A Quality-of-Care Analysis of Cascade latrogenesis In Frail Elderly Hospital Patients

Potts, Steven; Feinglass, Joe; Lefèvre, Frank; Kadah, Hayssam; Branson, Christine; Webster, James R.

doi:10.1016/s0097-5990(16)30617-0

Cited by 18 publications

(15 citation statements)

References 25 publications

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“…For the patients in whom non-acute codes were found, as much as 85% of their stay was post-acute. Patients awaiting transfer to another facility are not likely to be active users of acute hospital services (Hochstein,1985) and are susceptible to the detrimental effects of hospitalization, such as iatrogenesis and loss of independence (Rudberg, Sager and Zhang, 1996;Potts et al, 1993). Our analyses suggest that the addition of PCH beds may only temporarily reduce the excess utilization of hospital resources for long-stay patients.…”

Section: Discussionmentioning

confidence: 85%

“…In addition, older patients are at increased risk of cognitive dysfunction, mood disorders and malnutrition. These losses can lead to prolonged hospital stay and if there is a failure to restore independence prior to discharge, then patients are at increased risk of death, or placement in a nursing home (Rudberg, Sager and Zhang, 1996;Palmer and Bolla, 1997;Palmer et al, 1994;Potts et al, 1993).…”

Section: Detrimental Effects Of Hospital On Older Patientsmentioning

confidence: 99%

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Long Stay Patients in Winnipeg Acute Care Hospitals

Kozyrskyj

Coster²,

John³

2002

Healthc Manage Forum

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Risk factors for long-stays (more than 30 days) in Winnipeg hospitals were identified, including sociodemographic, illness, and system characteristics. The largest determinant of length of stay was discharge destination; discharge to a nursing home increased length of stay by 173% and 89% for medical and surgical patients, respectively. Hospital of stay also made a big difference for patients discharged to nursing homes. Only 13% of long-stay patients were discharged to a nursing home; 52% were discharged home. Other factors which were associated with an extended length of stay included: hospitalization for stroke, cognitive impairment, rehabilitation therapy, PEG tube insertion, and inhospital fall.

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Section: Discussionmentioning

confidence: 85%

Section: Detrimental Effects Of Hospital On Older Patientsmentioning

confidence: 99%

Long Stay Patients in Winnipeg Acute Care Hospitals

Kozyrskyj

Coster²,

John³

2002

Healthc Manage Forum

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“…Implicit care rationing by nurses can lead to functional and cognitive decline, which are preventable risk factors for the development, or 'cascade', of complications for complex older patients (Parke et al, 2013). It is not simply one injury, or a single, adverse 'event', but a series of mild cases of neglect, missed opportunities and missed red flags (Potts et al, 1993) that produce a cascade of iatrogenesis (Thornlow et al, 2009). The intrinsic risk factors for older people with complex health needs are outlined in Table 3.…”

