Balthasar Luzius Hug

Background: Reporting adverse drug reactions (ADRs) is essential for drug safety. In Switzerland, healthcare professionals are legally required to report serious and unlabelled ADRs, yet under‐reporting remains widespread. We tested a novel method to increase reporting of ADR‐related hospitalizations. Methods: This retrospective observational study used ADR‐indicative ICD‐10 codes to screen admissions to four Swiss hospitals, identify suspected drugs and send individual case safety reports (ICSRs) of confirmed cases to Swissmedic. Results: Participating hospitals previously reported ~18 ICSRs annually. During the study period (7/2023–12/2023), 200 ADR‐related hospitalizations were reported following a review of 814 pre‐filtered admissions. Most ICSR data were available in structured format: Median age of patients was 59 (interquartile range [IQR] 42–75); 87 (44%) males; median of two comorbidities (IQR 1–3); the three most frequent ADRs were ‘K52.1 Toxic gastroenteritis and colitis’ (11 [6%]), ‘T42.4 Poisoning by benzodiazepines’ (10 [5%]) and ‘R11 Nausea and vomiting’ (10 [5%]). Discharge reports contained free‐text information on suspected drugs: More than half of ADR‐related hospitalizations were caused by antineoplastics (45 [23%]), psycholeptics (38 [19%]), opioids and other analgesics (34 [17%]). The median time to screen a case was 1 min, 8 min to collect, compile and send data of confirmed cases. Conclusion: The approach successfully increased reporting of serious ADRs. The time investment for creating ICSRs might soon be rendered obsolete, as most data are available in structured format, and large language models are key to identifying suspected drugs in discharge reports.

Aging population and growing shortage of specialists present increasing challenges to anesthetic care. In Switzerland, advanced practice nurses in anesthesia are not yet integrated, despite their potential to contribute to innovative care models. This qualitative study explored current gaps in anesthetic care and assessed the potential role of advanced practice nursing in anesthesia. Semi‐structured interviews were held with 46 participants, including patients, nurse anesthetists, and anesthesiologists. Data were analyzed using Mayring's summarizing content analysis. Patients emphasized “Information and Preparation Needs,” “pain,” and “recurrent hospital stays.” Nurse anesthetists highlighted gaps in “making nursing care visible,” “(interprofessional) practice development,” and “pain therapy.” Anesthesiologists identified challenges in “changes in anesthesia,” the “treatment process,” and “pain management.” The results reveal relevant deficits in perioperative care, underscoring the need for sustainable solutions. Integrating advanced practice nurses into anesthesia could address these gaps by providing patient‐centered preoperative support, fostering interprofessional practice development in the operating room, and providing clinical leadership in the postoperative recovery room and pain management. Advanced practice nursing in anesthesia is a promising strategy to sustainably improve the quality of perioperative health care.

Hospital readmissions prolong patient suffering and increase healthcare expenditures. Unplanned readmission rates, such as those reported by the Center for Medicare & Medicaid Services (CMS), distinguish between planned and unplanned readmissions. However, within unplanned readmissions, there is no distinction between those that are preventable versus unpreventable by the hospitals. Alternative approaches attempting to identify potentially preventable readmissions directly from coded medical data have been explored but have shown low sensitivity. Consequently, identifying preventable readmissions remains a time-consuming task for hospital quality managers seeking to allocate improvement resources effectively. To address this challenge, we aimed to develop and evaluate a probabilistic approach to improve the identification of preventable readmissions among unplanned readmissions. Using a retrospective record review of 600 single inpatient stays from a tertiary referral hospital group in Switzerland, we investigated the hypothesis that readmitted patients with a low expected probability for readmission (based on a logistic regression model using patient characteristics) would retrospectively show higher odds of having experienced a potentially or most likely preventable readmission (as assessed by the reviewers). The results confirmed our hypothesis: patients in the third with the lowest expected probability of readmission (compared with those in the highest third) had 6.6 and 8.7 times higher odds, respectively, of having experienced a potentially or most likely preventable readmission. Among preventable readmissions, the leading causes of readmission were surgical complications, medication-related reasons, nonsurgical complications, and premature discharge. Our proposed probabilistic approach can be used by hospital quality managers to focus case finding efforts on unexpectedly readmitted patients and aid effective resource allocation for improvement initiatives.

