aid in defining strategies for diagnosis, management and prevention. Up to date information on the impact of rotavirus disease in South America is scarce. AIM: To determine prospectively the impact of rotavirus disease as a cause of medical visits and hospitalizations at three large sentinel pediatric hospitals in Argentina, Chile and Venezuela. METHODS: A 2-year prospective surveillance for rotavirus-associated medical visits and hospitalizations was conducted during 1997 through 1998 at three large sentinel public hospitals, one each in Argentina, Chile and Venezuela. A common surveillance protocol was implemented at the three sites, and a representative number of nonbloody diarrhea stool samples from children <36 months of age were tested for rotavirus by enzyme-linked immunosorbent assay. RESULTS: For our target age group, acute diarrhea-associated medical visits/hospitalizations represented 41%/2%, 5%/6% and 9%/13% of all medical visits/all hospitalizations at the Argentinean, Chilean and Venezuelan sites, respectively (P < 0.001 for difference among the three sites). Rotavirus detection rates among a total of 5,801/1,256 medical visit/hospitalization diarrhea stool samples tested were 39%/71% in Argentina, 34%/47% in Chile and 29%/38% in Venezuela (P < 0.01 by chi square for difference among the three sites). Rotavirus was associated with a mean of 1.5, 1.8 and 3% of total medical visits and 1.6, 2.8 and 5% of hospitalizations among children <36 months of age at the Argentinean, Chilean and Venezuelan sites, respectively. Seasonality was evident for medical visits at all three sites (although less striking in Chile) with peak activity occurring between November and May. Rotavirus-associated hospitalizations had a marked peak in Venezuela, represented largely by short stays, but not in Argentina and Chile. CONCLUSIONS: Rotavirus was a significant cause of medical visits at all three sentinel sites. Rotavirus caused less hospitalizations than previously reported in Argentina and Chile. On the basis of our findings we estimate that approximately 106,000/ 21,000, 48,000/8,000 and 98,000/31,000 rotavirus-associated medical visits/hospitalizations occur yearly in Argentina, Chile and Venezuela, respectively.

Argentina↗

PubMed2000

Prediction of survival for older hospitalized patients: the HELP survival model. Hospitalized Elderly Longitudinal Project.

OBJECTIVE: To develop and validate a model estimating the survival time of hospitalized persons aged 80 years and older. DESIGN: A prospective cohort study with mortality follow-up using the National Death Index. SETTING: Four teaching hospitals in the US. PARTICIPANTS: Hospitalized patients enrolled between January 1993 and November 1994 in the Hospitalized Elderly Longitudinal Project (HELP). Patients were excluded if their length of hospital stay was 48 hours or less or if admitted electively for planned surgery. MEASUREMENTS: A log-normal model of survival time up to 711 days was developed with the following variables: patient demographics, disease category, nursing home residence, severity of physiologic imbalance, chart documentation of weight loss, current quality of life, exercise capacity, and functional status. We assessed whether model accuracy could be improved by including symptoms of depression or history of recent fall, serum albumin, physician's subjective estimate of prognosis, and physician and patient preferences for general approach to care. RESULTS: A total of 1266 patients were enrolled over a 10-month period, (median age 84.9, 61% female, 68% with one or more dependency), and 505 (40%) died during an average follow-up of more than 2 years. Important prognostic factors included the Acute Physiology Score of APACHE III collected on the third hospital day, modified Glasgow coma score, major diagnosis (ICU categories together, congestive heart failure, cancer, orthopedic, and all other), age, activities of daily living, exercise capacity, chart documentation of weight loss, and global quality of life. The Somers' Dxy for a model including these factors was 0.48 (equivalent to a receiver-operator curve (ROC) area of 0.74, suggesting good discrimination). Bootstrap estimation indicated good model validation (corrected Dxy of 0.46, ROC of 0.73). A nomogram based on this log-normal model is presented to facilitate calculation of median survival time and 10th and 90th percentile of survival time. A count of geriatric syndromes or comorbidities did not add explanatory power to the model, nor did the hospital of patient recruitment, depression, or the patient preferences for general approach to care. The physician's perception of the patient's preferences and the physician's subjective estimate of the patient's prognosis improved the estimate of survival time significantly. CONCLUSIONS: Accurate estimation of length of life for older hospitalized persons may be calculated using a limited amount of clinical information available from the medical chart plus a brief interview with the patient or surrogate. The accuracy of this model can be improved by including measures of the physician's perception of the patient's preferences for care and the physician's subjective estimate of prognosis.

Activities of Daily Living↗

PubMed2000

"Hospital at home" versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial.

OBJECTIVES: To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease. DESIGN: Prospective randomised controlled trial with three months' follow up. SETTING: University teaching hospital offering secondary care service to 350 000 patients. PATIENTS: Selected patients with an exacerbation of chronic obstructive pulmonary disease where hospital admission had been recommended after medical assessment. INTERVENTIONS: Nurse administered home care was provided as an alternative to inpatient admission. MAIN OUTCOME MEASURES: Readmission rates at two weeks and three months, changes in forced expiratory volume in one second (FEV(1)) from baseline at these times and mortality. RESULTS: 583 patients with chronic obstructive pulmonary disease referred for admission were assessed. 192 met the criteria for home care, and 42 refused to enter the trial. 100 were randomised to home care and 50 to hospital care. On admission, FEV(1) after use of a bronchodilator was 36.1% (95% confidence interval 2.4% to 69.8%) predicted in home care and 35.1% (6.3% to 63. 9%) predicted in hospital care. No significant difference was found in FEV(1 )after use of a bronchodilator at two weeks (42.6%, 3.4% to 81.8% versus 42.1%, 5.1% to 79.1%) or three months (41.5%, 8.2% to 74.8% versus 41.9%, 6.2% to 77.6%) between the groups. 37% of patients receiving home care and 34% receiving hospital care were readmitted at three months. No significant difference was found in mortality between the groups at three months (9% versus 8%). CONCLUSIONS: Hospital at home care is a practical alternative to emergency admission in selected patients with exacerbations of chronic obstructive pulmonary disease.

