-It is a concern that increasing pressure to diagnose, treat and discharge patients rapidly is leading to unacceptably high readmission rates. Readmissions were studied over a two-month period. Patients were identified through the hospital coding system, and electronic discharge summaries provided details of each admission. In total, 69 readmissions were identified, representing 4.34% of medical admissions. Readmitted patients were older than those with single admissions (median age 75 and 71 years, respectively; pϽ Ͻ0.05). Initial length of stay was greater in those patients who would go on to be readmitted (median six days; single admission, two days; pϽ Ͻ0.0001). Seventyone per cent of readmissions were deemed avoidable, with discharge before conclusive therapy being the leading factor implicated (56%). Readmission is more likely in older patients with complex care needs. Rapid throughput of patients is not associated with readmission. The majority of readmissions can potentially be avoided with judicious medical care.KEY WORDS: discharge planning, hospital-acquired infection, length of stay, medical admissions, medical assessment unit, medication error, readmission, rehospitalisation IntroductionReadmission into hospital is frequently cited as an indicator of the quality of medical care. 1 Although widely used, the term 'readmission' is poorly defined and confusion persists with regard to its precise interpretation and application. 1 The lack of a standardised time frame (varying from 24 hours to one year) makes effective comparison between studies difficult. Furthermore, absence of uniform inclusion criteria makes the definition highly variable and almost indistinguishable from other common terms such as unscheduled admission and rehospitalisation. [1][2][3] Many factors have been highlighted as contributors to patient readmission. Common causes include inappropriate or incomplete treatment, failure of adequate handover from secondary back to primary care, as well as poor social planning, particularly in the elderly. [4][5][6] There is increasing pressure to diagnose, treat and discharge patients in the shortest possible length of time. Average length of stay targets for each medical condition contribute to this pressure, as well as an awareness that prolonged hospital admissions can result in complications such as hospital-acquired infection.Acute medical assessment units (MAUS) are now well established in the UK. They act to decrease accident and emergency (A&E) waiting times and provide an alternative to standard inpatient hospitalisation in certain conditions that are likely to be acute and short term. This has certainly been evident in retrospective studies in the UK, showing reduced length of stay and A&E waiting times. 7-8 Accelerated patient turnover has often been considered to be related to increased rates of readmission and is particularly relevant to acute medical wards, that is, discharges within the first 24 to 48 hours.One method of reducing length of stay and readmissions is dischar...

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Background The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods One hundred and sixty‐six coronavirus disease 2019 (COVID‐19) Iranian pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. Results Of 166 patients, 102 (61%) and 64 (39%) were males and females, respectively. Ninety‐six (57.8%) and 70 (42.2%), had moderate and severe conditions, respectively. Thirty (18%) of patients died. The common symptoms were fever (73%), cough (54%), and shortness of breath, headache decrease in neutrophil and platelet counts; increase values in lactate dehydrogenase, decrease in the blood pH and HCO3 were significantly associated with the disease severity. 54% and 56% of patients showed abnormal radiographic appearance in Chest X‐ray and in chest computed tomography scan, respectively. Sixty‐one (36.7%) of patients were referred to intensive care unit (ICU). The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome, acute cardiac injury, and death. Conclusions We describe a higher than previously recognized rate of COVID‐19 mortality in Iranian pediatric patients. Epidemiological factors, such as the relatively high case fatality rate in the country and the presence of underlying diseases were the main factors for the high death rate.

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood, and the increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents against it has become a major concern. The aim of this study was to determine the antibiotic resistance and genotyping of bacteria isolated from urine cultures in patients referred to the Children's Medical Center, Tehran, Iran. Methods: During the 1-year period, antimicrobial susceptibility profiles of strains isolated from patients with UTI were determined. Typing of the isolates causing nosocomial infections was performed by random amplified polymorphic DNA (RAPD) analysis, and the results were analyzed by Gelcompar II software. Results: In this study, 203 children (130 girls and 73 boys) were included. The patients' age ranged from 1 day to 16 years (IQR average=4 months to 4 years). The most frequent isolated organisms were Escherichia coli (118 isolates, 58%), followed by Klebsiella pneumoniae (30 isolates, 15%). Sixty-two strains (18 strains of E. coli, 13 strains of K. pneumoniae, 11 strains of Enterococcus faecium, and five strains of Burkholderia cepacia complex) had criteria of nosocomial infection. A high resistance rate to trimethoprim-sulfamethoxazole (69%) and cefotaxime (60%) was reported in E. coli and K. pneumoniae strains, respectively. Pseudomonas aeruginosa strains showed high sensitivity to amikacin (100%). All E. faecium strains were susceptible to trimethoprim-sulfamethoxazole (100%), and 23% of the strains were resistant to vancomycin. The analysis of RAPD-typing revealed the presence of three clusters in E. coli, two clusters in E. faecium, and one clone in K. pneumoniae. Besides, four out of five isolates of B. cepacia complex had more than 90% genetic similarity. Conclusion: The most frequent isolated pathogen was E. coli, and an increasing rate of antibiotic resistance to the commonly prescribed antimicrobial agents such as trimethoprim/ sulfamethoxazole and cephalosporins was observed. Moreover, the results of this study showed the presence of clones with ≥80% similarity in E. coli, K. pneumoniae, E. faecium, and B. cepacia complex isolates; therefore, the transmission of nosocomial infections from one patient to another or one ward to another is probable.