BACKGROUND: Medication-related readmissions are significant burdens on patients and healthcare systems and are particularly prevalent among older adults. We aimed to identify potentially preventable medication-related readmissions and to describe their causes. METHODS: We conducted a retrospective cohort study of 500 randomly selected patients, aged 65 or older, discharged from the general internal medicine department of a university hospital in Switzerland between January 2022 and October 2023 and readmitted within 30 days. Two pharmacists independently screened their electronic health records and analysed whether their readmission was medication-related using the AT-HARM10 tool. We assessed preventability using judgements similar to the Schumock statements. In cases of disagreement between the two pharmacists, readmissions were also screened by a senior physician. We analysed the causes of potentially preventable medication-related readmissions. RESULTS: We identified 116 (23.2%) potentially preventable medication-related readmissions among the 500 readmissions analysed. The most common diagnoses associated with readmission were heart failure (21.6%), worsening pain (12.1%) and infection (12.1%). The most common causes of readmission were underprescribing (29.3%), Other prescribing problems such as suboptimal medication selection or dosage issues (28.4%), and non-adherence (12.9%). Diuretics, analgesics and antibiotics were the most frequently involved medications. CONCLUSIONS: Nearly one-quarter of 30-day readmissions involving older adults were medication-related and potentially preventable. The primary contributing factors were prescribing and non-adherence issues. The study highlighted common causes of such readmissions and underlines the need for further research to determine which interventions – such as medication reviews or improved care transitions – are most effective in addressing them. Identifying high-risk patients will also be essential to optimise the use of healthcare resources.

The objective of this study was to analyze immune-related adverse events (irAEs) in a real-world data sample and examine the differences in incidence between affected organ systems, irAE severity, therapeutic agent, and gender. We retrospectively analyzed all consecutive patients treated with anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4) antibodies, anti-programmed death 1 (PD-1) inhibitors, and programmed death-ligand 1 (PD-L1) inhibitors between January 2020 and May 2023 in a tertiary referral center in Switzerland. IrAEs documented in the electronic health records (EHR) were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) and analyzed descriptively. Among the 500 patients, 196 (39.2%) were female. Treatments included pembrolizumab (51.2%), atezolizumab (20.2%), nivolumab (14.4%), durvalumab (6.4%), ipilimumab in combination with nivolumab (4.8%), cemiplimab (1.4%), avelumab (1.2%), and ipilimumab (0.4%). N = 216 (43.2%) patients had ≥ 1 irAEs (females: 47.4%; males: 40.5%). Severe (≥ grade 3) irAEs were reported in 13.6% of patients. The following irAE incidences were found: dermatological (15.2%), gastrointestinal (13.0%), endocrine (10.8%), musculoskeletal (4.8%), pulmonary (3.8%), systemic (3.6%), neurological (2.6%), cardiac (1.4%), renal (1.4%), hematological (0.6%), and ocular (0.2%). Nearly half of the patients experienced ≥ 1 irAEs, of which one-third severe. Females experienced more irAEs than males, above all due to a higher incidence of grade 1 irAEs. Only about half of the irAEs were reported as coded diagnosis. Further prospective studies on irAEs are warranted using structured documentation. The online version contains supplementary material available at 10.1186/s12885-025-14733-5.

Background: To enhance patient empowerment, the Cantonal Hospital of Lucerne launched a patient portal (MyChart) in December 2019, granting patients access to their medical records, diagnoses, and laboratory results. Months later, the first COVID-19 case was reported in Switzerland, with the pandemic dramatically affecting health care services. Objective: This analysis aims to investigate how the pattern of patient portal registrations evolved during the pandemic, with reference to the spread of COVID-19, as well as local and federal policies. Methods: This retrospective observational study analyzed the distribution of patient portal registrations after its introduction at the study site from December 1, 2019, until July 31, 2022. The descriptive analysis included the 7-day mean of registrations, plotted alongside the number of administered COVID-19 tests and COVID-19 vaccinations. This was analyzed concerning predefined time periods and stratified by age and gender. Additionally, an interrupted time series analysis was conducted for the different time periods. Results: A total of 126,519 patients registered on the patient portal during the study period, with a slightly higher proportion of female patients (n=66,118, 52.3%) and 11.3% (n=14,259) being 65 years of age or older. The daily registration rate differed substantially over the course of the COVID-19 pandemic, whereby four peaks with >200 registrations per day were identified. The first and third peaks coincide with high COVID-19 testing rates in autumn 2020 and 2021, whereas the second and fourth peaks coincide with the release of the vaccine in spring 2021 and the booster at the end of 2021. These patterns are also reflected in the interrupted time-series analysis: for every transition from one period to the next, the immediate effect of the intervention (level change) is statistically significant with P<.05. Regarding patient portal users aged 65 years or older, only two major peaks in registrations can be identified which coincide with the release of the COVID-19 vaccine and booster. Conclusions: The COVID-19 pandemic, with its disease dynamics, including testing and vaccinations, seems to have influenced the number of patient portal registrations. In addition, it appears that patients aged 65 years or older predominantly registered for COVID-19 vaccines.

