'Discharge bias' disproportionally hurts large and academic hospitals

'Discharge bias' disproportionally hurts large and academic hospitals

"State and national programs that use in-hospital mortality to benchmark hospitals should note how discharge bias unfairly disadvantages certain types of hospitals," concluded Dr. Reineck. "Discharge bias must be accounted for to prevent unfair performance assessments."
Future studies are planned to assess the effects that using this measure in public reporting has on outcomes of ICU patients"

paywalled: Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Blogger's Note/Opinion: while this is not ovarian cancer surgery but endometrial cancer surgery, the surgery described is the same; drive thru mastectomies, cancer surgeries - amazing really -  disgusting might be a more accurate term with a reminder that studies can and often do make policy, the abstract does not define many factors involved in gyn cancer surgeries and notable is the lack of any indication of followup period (of time), readmission rates (days) can vary depending on the hospital.....
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Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Clinical Study
Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy
Mark A. Rettenmaier, Alberto A. Mendivil, John V. Brown, III, Lisa N. Abaid, John P. Micha, Bram H. Goldstein

Gynecologic Oncology Associates, Newport Beach, Calif., USA

Address of Corresponding Author
Oncology 2012;82:321-326 (DOI: 10.1159/000337573)

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   Abstract
Objectives:

The purpose of this retrospective study was to evaluate the capacity for same-day discharge in clinical stage I endometrial cancer (EC) patients treated with total laparoscopic hysterectomy (TLH), bilateral salpingo-oophorectomy (BSO) and bilateral pelvic lymph node dissection (BPLND).  

Methods:
We retrospectively reviewed the charts of stage I EC patients who were treated with TLH, BSO and BPLND and discharged on the same day. The intra- and postoperative clinical variables (e.g., age, complications, surgery time, patient hospital stay) were evaluated in an attempt to discern which factors may predispose a patient to same-day discharge.

Results:
Twenty-one patients were successfully discharged on the same day of surgery. Mean operative time was 1.48 h and length of hospital stay was 6.35 h. There were no intraoperative complications or hospital readmissions.  

Conclusions:
We present a single, institutional experience solely assessing the capacity for same-day discharge in clinical stage I EC patients treated with TLH, BSO and BPLND. Since the postoperative complication rate was minimal with no hospital readmissions, we suggest that particularly selected stage I EC patients are amenable to outpatient management.
Copyright © 2012 S. Karger AG, Basel

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  Author Contacts
Bram H. Goldstein, PhD
Gynecologic Oncology Associates
351 Hospital Road, Suite 507
Newport Beach, CA 92663 (USA)
Tel. +1 949 642 5165, E-Mail bram@gynoncology.com

Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards – a questionnaire study

Advanced cancer patients' self-assessed physical and emotional problems on admission and discharge from hospital general wards – a questionnaire study

 (2012) European Journal of Cancer Care

Most cancer patients receiving life-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff's reported intervention.

A prospective study was undertaken over 12 months, where advanced cancer patients completed a patient questionnaire, EORTC QLQ C15-PAL, on admission (n= 97) and discharge (n= 46). The incidences of the problems were dichotomised in intensity categories. The average number of ‘clinically relevant problems’ on admission was 5 (SD 2) and on discharge 4 (SD 2).

A Wilcoxon signed rank test showed significant change in mean score for six out of nine problem areas, but the majority of the patients did not move to the lower intensity category. The highest concurrence was between patient-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative services and for a special service for pain and constipation that could prevent some admissions.