Academic literature on the topic 'Post-discharge healthcare'

OBJECTIVEHealthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization.METHODSOur study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge.RESULTSOur full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008).CONCLUSIONSThe results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.Infect Control Hosp Epidemiol 2015;00(0): 1–9

Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.

AbstractObjective:Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design:Retrospective cohort study.Setting:Academic, quaternary care, referral center.Patients:Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods:Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results:We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).Conclusions:HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

Abstract Background Hospital-based antimicrobial stewardship interventions and metrics have typically focused only on inpatient antimicrobial exposure. However, single-center studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. We sought to describe antimicrobial-prescribing upon hospital discharge across the Veterans Health Administration (VHA) and to compare inpatient and post-discharge antimicrobial use at the hospital-level. Methods This retrospective study used national VHA administrative data to identify all acute-care admissions from January 1, 2014 to December 31, 2016. Post-discharge antimicrobials were defined as oral outpatient antimicrobials prescribed at the time of hospital discharge. We measured inpatient-days of therapy (DOT) and post-discharge DOTs. At the hospital-level, inpatient DOTs per 100 admissions were compared with post-discharge DOTs per 100 admissions using Spearman’s rank-order correlation. Results Among 1.7 million acute-care admissions across 122 VHA hospitals, 46.1% were administered inpatient antimicrobials and 19.9% were prescribed an oral antimicrobial at discharge. Fluoroquinolones were the most common antimicrobial prescribed at discharge among 335,396 antimicrobial prescriptions (38.3%). At the hospital-level, median inpatient antimicrobial use was 331.3 DOTs per 100 admissions (interquartile range (IQR) 284.9–367.9) and median post-discharge use was 209.5 DOTs per 100 admissions (IQR 181.5–239.6). Thirty-nine percent of the total duration of antimicrobial exposure occurred after hospital discharge. The metrics of inpatient DOTs per 100 admissions and post-discharge DOTs per 100 admissions were weakly correlated at the hospital-level (rho = 0.44, P < 0.0001). Conclusion Antimicrobial-prescribing at hospital discharge was common and contributed substantially to the total antimicrobial exposure associated with an acute-care hospital stay. A hospital’s inpatient antimicrobial use was only weakly correlated with its post-discharge antimicrobial use. Antimicrobial stewardship interventions should specifically target antimicrobial-prescribing at discharge. Disclosures All Authors: No reported Disclosures.

Objective To assess attitudes, perceptions, and practices of healthcare workers regarding hospital discharge and follow-up care for children under age five in Migori and Homa Bay, Kenya. Methods This mixed-methods study included surveys and semi-structured telephone interviews with healthcare workers delivering inpatient pediatric care at eight hospitals between November 2017 and December 2018. Results The survey was completed by 111 (85%) eligible HCWs. Ninety-seven of the surveyed HCWs were invited for interviews and 39 (40%) participated. Discharge tasks were reported to be “very important” to patient outcomes by over 80% of respondents, but only 37 (33%) perceived their hospital to deliver this care “very well” and 23 (21%) believed their facility provides sufficient resources for its provision. The vast majority (97%) of participants underestimated the risk of pediatric post-discharge mortality. Inadequate training, understaffing, stock-outs of take-home therapeutics, and user fees were commonly reported health systems barriers to adequate discharge care while poverty was seen as limiting caregiver adherence to discharge and follow-up care. Respondents endorsed the importance of follow-up care, but reported supportive mechanisms to be lacking. They requested enhanced guidelines on discharge and follow-up care. Conclusion Kenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality. Pre- and in-service training should incorporate instruction on discharge and follow-up care. Improved post-discharge deaths tracking–e.g., through vital registry systems, child mortality surveillance studies, and community health worker feedback loops–is needed, alongside dissemination which could leverage platforms such as routine hospital-based mortality reports. Finally, further interventional trials are needed to assess the efficacy and cost-effectiveness of novel packages to improve discharge and follow-up care.