Aged↗

PubMed2003

Modification of patients' endogenous bacterial flora during hospitalization in a large teaching hospital in Naples.

The increasing attention addressed to methicillin-resistant staphylococci, vancomycin-resistant enterococci (VRE) and Extended Spectrum beta-Lactamases (ESbetaL)-producing enterobacteria is due to their etiologic role especially in nosocomial infections. In March 2001 we started an 8-month microbiological prospective surveillance of patients in the General Surgery, Orthopedic and Obstetric & Gynecology wards of the Azienda Universitaria Policlinico, 2nd University of Naples, Italy, to monitor the possible changes in endogenous flora during patients' hospital stay and the possible emergence of bacterial resistance. Data concerning antibiotic surgical prophylaxis (antimicrobial agent and duration) and length of hospitalization (pre- and post-surgery) were also collected. All patients underwent a microbiological screening by culturing nasal, pharyngeal and rectal swabs performed at admission and during hospitalization. Overall, 526 nasal swabs, 506 pharyngeal swabs and 482 rectal swabs were performed. Methicillin-resistant staphylococci were isolated from nasal swabs at admission in 2.1% of patients and in 7.5% of patients during hospitalization (day-14). VRE and ESbetaL-producing strains were isolated from rectal swabs in 1.9 and 4.7% of patients, respectively, with no change during hospital stay. Nasal and pharyngeal flora significantly changed after 7-14 days of hospitalization, Gram-negative microorganisms being isolated more frequently following hospitalization. The authors conclude that excessive hospital stay duration, along with the inappropriate duration of surgical antibiotic prophylaxis could be important causes of bacterial flora modification.

Adult↗

PubMed1999

Identification of the decision maker for a patient's hospital choice: who decides which hospital?

If marketers wish to communicate the positive characteristics of purchasing the private hospital experience, the marketers need to be able to identify which of the participants in the purchasing process is acting in the role of decision maker. Research was undertaken of doctors in the rural setting. Potential respondents were selected from Orange to Broken Hill; from Coonabarabran to Young. Two private hospitals are known to be located within this region--one in Orange and one in Dubbo. In most cases, patients in the rural setting are having the final say as to which hospital to attend. They are filling the role of decision maker. The factors that potential patients are considering in their decision include the services provided by the hospital--specifically factors relating to accommodation, services and cost. These observations are those as interpreted by the doctors who see these patients. Based on the findings of the survey a number of recommendations have been made: (1) Any marketing communication by hospitals should target primarily patients and then doctors. (2) Further research should be undertaken to attempt to accurately determine what characteristics are considered when patients and doctors refer to hospital services. (3) Research should be undertaken to determine the identity of all parties involved in the purchasing decision process. (4) Further research should be undertaken of the general population to determine what factors relating to a hospital are considered when making the hospital purchasing decision. (5) Further in depth analysis should be conducted with the raw data.

Catchment Area, Health↗

PubMed2004

Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital.

BACKGROUND: Adverse events are poor patient outcomes that are due to medical care. Studies of hospital patients have demonstrated that adverse events are common, but few data describe the timing of them in relation to hospital admission. We evaluated characteristics of adverse events affecting patients admitted to a Canadian teaching hospital, paying particular attention to timing. METHODS: We randomly selected 502 adults admitted to the Ottawa Hospital for acute care of nonpsychiatric illnesses over a 1-year period. Charts were reviewed in 2 stages. If an adverse event was judged to have occurred, a physician determined whether it occurred before or during the index hospitalization. The reviewer also rated the preventability, severity and type of each adverse event. RESULTS: Of the 64 patients with an adverse event (incidence 12.7%, 95% confidence interval [CI] 10.1%-16.0%), 24 had a preventable event (4.8%, 95% CI 3.2%-7.0%), and 3 (0.6%, 95% CI 0.2%-1.7%) died because of an adverse event. Most adverse events were due to drug treatment, operative complications or nosocomial infections. Of the 64 patients, 39 (61%, 95% CI 49%-72%) experienced the adverse event before the index hospitalization. INTERPRETATION: Adverse events were common in this study. However, only one-third were deemed avoidable, and most occurred before the hospitalization. Interventions to improve safety must address ambulatory care as well as hospital-based care.

Adult↗

PubMed1998

Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality.

OBJECTIVE: To examine the relationship between annual provider (hospital and surgeon) volume of pediatric cardiac surgery and in-hospital mortality. DESIGN: Population-based retrospective cohort study using a clinical database. SETTING: The 16 acute care hospitals in New York with certificate of need approval to perform pediatric cardiac surgery. PATIENTS: All children undergoing congenital heart surgery in New York from 1992 to 1995. MAIN OUTCOME MEASURES: Risk-adjusted mortality rates for various hospital and surgeon volume ranges. Adjustments were made for severity of illness using logistic regression. RESULTS: A total of 7169 cases were analyzed. After controlling for severity of preprocedural illness using clinical risk factors, hospitals with annual pediatric cardiac surgery volumes of fewer than 100 had significantly higher mortality rates (8.26%) than hospitals with volumes of 100 or more (5.95%), and surgeons with annual volumes of fewer than 75 had significantly higher mortality rates (8.77%) than surgeons with annual volumes of 75 or more (5.90%). CONCLUSIONS: Both hospital volume and surgeon volume are significantly associated with in-hospital mortality, and these differences persist for both high-complexity and low-complexity pediatric cardiac procedures.

Cardiac Surgical Procedures↗