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Acute Care for the Elderly (ACE) units have successfully decreased length of stay, hospital costs, and readmission rates. Furthermore, patients return home with increased functional capacity and improved satisfaction with their hospital stay. The ACE unit concept was geared toward patients returning to independent living, but the average hospitalized geriatric patient is increasingly more frail, vulnerable, and dependent. The purpose of this study is 2-fold: (1) to determine if the ACE unit continues to offer the same benefit to the frail, often bedbound elderly, and (2) to determine if such a unit is able to maintain standard hospital quality indicators. A total of 1096 cases discharged from the Memorial-Hermann ACE unit between July 2008 and June 2010 were compared to a sample of 383 patients with similar illness severity who were discharged between July 2007 and June 2008. Metrics measured include: average length of stay (ALOS), case mix index (CMI), case mix adjusted average length of stay (CMI adj ALOS), average direct costs per case, and readmission rate. Patient satisfaction was measured using Hospital Consumer Assessment of Healthcare Providers and Systems and Press-Ganey surveys; quality and safety data were provided by Memorial-Hermann's Quality and Safety Department. The ACE unit resulted in a statistically significant decrease in ALOS and CMI adj LOS with a simultaneous increase in Health Care Financing Administration CMI, indicating that the unit was serving a sicker, more frail population. The readmission rate was 11.95%. The decrease in length of stay, readmission rate, and direct cost translates into a decrease in cost per case. Furthermore, the ACE unit successfully met hospital quality indicators.

Some of the worst human rights conditions globally are found in Rajasthan’s sandstone quarries. This paper asks if state-based regulation in the economic-North advanced under the Business and Human Rights agenda: disclosure-based regimes, due diligence compliance regimes and trade-based regimes, could advance efforts to improve respect for human rights in this sector. It adopts fields of struggle lens and global value chain theoretical approaches to business power and governance to understand the challenging political and economic dynamics that entrench harm within sandstone quarrying in Rajasthan. This analysis suggests that company-based disclosure and due diligence regimes will struggle to ameliorate these dynamics whilst trade-based approaches hold some potential to generate meaningful change.

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Introduction: With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD. Methods: Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes. Results: Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners’ future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future. Conclusions: In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.

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Background The lifetime journey of patients with single‐ventricle congenital heart disease is characterized by long‐term challenges that are incompletely understood and still unfolding. Health care redesign requires a thorough understanding of this journey to create and implement solutions that improve outcomes. This study maps the lifetime journey of individuals with single‐ventricle congenital heart disease and their families, identifies the most meaningful outcomes to them, and defines significant challenges in the journey. Methods and Results This qualitative research study involved experience group sessions and 1:1 interviews of patients, parents, siblings, partners, and stakeholders. Journey maps were created. The most meaningful outcomes to patients and parents and significant gaps in care were identified across the life journey. A total of 142 participants from 79 families and 28 stakeholders were included. Lifelong and life‐stage specific journey maps were created. The most meaningful outcomes to patients and parents were identified and categorized using a “ capability (doing the things in life you want to), comfort (experience of physical/emotional pain/distress), and calm (experiencing health care with the least impact on daily life) ” framework. Gaps in care were identified and classified into areas of ineffective communication, lack of seamless transitions, lack of comprehensive support, structural deficiencies, and insufficient education. Conclusions There are significant gaps in care during the lifelong journey of individuals with single‐ventricle congenital heart disease and their families. A thorough understanding of this journey is a critical first step in developing initiatives to redesign care around their needs and priorities. This approach can be used for people with other forms of congenital heart disease and other chronic conditions. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04613934.

Introduction: Children with congenital heart disease (CHD) receiving cardiac surgical intervention are at greater risk for developmental delays (DD). Identification of DD and early interventions may improve long term outcomes. The Ages and Stages Questionnaire (version 3) (ASQ3) is a DD screening tool. We hypothesized that clinical and perioperative risk factors are associated with DD in the early post-operative period. Methods: Patients who received an ASQ3 from 2019-2021 post CHD surgery were included. The ASQ3 was administered at outpatient surgical consultation or inpatient, if specific DD risk criteria were met. Those with incomplete operative data were excluded. DD was defined by an ASQ3 score for any domain below the at-risk cutoff. Associations between DD, patient characteristics, clinical factors, and perioperative factors were analyzed utilizing descriptive, univariate, and multivariable statistics. Results: A total of 57 patients were identified: median age at screening was 4 [IQR: 2-9] months, 22(39%) had a non-cardiac congenital abnormality (NCAA) and 17 (30%) a chromosomal abnormality (CA) (Table). Median cardiopulmonary bypass (CPB) time was 194 [IQR: 89-239] minutes. Forty-six (81%) patients had a DD. The median time between surgery and screening was 2 [IQR: 1-5] months. Patients with a NCAA (p = 0.037) and CA (p = 0.024) were more likely to have a DD. No other significant differences were found. In models adjusted for NCAA and CA, CPB times were not significant. Conclusions: The ASQ3 detected a high prevalence of DD among patients screened post CHD surgery. Despite known associations between CHD surgery and DD, few clinical factors, including CPB times, in our sample were associated with ASQ3 determined DD. More studies are needed to assess if the ASQ3 is sensitive and specific enough to serve as a screening tool in this population.