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Background Patients admitted to acute care hospitals may have multiple co-morbidities, and a small proportion may stay a protracted period. Aims To assess the proportion of hospital patients who are long stay (≥14 days), evaluate associations with baseline variables and subsequent in-patient morbidity and mortality. Methods Retrospective observational study of patients aged ≥ 18 years staying in hospital for at least 24 hr between 1-7-2013 and 30-6-2014. Results There were 22,094 admissions in 15,623 patients. The median (IQR) length of stay was 4 (2–8) days, and 10% had a length of stay > 16 days. Long stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long stay admissions were more likely to be associated with intensive care unit admission (21.2% vs 6.0%), medical emergency team review (20.5% vs 4.3%), and a longer duration of mechanical ventilation (p

Background Platelet transfusions are commonly used to treat critically ill patients with thrombocytopenia. Whether platelet transfusions are associated with a reduction in the risk of major bleeding is unknown. Patients/Methods Observational cohort study nested in a previous multicenter, randomized thromboprophylaxis trial in the intensive care unit (ICU). The objective was to evaluate the association between platelet transfusions and adjudicated major bleeding events. Platelet transfusion episodes were reviewed for timing of administration, product type, and dose. Major bleeding with and without platelet transfusions was adjusted for severity of thrombocytopenia, use of anti‐platelet agents, surgery and other covariates. Secondary outcomes were thrombosis, death in ICU and platelet count increment. Results Among 2,256 patients, 71 (3.1%) received 190 platelet transfusions. Of those, 121 (63.7%) were administered to 54 non‐bleeding, thrombocytopenic patients. Adjusted rates of major bleeding were not statistically different with or without the administration of platelet transfusions (hazard ratio for transfused patients 0.85; 95% confidence interval, 0.42‐1.72). We did not find a significant association between platelet transfusion use and thrombosis or death in ICU in adjusted analyses. Thrombocytopenia, anemia, major or minor bleeding and use of anticoagulants were associated with platelet transfusion administration. The median post‐transfusion platelet count increment was 20×109/L at 3.5 hours post‐transfusion. Conclusions Rates of major bleeding were not different for patients who did and did not receive platelet transfusions. Inferences were limited by the small number of transfused patients. Clinical trials are needed to better investigate the potential hemostatic benefit and potential harms of platelet transfusions for this high‐risk population.

Patients admitted to acute care hospitals may have multiple comorbidities, and a small proportion may stay for a protracted period.To assess the proportion of hospital patients who are long stay (≥14 days) and evaluate associations with baseline variables and subsequent inpatient morbidity and mortality.This is a retrospective observational study of patients aged ≥18 years staying in hospital for at least 24 h between 1 July 2013 and 30 June 2014.There were 22 094 admissions in 15 623 patients. The median (interquartile range (IQR)) length of stay (LOS) was 4 (2-8) days, and 10% had a LOS16 days. Long-stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long-stay admissions were more likely to be associated with intensive care unit admission (21.2 vs 6.0%), medical emergency team review (20.5 vs 4.3%) and a longer duration of mechanical ventilation (P 0.0001 all comparisons). Long-stay patients were more likely to develop in-hospital complications, were more likely to die in hospital (8.2 vs 3.1%) and were less likely to be discharged home (P 0.001 all comparisons). Multiple variable analysis revealed several associations with prolonged stay, including multiple admissions in the study period, the nature of the admitting unit, the Charlson comorbidity index at admission, admission from another hospital and any history of smoking.Patients staying at least 14 days comprised one seventh of hospital admissions but used half of bed days and suffered increased in-hospital morbidity and mortality. Several pre-admission associations with prolonged stay were identified.

We describe the accuracy validation of a model to predict service demand in a hospital environment and illustrate its application to long term capacity planning. Forecast accuracy for predicting daily Emergency Department presentations, inpatient admissions and discharges at the study site is around 90%, and forecasts can be visualized in a format that identifies potential shortfalls in hospital capacity.

Less than a month after the 2015 Budget a coroner released a report on the tragic 2014 death of Emma-Lita Bourne, who had been living with her family in a state house in Ötara until unexpected complications of a respiratory infection led to her death in Starship Hospital. For the first time a coroner implicated poor housing as a cause, stating that ‘Whether the cold living conditions of the house became a contributing factor to the circumstances of Emma-Lita’s death cannot be excluded’ (Shortland, 2015, p.9). The house was cold and mouldy and the family had been unable to afford any heating.

Introduction Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation. Methods We conducted a randomised, open-label, parallelgroups pilot trial in the medical and surgical intensive care unit of a university hospital. Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were randomised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 μg/kg/hr, with or without loading doses of 2.5 mg haloperidol or 1 μg/kg dexmedetomidine, according to clinician preference. Results Dexmedetomidine significantly shortened median time to extubation from 42.5 (IQR 23.2 to 117.8) to 19.9 (IQR 7.3 to 24) hours (P = 0.016). Dexmedetomidine significantly decreased ICU length of stay, from 6.5 (IQR 4 to 9) to 1.5 (IQR 1 to 3) days (P = 0.004) after study drug commencement. Of patients who required ongoing propofol sedation, the proportion of time propofol was required was halved in those who received dexmedetomidine (79.5% (95% CI 61.8 to 97.2%) vs. 41.2% (95% CI 0 to 88.1%) of the time intubated; P = 0.05). No patients were reintubated; three receiving haloperidol could not be successfully extubated and underwent tracheostomy. One patient prematurely discontinued haloperidol due to QTc interval prolongation. Conclusions In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICUassociated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial. Trial registration Clinicaltrials.gov NCT00505804