scholarly journals Experiences in Electronic Consultation (eConsult) Service in Gynecology from a Quaternary Academic Medical Center

2021 ◽  
Vol 45 (5) ◽  
Author(s):  
Chiara M. Corbetta-Rastelli ◽  
Tamandra K. Morgan ◽  
Nazaneen Homaifar ◽  
Lisa Deangelis ◽  
Amy M. Autry
Keyword(s):  
Pap Smear ◽  
Medical Center ◽  
Academic Medical Center ◽  
Abnormal Uterine Bleeding ◽  
Turnaround Time ◽  
Senior Author ◽  
Fiscal Year ◽  
Program Manager ◽  
Electronic Consultation ◽  
Improve Access

AbstractTo evaluate an academic institution’s implementation of a gynecologic electronic consultation (eConsult) service, including the most common queries, turnaround time, need for conversion to in-person visits, and to demonstrate how eConsults can improve access and convenience for patients and providers. This is a descriptive and retrospective electronic chart review. We obtained data from the UCSF eConsult and Smart Referral program manager. The medical system provided institution-wide statistics. Three authors reviewed and categorized gynecologic eConsults for the last fiscal year. The senior author resolved conflicts in coding. The eConsult program manager provided billing information and provider reimbursement. A total of 548 eConsults were submitted to the gynecology service between July 2017 and June 2020 (4.5% of institutional eConsult volume). Ninety-five percent of the eConsults were completed by a senior specialist within our department. Abnormal pap smear management, abnormal uterine bleeding, and contraception questions were the most common queries. Over half (59.3%) of all inquiries were answered on the same day as they were received, with an average of 9% declined. Gynecology was the 10th largest eConsult provider at our institution in 2020. The present investigation describes one large university-based experience with eConsults in gynecology. Results demonstrate that eConsults permit appropriate, efficient triaging of time-sensitive conditions affecting patients especially in the time of the COVID-19 pandemic. eConsult services provide the potential to improve access, interdisciplinary communication, and patient and provider satisfaction.

Abstract W P345: Strength in Numbers: Stroke Coordinators Improving Care Through Collaboration

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kathy Morrison ◽  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Care ◽  
Direct Care ◽  
Emergency Responders ◽  
Program Manager ◽  
Group Data ◽  
Suspected Stroke ◽  
Host Organization

Background: Stroke care evolution has been remarkable since 2000, when the Brain Attack Coalition published their recommendations for Primary Stroke Centers. For the first time, hospitals had evidence-based standards to improve patient outcomes. Today, many states require emergency responders to take suspected stroke patients only to certified stroke centers. As a result, many hospitals have established the role of stroke coordinator to oversee the myriad facets of stroke care. Coordinators are overwhelmed with the opportunities - and responsibilities - to improve care processes. Method: In 2009, the stroke program manager at a Magnet academic medical center established a regional stroke coordinators’ group. Eight coordinators met and established milestones for success. Information has been shared and nurses have traded services, providing education for each other’s organization. The group of now 28 coordinators meets every other month. Results: Positive outcomes of membership in this dynamic group include a 65% increase in professional membership in American Association of Neuroscience Nurses. In addition, the coordinators report confidence and empowerment to impact change in their own organization that improved care and outcomes. Aggregate group data demonstrates improvement in the following measures: thrombolytic administration 44%; door-to-needle time 16%; & patient education 12%. Nine additional hospitals (from 6 to 17, a 183% increase) have attained Advanced Primary Stroke certification and the host organization achieved Comprehensive Stroke certification. Conclusion: Neuroscience nurses are influential leaders - not just within their own organization. These outcomes demonstrate the mutual benefit of stroke coordinator colleagues working together and sharing best practice strategies. Through multi-organizational collaboration, they have become empowered to establish programs and become experts within their organization, able to guide and improve the care provided by their own direct-care nurses.

scholarly journals Mounting a Regional Response to the COVID-19 Pandemic: Another Reason to “Keep” Your Lab

2020 ◽  
Vol 144 (11) ◽  
pp. 1321-1324
Author(s):  
Tamera A. Paczos
Keyword(s):  
Health System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Diagnostic Testing ◽  
Turnaround Time ◽  
Test Method ◽  
Regional Health ◽  
The Core ◽  
Local Access ◽  
Average Turnaround Time

Context.— Declining reimbursement shifts hospital laboratories from system assets to cost centers. This has resulted in increased outsourcing of laboratory services, which can jeopardize a hospital systems' ability to respond to a health care crisis. Objectives.— To demonstrate that investment in a core laboratory serving an academic medical center equipped a regional health system to respond to the Coronavirus disease 2019 (COVID-19) pandemic. Design.— COVID-19 diagnostic testing data were analyzed. Volumes were evaluated by result date (March 16, 2020–May 6, 2020), and the average of received-to-verified turnaround time was calculated and compared for in-house and send-out testing, and different in-house testing methodologies. Results.— Daily viral diagnostic testing capacity increased by greater than 3000% (from 21 tests per day to 658 tests per day). Total viral diagnostic testing reported by the core laboratory increased by 128 times during 22 days of test method validation and 826 times during the analysis period, while average turnaround time per day for send-out testing increased from 3.7 days to 21 days. Decreased overall average turnaround time was observed at the core laboratory (0.45 days) versus send-out testing (7.63 days) (P < .001). Conclusions.— Investment in a core laboratory provided the health system with the necessary expertise and resources to mount a robust response to the pandemic. Local access to testing allowed rapid triage of patients and conservation of scarce personal protective equipment (PPE). In addition, the core laboratory was able to support regional health departments and several hospitals outside of the system.