Section: Nurses Ration Carementioning

confidence: 99%

‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital

Bail

Grealish

2016

International Journal of Nursing Studies

123

132

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Complex older patients represent about half of all acute public hospital admissions in Australia. People with dementia are a classic example of complex older patients, and have been identified to have higher rates of hospital-acquired complications. Complications contribute to poorer patient outcomes, and increase length of stay and cost to hospitals. The care for older people with dementia is complex, and this has been attributed to: their cognitive response to being hospitalised; their limited ability to self-care; and lack of nursing engagement with the family caregiver. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications. However, it is known that when demand for nursing care exceeds supply, care is prioritised according to acute medical need. Consequently some basic but essential nursing care activities such as patient mobility, communication, skin care, hydration and nutrition are implicitly rationed. This paper offers a theoretical proposition of 'Failure to Maintain' as a conceptual framework to indicate implicit care rationing by nurses. Care rationing contributes to functional and cognitive decline of complex older patients, which then contributes to higher rates of hospital acquired complications. Four key hospital acquired complications: pressure injuries, pneumonia, urinary tract infections and delirium are proposed as measurable indicators of 'Failure to Maintain'. Hospital focus on throughput constrains nurses to privilege predictable, solvable and medically-related procedures and processes that will lead to efficient discharge over patient mobility, communication, skin care, hydration and nutrition. This privileging, also known as implicit rationing, is theoretically and physiologically associated with a rise in the incidence of complications such as pressure injuries, pneumonia, urinary tract infection, and delirium. Complex older patients, including those with dementia, are at higher risk of the complications, therefore should have higher delivery of prophylactic intervention (ie have higher care needs). 'Failure to Maintain' offers a conceptual framework that is inclusive of, and sensitive to, this vulnerable population. Implicit rationing is occurring and it likely contributes to functional and cognitive decline in complex older patients and hospital-acquired complications. However, the lack of patient functional ability data at admission and discharge for hospitalised patients, and lack of usable ward and hospital level nurse staffing and workload data makes it difficult to monitor, understand and improve quality of care. Current research in the fields of acute geriatrics and nursing work environments show promise through enabling multidisciplinary team communication, and facilitating clinical autonomy to provide patient focussed care, and avoid 'Failing to Maintain'. The research field of acute geriatrics can understand and act on the risk modification role of nurses, including controlling for nurse staffing and work env...

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“…One prior study did not find age to be independently predictive of short-term outcomes after an episode of syncope. 11 Understanding this relationship is clinically important, because hospitalization for syncope does not clearly improve outcomes, 12 may be associated with iatrogenic complications in elderly patients, 13,14 and represents more than $2 billion in annual U.S. healthcare costs. 3 The goal of this study was to assess the relationship between age and 14-day serious clinical events after an ED visit for syncope.…”

mentioning

confidence: 99%

Older Age Predicts Short‐Term, Serious Events After Syncope

Sun

Hoffman

Mangione

et al. 2007

J American Geriatrics Society

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OBJECTIVES: To assess the relationship between age and 14-day serious events after an emergency department (ED) visit for syncope. DESIGN: One-year prospective cohort study. SETTING: Single academic ED. PARTICIPANTS: Adult patients with an ED complaint of syncope or near-syncope. MEASUREMENTS: Treating physicians prospectively recorded the presence or absence of potential risk factors for serious clinical events. Patients were contacted by telephone at 14 days for a structured interview. A three-physician panel reviewed ED charts, hospital records, and telephone interview forms to identify predefined events. The primary outcome included any 14-day predefined event. A secondary outcome included any 14-day predefined event that was first diagnosed after the initial ED visit. Age was analyzed in 20-year intervals. Multivariate logistic regression controlled for baseline demographic, comorbidity, and electrocardiogram data. RESULTS: Of 592 eligible patients, 477 (81%) provided informed consent. Follow-up was successfully obtained for 463 (97%) patients. The age range was 18 to 96, and 47% of patients were aged 60 and older. There were 80 (17%) patients who had a 14-day event, including 18 (4%) with a delayed diagnosis. Compared with patients aged 18 to 39, the adjusted odds ratio (OR) of a serious outcome was 2.7 (95% confidence interval (CI) 5 0.9-8.4) for patient aged 40 to 59, 3.8 (95% CI 5 1.3-12) for patients aged 60 to 79, and 3.8 (95% CI 5 1.2-12) for patients aged 80 and older. CONCLUSION: Age of 60 and older is strongly associated with short-term serious events after an ED visit for syncope. J Am Geriatr Soc 55: 907-912, 2007.

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A Quality-of-Care Analysis of Cascade latrogenesis In Frail Elderly Hospital Patients

Cited by 18 publications

References 25 publications

Long Stay Patients in Winnipeg Acute Care Hospitals

Long Stay Patients in Winnipeg Acute Care Hospitals

‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital

Older Age Predicts Short‐Term, Serious Events After Syncope

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