Background: The comprehensive geriatric assessment (CGA) is a multidimensional in-depth evaluation that can be used to assess and estimate life expectancy, risk of morbidity and the physiological age of older cancer patients. Conducting a CGA, however, is resource-intensive. The CGA is also not specifically targeted towards assessing cancer patients and fails to take into account the impact of past medical events. Objectives: We sought to determine if age-specific risk factors comprising the CGA as well as patterns of healthcare use could be assessed in patients 65 years and older undergoing colon cancer surgery between 2000-2006 using administrative healthcare data. We also aimed to determine whether any associations exist between these risk factors and the occurrence of post-discharge emergency room visits (PERVs). Methods: We first conducted a systematic review (PROSPERO registration number CRD42012002476) using MEDLINE, CINAHL, EMBASE and CANCERLIT databases. to identify CGA domains most predictive of adverse cancer-related outcomes, including treatment-related toxicity, mortality and postoperative complications. Studies published in English or French between May 1997 and May 2012, in which a CGA was conducted in patients over the age of 65 initiating cancer treatment, were assessed for eligibility, of which 9 studies were selected for this review. We subsequently conducted a historical cohort study using administrative healthcare data. This involved using administrative claims provided by Quebec's healthcare insurance program (RAMQ) and hospitalization data to identify patients 65 years and older receiving colon cancer surgery between January 1, 2000 and December 31, 2006. Using a one-year look-back period, ICD-9 and generic drug codes were used to characterize patients' history of relevant comorbidities. Service claims, hospitalization and prescription data were also used to characterize past patterns of healthcare use. Following bivariate analyses, a multivariate logistic regression was used to quantify risk factors for ER visits occurring within 30 days of discharge. Results: Our systematic review indicated that, in predicting mortality, in at least one study or another, all CGA domains were found to be significant. Most frequently, the following domains were reported for predicting mortality: nutritional status, the presence of geriatric syndromes such as depression, and functional status. With regards to chemotherapy-related toxicity, similar findings were obtained where functional status and the presence of geriatric syndromes, such as impaired hearing, had the most significant predictive value. Only one study reported on the incidence of post-operative complications for which severe comorbidity was found to be highly associated with experiencing severe complications, while functional status was found to be significantly associated with experiencing any complication. 3789 patients were included in our historical cohort, of which 17.18% made a PERV. The results of the multivariate logistic regression indicated that certain CGA domains were predictive of PERVs. Specifically, individuals that had recently received care for either diabetes or cardiovascular disease had a greater odds of experiencing a PERV. In addition, individuals with increased medication use, as measured by the number of unique medications dispensed within 6 months preceding surgery were more likely to experience a PERV. A number of patterns of past healthcare use also demonstrated predictive utility for the PERV outcome, including a history of visiting the ER, and whether a patient had visited the ER within 30 days preceding surgery for colon cancer-related symptoms. Conclusions: Certain age-specific risk factors and past patterns of healthcare use may predict PERVs. This has important implications in the development of age-sensitive electronic risk-profiling tools.
Contexte: L'évaluation gériatrique globale (CGA) est une évaluation approfondie multidimensionnel qui peut être utilisé pour évaluer et estimer l'espérance de vie, risque de morbidité et l'âge physiologique des patients âgés cancereux. Mais, la réalisation d'une CGA exige beaucoup de ressources. Elle est non spécifiquement dirigée pour l'évaluation des patients cancéreux et ne prend en considération la conséquence des événements médicaux passés. Objectifs : Nous voulions déterminer si des éléments à risques concernant l'âge, y compris la CGA ainsi que les différents usages des systèmes médicaux pourraient être évalués pour ceux de ≥ 65 ans qui ont subis la chirurgie du cancer du colon entre 2000 à 2006 en utilisant les données administratives des services de santé. On a aussi cherché à savoir si des liens existent entre ces facteurs des risque objectif et des événements suivant la d'échange des visites postopératoires (PERVs).Méthodes : On a d'abord entrepris une revue systématique en utilisant MEDLINE, CINAHL, EMBASE et CANCERLIT pour identifier les domaines CGA les plus prédictifs d'effets indésirables liés au cancer, notamment la toxicité liée au traitement, la mortalité et les complications postopératoires. Les études publiées en anglais ou en français, entre mai 1997 et mai 2012, dans lesquelles un CGA a été menée chez des patients ≥ 65 ans commencent le traitement du cancer, ont été évalués pour l'admissibilité et dont 9 études ont été choisis pour cette revue. Puis, on a mené une étude d'ensemble historique en utilisant les données administratives de la santé, y compris les réclamations permises par l'assurance de santé du Québec (RAMQ) et les données d'hospitalisation pour identifier ceux de ≥ 65 ans qui ont subi la chirurgie du cancer du colon (2000-2006). L'utilisation d'une année d'histoire médicale passée, les codes diagnostiques (ICD-9) et ceux de médicaments génériques ont servi à mieux comprendre l'histoire de comorbidités. On a aussi utilisé les mêmes données pour cerner les tendances passées de l'utilisation des soins. Une régression logistique multiple a été utilisée pour mesurer les facteurs de risque de visites à l'urgence survenant dans les 30 jours après la sortie de l'hôpital. Résultats: Les résultats de notre étude ont indiqué que, le plus souvent, les domaines suivants ont été rapportés pour prédire la mortalité : l'état nutritionnel, la présence de syndromes gériatriques tels que la dépression et l'état fonctionnel. Concernant la toxicité liée à la chimiothérapie, l'état fonctionnel et la présence de syndromes gériatriques comme les troubles de l'audition, avaient une valeur prédictive importante. Une seule étude est publiée sur l'incidence des complications postopératoires dont la comorbidité sévère a été jugée associée à des complications graves, tandis que l'état fonctionnel a été trouvé significativement lié à aucune complication. 3789 patients ont été inclus dans notre étude, dont 17.18% ont fait une visite à la salle d'urgence. Les résultats de la régression logistique multiples ont indiqué que certains domaines CGA étaient prédictifs de PERV. Plus précisément, ceux qui ont récemment reçu des soins pour le diabète ou les maladies cardiovasculaires avaient une plus grande probabilité de faire un PERV. Aussi, les individus avec une forte consommation de médicaments uniques dans les six mois précédant la chirurgie étaient les plus susceptibles de faire un PERV. En plus, les patients qui avaient visité la salle d'urgence, et ceux qui ont fait la même chose dans les 30 jours précédant la chirurgie pour des symptômes liés au cancer du côlon étaient plus susceptibles d'avoir besoin d'un PERV. Conclusions : Certaines facteurs de risque spécifiques à l'âge et les habitudes passées d'utilisation des soins de santé peuvent prédire PERV. Ceci a des implications importantes dans le développement des méthodes et autres outils électroniques.

Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients even decades after the occurrence of traumatic events. The “health behavioral model” is adopted to examine the effects of external environmental, predisposing, enabling, and need for care factors on the use of VA post-discharge ambulatory care and readmissions. Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File (OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR). The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6). In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care. For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs. The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans. The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings. Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.

Inpatient rehabilitation is a transition phase and a component of integrated healthcare for high-risk patients with different cardiovascular diseases. Therefore its main focus is on functional and structural evaluation and risk stratification for the rehabilitation process and post-discharge period. Exercise electrocardiogram, transthoracic echocardiography, and a 6-minute walk test should be considered in all patients, at admission and at discharge. Particular attention should be given to specific conditions such as, myocarditis, patients with cardiac devices, and/or after heart valve interventions as well as concomitant disorders (for example diabetes mellitus or chronic kidney disease). Variables of frailty should be considered, particularly in the elderly. Because cognitive decline complicates early recovery after heart interventions, a cognition test may be needed.

Preventive cardiology (PC), as performed in various cardiac rehabilitation (CR) settings, is effective in reducing recurrent cardiovascular events after both acute coronary syndromes or myocardial revascularization. However, the need for newly structured PC programmes and processes to provide a continuum of care and surveillance from the acute to post-acute phases is evident. Phase I CR serves as a bridge between acute therapeutic interventions and phase II CR. After clinical stabilization, phase I CR ideally provides a multifaceted and multidisciplinary intervention, including post-acute clinical evaluation and risk assessment, general counselling, supportive counselling, early mobilization, discharge planning, and referral to phase II CR. All these are important and contribute to achieving the preventive target. All the interventions within phase I CR should be supervised and provided in a comprehensive manner involving several healthcare professionals. For explanatory purposes this chapter analyses and describes these components separately.

