Objective To determine the trend in the causes of admission among diabetic patients in West China Hospital from 1996 to 2005. Methods The medical records of diabetic inpatients from January 1996 to December 2005 were retrieved, and half of them were randomly selected. A questionnaire was completed and SPSS13.0 software was used for statistical analyses. Results The most common causes of admission for diabetic patients were diabetic chronic complications (20.2%), infection (19.5%), hyperglycemic symptoms (11.7%), malignant tumor (8.9%) and diabetic acute complications (5.8%). The constituent ratios of diabetic macrovascular disease and malignant tumor as the admission causes tended to increase, while the constituent ratios of diabetic microvascular disease, hyperglycemic symptoms and diabetic acute complications tended to decrease. Infection remained as one of the main causes of admission among diabetic patients. Conclusion The main cause of admission to West China Hospital for diabetic patients from 1996 to 2005 was diabetic chronic complications.
Objective To construct an information hospital service system and discuss the application effect of information construction in the hospital service center. Methods Patients admitted to West China Hospital of Sichuan University between June 2022 and January 2023 were selected. We innovatively practiced intelligent safety gate, self-appointment admission registration, pre-hospital examination and advance migration, pre-hospital health education, an age-appropriate transformation of information service, and other information service measures to investigate the medical experience of patients, and compared patients’ satisfaction with medical treatment under four admission management methods (Huayitong APP, WeChat, self-service machine, and manual management). Results A total of 1452 patients were surveyed. The overall satisfaction score for medical treatment of patients was (4.98±0.04) points. Among them, Huayitong APP was (4.99±0.03) points, WeChat was (4.98±0.13) points, self-service machine was (4.97±0.05) points, and manual treatment was (4.92±0.11) points. There was a statistically significant difference between groups in overall satisfaction with different admission procedures (F=68.582, P<0.001). Since the information construction of the hospital admission service center was carried out, the average time of admission was (12.4±2.3) minutes, and 89.4% (1 298/1 452) of patients thought the time of admission was ideal. Conclusions The information construction of a hospital admission service center can effectively improve patients’ medical experience and enhance patient satisfaction. In the future, it is necessary to explore the influencing factors of patients’ satisfaction with information construction, and constantly improve and upgrade the information construction of hospital admission service centers.
ObjectiveTo explore a method for establishing a priority-scoring model for thyroid carcinoma patient admission. MethodsA questionnaire survey was conducted among specialists and outpatients in the thyroid surgery department of the hospital. The weight coefficient of the index factors was calculated to establish the priority-scoring mode by the analytic hierarchy process. The differences in results between specialists and patients were compared. The logical rationality of the model index was tested. ResultsA priority-scoring model for thyroid carcinoma surgery admission was established, including 10 first-level indicators, such as sex, age, cancer type and TNM stage. The weight coefficients of the indicators from high to low were cancer type (0.137), TNM stage (0.134), tumor size (0.127), tumor invasion degree (0.126), tumor invasion site (0.124), relationship between tumor and capsule (0.111), age (0.093), sex (0.061), place of residence (0.05) and medical insurance type (0.035). After the total ratio test, the model CR value was 0.0073, and the model index was highly rational. ConclusionThis study successfully establish a priority-scoring model for thyroid carcinoma surgery admission, which can provide references and a basis for tiered medical services and relevant researches in the future.
ObjectiveTo understand the current situation of unplanned readmission of colorectal cancer patients within 30 days after discharge under the enhanced recovery after surgery (ERAS) mode, and to explore the influencing factors.MethodsFrom May 7, 2018 to May 29, 2020, 315 patients with colorectal cancer treated by Department of Gastrointestinal Surgery, West China Hospital, Sichuan University and managed by ERAS process during perioperative period were prospectively selected as the research objects. The general data, clinical disease data and discharge readiness of patients were obtained by questionnaire and electronic medical record. Telephone follow-up was used to find out whether the patient had unplanned readmission 30 days after discharge and logistic regression was used to analyze the influencing factors of unplanned readmission within 30 days after discharge.ResultsWithin 30 days after discharge, 37 patients were admitted to hospital again, the unplanned readmission rate was 11.7%. The primary cause of readmission was wound infection. Logistic regression analysis showed that the body mass decreased by more than 10% in recent half a year (OR=2.611, P=0.031), tumor location in rectum (OR=3.739, P=0.026), operative time ≤3 hours (OR=0.292, P=0.004), and discharge readiness (OR=0.967, P<0.001) were independent predictors of unplanned readmission.ConclusionsUnder the ERAS mode, the readmission rate of colorectal cancer patients within 30 days after discharge is not optimistic. Attention should be focused on patients with significant weight loss, rectal cancer, more than 3 hours of operative time, and low readiness for discharge. Among them, the patient’s body weight and discharge readiness are the factors that can be easily improved by clinical intervention. It can be considered as a new way to reduce the rate of unplanned readmission by improving the patients’ physical quality and carrying out discharge care program.