Objectives: Despite frequent diagnosis of anemia of inflammation in hospitalized patients, little is known about patients' sex‐specific differences in iron deficiency (ID) and its biomarkers. We aimed to study sex‐specific differences in anemic patients with inflammation and their influence on iron biomarkers. Methods: This retrospective cross‐sectional study included anemic patients with inflammation (CRP > 5 mg/L) hospitalized at a Swiss tertiary referral center (01.01.2020–31.12.2023). ID was defined as ferritin‐index (sTfR/log(ferritin)) ≥ 1.5. Patient characteristics were reported as medians for continuous variables and frequencies for categorical variables. Age, laboratory parameters, treatment, comorbidities, illness severity, and in‐hospital mortality were analyzed. Sex‐specific effects on ID biomarkers (ferritin‐index, sTfR) were assessed using linear regression models. Results: Of 439 participants, 41.2% were female. 44.2% had ID (women: 49.7%, men: 40.3%, p = 0.052). Regression models showed no association between log(ferritin‐index) and sex (coefficient 0.02, 95% CI −0.13 to 0.18, p = 0.76). Ferritin levels were lower in women (221.0 vs. 373 μg/L, p = 0.014). No sex differences in in‐hospital mortality were observed (women 7.2%, men 4.3%, p = 0.21). Conclusions: Despite no significant sex differences regarding ID biomarkers, treatment, illness severity, and mortality, we hypothesize that factors beyond sex, for example underlying diseases and inflammation itself, play a more prominent role in these patients' outcomes.

Background: Preventable medication‐related readmissions (pMRRs) are a significant contributor to older adult morbidity, mortality, and health care costs. There are currently no specific screening tools for identifying patients at a high risk of pMRRs. This study aimed to develop and internally validate a screening tool to identify general internal medicine patients aged 65 or older at risk of 30‐day pMRRs.Methods: Data on 500 patients discharged between January 1, 2022 and October 18, 2023, and readmitted within 30 days were reviewed, and 116 pMRRs were identified. An additional 500 control patients without pMRRs were selected. A multivariable logistic regression model was developed using the four pre‐specified predictors of each patient's number of medications, hospitalizations in the past year, high‐risk medications at discharge (anticoagulants, opioids, and sedatives), and the number of the following diagnoses: heart failure, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease.Results: The screening tool's performance was evaluated and internally validated using bootstrapping. The screening tool demonstrated moderate discriminatory power, with a C‐statistic of 0.714 (95% confidence interval [CI]: 0.663–0.764). Overall performance was assessed as acceptable, with a Brier score of 0.177. Bootstrapping yielded an optimism‐corrected C‐statistic of 0.704 (95% CI: 0.654–0.755), indicating the tool's robustness.Conclusions: The screening tool's discriminatory power suggested its potential utility for flagging patients at risk of pMRRs. External validation and a search for additional predictors will be necessary to enhance the tool's performance and generalizability. If validated, a cost‐effectiveness analysis would be needed to ensure its feasibility for clinical implementation.

BACKGROUND: Digital tools are widely utilised to improve communication and information exchange among healthcare professionals. The cantonal hospital in Lucerne was the first to implement the Epic clinical information system in a German-speaking country, including information access for primary care physicians via an electronic health record portal. OBJECTIVES: This study assessed how primary care physicians perceive the communication with hospitals in the canton of Lucerne, including their preferences for discharge summary contents and experiences and utilisation of a regionally implemented electronic health record portal. METHODS: We performed an online survey among primary care physicians and contacted all 323 primary care physicians enlisted as members of the cantonal medical society in Lucerne, Switzerland. RESULTS: A total of 109 primary care physicians completed the online survey (34% response rate). Half of the primary care physicians were satisfied with hospital communication. Three-quarters (n = 83) wanted to be informed of patients’ emergency hospital admission within 48 hours, but only 30% (n = 33) reported being notified. In discharge summaries, primary care physicians expect information on the diagnosis, medication, therapies, and recommendations for follow-up care. A large portion of primary care physicians deemed the electronic health record portal beneficial for patient management. Most primary care physicians utilise the portal to retrieve patient data, but it is rarely used for patient referrals. CONCLUSION: Half of primary care physicians were satisfied with communication with regional hospitals. Primary care physicians reported a lack of timely notifications or reports about emergency admissions, in-hospital deaths, and discharges of their patients. Primary care physicians value the electronic health record portal as a supporting tool for patient management.