Anaesthetists have a central role in cardiopulmonary resuscitation (CPR). The incidence of treated out-of-hospital cardiopulmonary arrest is 40 per 100 000 population and is associated with a survival rate to hospital discharge of 8–10%. The incidence of in-hospital cardiac arrest (IHCA) is 1–5 per 1000 admissions and is associated with a survival rate to hospital discharge of 13–17%. The most effective strategy for reducing mortality from IHCA is to prevent it occurring by detecting and treating those at risk or to identify in advance those with no chance of survival and to make a decision not to attempt resuscitation. The European Resuscitation Council and the Resuscitation Council (UK) publish guidelines for CPR every 5 years and the evidence supporting these is described in the international consensus on CPR science. The advanced life support algorithm forms the core of the guidelines but the precise interventions depend on the circumstances of the cardiac arrest and the skills of the healthcare providers. High-quality CPR with minimal interruptions will optimize survival rates. Shockable rhythms are treated with defibrillation while minimizing the pause in chest compressions. Although adrenaline (epinephrine) is used in most cardiac arrests, no studies have shown that it improves long-term outcome. The post-cardiac arrest syndrome is common and requires multiple organ support in an intensive care unit. Therapy in this phase is aimed at improving neurological (e.g. targeted temperature management) and myocardial (e.g. percutaneous coronary intervention) outcomes. Based on standard outcome measurements (e.g. cerebral performance category), 75–80% of survivors will have a ‘good’ neurological outcome, but many of these will have subtle neurocognitive deficits.

For patients undergoing surgery in a multi-day admission, standard care requires that their surgeon review the patient post-operatively to check on their progress. This is usually done by the specialist attending in person. However, in the Australian setting, most specialists work at multiple institutions. As a result, review ward rounds, especially of post-operative patients, can be delayed, which can delay management decisions and discharge, which in turn may lower patient satisfaction. A telemedicine solution is designed, and results from a pilot test are examined to assess the benefits of incorporating an electronic discharge capability into the current process.

This chapter describes how managed healthcare is a systemic and institutional approach for cost management. It might be the remedy for increasing demand for limited human and material resources. In most of the developed countries the number of elderly patients with multimorbidity is increasing every year. This situation creates the necessity for implementing new policies based on cost-effective methods of diagnosis and treatment. Keeping quality high is crucial for patient safety, although cost reduction must occur to ensure the proper care for all. However, several ethical concerns are raised with these changes. The main is that although the physicians are focused on cost-effective procedures, they will take the patient's opinions into consideration. The outcome of an undermined relationship between doctors and their patients may be contrary to the reduction of the compliance and adherence may in fact increase the cost of services for specific patients. The proper communication patterns and post-discharge care is mandatory for limiting unwanted additional costs and benefits policy makers keeping patient satisfaction high.

For patients undergoing surgery in a multi-day admission, standard care requires that their surgeon review the patient post-operatively to check on their progress. This is usually done by the specialist attending in person. However, in the Australian setting, most specialists work at multiple institutions. As a result, review ward rounds, especially of post-operative patients, can be delayed, which can delay management decisions and discharge, which in turn may lower patient satisfaction. A telemedicine solution is designed, and results from a pilot test are examined to assess the benefits of incorporating an electronic discharge capability into the current process.

Healthcare delivery is facing multiple orthogonal challenges around escalating costs and providing quality care, especially in OECD countries. This research examines the opportunity to leverage Health 4.0 technology and techniques to address the post-operative discharge phase of the patient journey. In so doing it serves to proffer a technology enabled model that supports not only a quality care experience post discharge but also prudent management to minimize costly unplanned readmissions and thereby subscribe to a value-based care paradigm. The chosen context is stoma patients but the solution can be easily generalized to other contexts. Next steps include the conducting of clinical trials to establish proof of concept, validity, and usability.

Today most people have at least one smart phone irrespective of socio-economic standing. Such a penetration of mobile phones has enabled mobile health to rapidly develop over the last 5 years. There are many benefits to patients and clinicians afforded by mobile health including the convenience of any time anywhere access to data and information and the possibility to monitor so that critical issues can be caught early. One key area is in the post discharge phase as patients return home to ensure they are making good progress. This chapter discusses developments of mobile health solutions and precision post-operative wellness monitoring solutions.

Information technology has enabled healthcare providers such as hospitals to extend their internal operations into external facilities such as urgent and ambulatory care centers and optimizeresources in support of patient care. With the development of the internet, social media, wearables, and telehealth technologies, the potential for patient engagement in preventive and post-discharge care transition has increased. Unlike other organizations where the provider has limited insight into the customer ecosystem, hospitals, for example, have an opportunity to gain insight into the patient ecosystem and influence patient behavior while the patients are within the provider ecosystem. This chapter looks at hospital engagement with patients in two settings—the emergency room (ER) and the patient room (PR)—to illustrate both the opportunities and the strategies that can help hospitals use patient touchpoints to improve continuity of care inside and outside hospital walls.