ObjectiveTo systematically review the risk prediction models for readmission within 30 days after discharge in patients with chronic obstructive pulmonary disease (COPD), and provide a reference for clinical selection of risk assessment tools. MethodsDatabases including CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library were searched for literature on this topic. The search time was from the inception of the database to April 25, 2023. Literature screening and data extraction were performed by two researchers independently. The risk of bias and applicability of the included literature were evaluated using the risk of bias assessment tool for predictive model studies. ResultsA total of 8 studies were included, including 14 risk prediction models for 30-day readmission of COPD patients after discharge. The total sample size was 125~8 263, the number of outcome events was 24~741, and the area under the receiver operating characteristic curve was 0.58~0.918. The top five most common predictors included in the model were smoking, comorbidities, age, education level, and home oxygen therapy. Although five studies had good applicability, all eight studies had a certain risk of bias. This is mainly due to the small sample size of the model, lack of reporting of blinding, lack of external validation, and inappropriate handling of missing data. ConclusionThe overall prediction performance of the risk prediction model for 30-day readmission of patients with COPD after discharge is good, but the overall research quality is low. In the future, the model should be continuously improved to provide a scientific assessment tool for the early clinical identification of patients with COPD at high risk of readmission within 30 days after discharge.
Objective To analyze the influencing factors of unplanned readmission for day surgery patients under the centralized management mode, and to provide a scientific basis for improving the medical quality and safety of day surgery. Methods The data of patients in the day surgery ward of the Second Affiliated Hospital Zhejiang University School of Medicine between October 2017 and October 2021 were retrospectively collected, and they were divided into an unplanned readmission group and a control group according to whether they were unplanned readmission within 31 days. Multivariate logistic regression model was used to analyze the influencing factors of patients’ unplanned readmission within 31 days. Results There were 30 636 patients, of which 46 were unplanned readmission patients, accounting for 0.15%. Logistic regression analysis showed that male [odds ratio (OR)=0.425, 95% confidence interval (CI) (0.233, 0.776), P=0.005], thyroid surgery [OR=19.938, 95%CI (7.829, 50.775), P<0.001], thoracoscopic partial lobectomy [OR=13.481, 95%CI (5.835, 31.148), P<0.001], laparoscopic cholecystectomy [OR=10.593, 95%CI (3.918, 28.641), P<0.001] and hemorrhoidectomy [OR=13.301, 95%CI (4.473, 39.550), P<0.001] were risk factors for unplanned readmission in patients undergoing day surgery. Conclusion Medical staff in day surgery wards need to strengthen supervision of male patients and high risk surgical patients, and improve patients’ awareness of recovery, so as to reduce the rate of unplanned readmission.
Objective To investigate the impact of nutritional risk on unplanned readmissions in elderly patients with chronic obstructive pulmonary disease (COPD), to provide evidence for clinical nutrition support intervention. Methods Elderly patients with COPD meeting the inclusive criteria and admitted between June 2014 and May 2015 were recruited and investigated with nutritional risk screening 2002 (NRS 2002) and unplanned readmission scale. Meanwhile, the patients’ body height and body weight were measured for calculating body mass index (BMI). Results The average score of nutritional risk screening of the elderly COPD patients was 4.65±1.33. There were 456 (40.07%) patients who had no nutritional risk and 682 (59.93%) patients who had nutritional risk. There were 47 (4.13%) patients with unplanned readmissions within 15 days, 155 (13.62%) patients within 30 days, 265 (23.28%) patients within 60 days, 336 (29.53%) patients within 180 days, and 705 (61.95%) patients within one year. The patients with nutritional risk had significantly higher possibilities of unplanned readmissions within 60 days, 180 days and one year than the patients with no nutritional risk (all P<0.05). The nutritional risk, age and severity of disease influenced unplanned readmissions of the elderly patients with COPD (all P<0.05). Conclusions There is a close correlation between nutritional risk and unplanned readmissions in elderly patients with COPD. Doctors and nurses should take some measures to reduce the nutritional risk so as to decrease the unplanned readmissions to some degree.