Information technology has enabled tertiary health care providers to improve patient access to preventive and post-discharge care transition services. When such services are supported by facilities that are under the control of the hospital, hospitals can still influence the delivery and overall quality of patient care services. However, for a variety of reasons, many hospitals rely on external care providers who operate relatively independently from the hospital to deliver these services. As such, service delivery intended to create efficiency and value to patients can become complex, challenging to deliver, and resource intensive—especially if the service delivery spans a prolonged time horizon. This chapter discusses one case of an intermediary who helps hospitals address the smoking cessation needs of patients. Using service dominant logic research, the service exchanges among three different ecosystems (healthcare providers, intermediary, and patients) are modeled and intelligence needed to align their goals using blockchain architecture is highlighted.

For many patients with CVD, CR offers an important introduction to secondary prevention. However, many do not enjoy the benefits of CR, often because they are not referred. Internationally, levels of CR attendance vary; overall, less than half of those eligible to attend do so. Patients who are least likely to be referred may benefit most from attendance: structured referral systems increase referral rates. Barriers to CR uptake exist at the levels of patients (education; adherence to healthy lifestyle advice; adherence to medication), healthcare providers (knowledge and motivation; risk stratification; post-discharge plans; inter-professional communication), and healthcare systems (availability of structured programmes; referral processes; performance measures). Multilevel interdisciplinary interventions are required to address these barriers.

Based on scientific studies, heart failure is the principal cause of hospitalization among seniors. More than 50% of elderly with heart failure are readmitted to hospital within six months. Readmission is linked with poor compliance with medical treatment and recommendations, emphasizing the need for a tool to help seniors better comply with post-discharge measures. The goal of this study was to identify end-user needs for the development of a coaching solution aiming to support elderly patients but also formal and informal caregivers. End-user needs were identified through interviews with the three end-user profiles: seniors with heart failure and formal and informal caregivers. The results present six categories of needs: daily treatment follow-up; healthcare network communication; transfer of information; synchronization with current digital tools; information access; and psychosocial support. The identified needs will help to develop an eHealth solution to improve care management and coaching after discharge.

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies the medical, psychosocial, and functional capabilities of older adults in order to develop a coordinated management plan. No standard criteria are available to readily identify subjects who are likely to benefit from CGA. Recent evidences suggested that the healthcare setting may modify the effectiveness of CGA programmes. Home CGA programmes and CGA performed in the hospital, especially in dedicated units, have been shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for post-hospital discharge CGA programmes, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programmes may be influenced also by particular settings or specific clinical conditions, with tailored CGA programmes for older frail patients evaluated for preoperative CGA, admitted or discharged from emergency departments and orthogeriatric units, or with cancer, organ failure, and cognitive impairment.

Introduction Over 50,000 appendicectomies are performed in the UK annually with significant associated costs to the healthcare system.The aim of this study was to investigate whether a significant difference in complication rate exists where different numbers of endoloop ligatures have been applied to the appendiceal base during laparoscopic appendicectomy, and to analyse for potential cost saving. Methods We performed a retrospective analysis of appendicectomies at our centre in one year, providing a sample of 254 patients. Cases were analysed against exclusion criteria, operative method, and histological findings. Each was followed up for complications in the 30 days post discharge and graded using the Clavien-Dindo system. Our null hypothesis of no difference in complication rate was tested using Fisher’s exact test. Results Of 254 patients, 59 were excluded due to open approach, non-endoloop method, or lack of available record, leaving a population of 195. The result of the two-tailed P value equalled 1.000, indicating no statistically significant difference in complication rate whether one or two endoloops were used. Regarding cost effectiveness, an endoloop costs £13.59. If the 62 cases in which 2 endoloops were used to secure the base had utilised a single endoloop, this would amount to a saving of £842.58. Conclusion Our study set out to assess whether the complication rate differs in cases where one or two endoloops have been applied. Retrospective statistical analysis found no significant difference between groups. Based on these findings, we recommend use of one endoloop to secure the base in laparoscopic appendicectomy.