Using an online portal and nurse navigators to improve access to cancer care between network hospitals.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 126-126
Author(s):  
Eleanor Miller ◽  
Margaret Rummel
Keyword(s):  
Cancer Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Community Setting ◽  
Cancer Center ◽  
Proton Radiation ◽  
Online Portal ◽  
Academic Medical ◽  
Nurse Navigator ◽  
Improve Access

126 Background: Nurse navigation-facilitated access to cancer care is an emerging trend in healthcare. One way to improve access to specialized cancer care is through nurse navigators in collaboration with affiliated network hospitals. The Abramson Cancer Center (ACC) has a network of 15 community hospitals in the tri-state area that provides patients access to an academic medical center for subspecialty care that is not always available the community cancer center. Methods: In 2010, a navigation referral process was developed using nurse navigators from the ACC and the network hospitals. Then in 2012, an online portal was developed to further streamline physician referrals to and from the ACC. Updates were made to the online portal in 2013 and 2014 for continued improvement. Results: Prior to the online portal, no central repository for network referrals existed to ensure that patients were scheduled with the correct provider(s). Now with the portal patients are referred, assessed, and scheduled with appropriate providers by the nurse navigator. This has increased accountability and streamlined the scheduling process. Now, patients can be seen by multiple providers during one visit to the ACC. It has also provided a network for the ACC nurse navigators to connect patients back to the community setting for ongoing care once consults or treatments at the ACC are completed. Since the navigation process was implemented, over 1200 patients have been referred (over 500 in the past year alone) for second opinions, clinical trials, proton radiation, bone marrow transplants, surgical options, and cutting- edge technology that may not have otherwise been available. Conclusions: Using nurse navigators at the core of the process ensures that patients are triaged and scheduled in a timely and medically-appropriate manner, thus enhancing their access to specialized cancer care.

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

2012 ◽  
Vol 33 (4) ◽  
pp. 338-345 ◽  
Author(s):  
Harold C. Standiford ◽  
Shannon Chan ◽  
Megan Tripoli ◽  
Elizabeth Weekes ◽  
Graeme N. Forrest
Keyword(s):  
Infectious Diseases ◽  
Cost Analysis ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Fiscal Year ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

scholarly journals A Location-Based Outcome Analysis of the Most Common Microsurgically Clipped Cerebral Aneurysms: A Single-Center Experience

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Peyton L Nisson ◽  
Ali Tayebi Meybodi ◽  
Garrett K Berger ◽  
Austen Thompson ◽  
Ramin A Morshed ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Cerebral Aneurysms ◽  
Neurological Status ◽  
Senior Author ◽  
Ruptured Aneurysm ◽  
Outcome Analysis ◽  
Anterior Communicating Artery ◽  
Single Center Experience ◽  
Microsurgical Clipping

ABSTRACT BACKGROUND Intracranial aneurysms of the anterior communicating artery (AComA), posterior communicating artery (PComA), and the middle cerebral artery (MCA) comprise the majority of all aneurysms encountered and treated by vascular neurosurgeons. OBJECTIVE To analyze and compare outcomes between these locations using multivariable logistic regression and to assess what clinical features may differ between them. METHODS Solitary aneurysms microsurgically clipped by the senior author were included from a prospective database of patients treated between January 2010 and April 2013 at a tertiary academic medical center. Neurological status was assessed using the modified Rankin Scale (mRS). Neurological outcomes were dichotomized, with mRS scores 0-2 considered “good” and 3-6 considered “poor.” RESULTS A total of 196 patients were treated; 69 aneurysms were located at the MCA, 77 at the AComA, and 50 at the PComA. A total of 48% (97/196) of patients presented with a ruptured aneurysm and 14% (25/180) were considered large. PComA was more commonly presented as a ruptured aneurysm (64%) compared to AComA (56%) and MCA (28%) (P ≤ .001), and when ruptured, PComA aneurysms were 1.6 times more likely to experience a favorable outcome compared to MCA aneurysms (P = .01). Regression analysis revealed PComA was associated with a lower risk for poor outcomes (odds ratio [OR] 0.19, P = .01) controlling for age, presentation type, and vasospasm. CONCLUSION Patients who underwent microsurgical clipping of ruptured PComA aneurysms experienced significantly better outcomes, while those with MCA aneurysms suffered the worst. Further investigation on this topic and the potential reasons that may account for these differences is warranted.

scholarly journals Responsivity of Utilization Rates to the Intensity of Case Management over Time Among High-Utilizing Adults with Sickle Cell Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5803-5803
Author(s):  
Wally R Smith ◽  
Daniel Sop ◽  
Shirley Johnson ◽  
Thokozeni Lipato ◽  
Sarah Hartigan
Keyword(s):  
Sickle Cell Disease ◽  
Case Management ◽  
Sickle Cell ◽  
Medical Center ◽  
Academic Medical Center ◽  
Fiscal Year ◽  
Cell Disease ◽  
Outpatient Visits ◽  
Academic Medical ◽  
Over Time

Background: Case management (CM) and community health workers (CHWs) are two evidence-based health management strategies that can help reduce health risks, reduce readmission rates, and improve patient-provider relationships, all of which may be suboptimal in adults with sickle cell disease (SCD). In Fiscal Year (FY) 2016, the actual average vs. expected average length of stay (ALOS) among SCD adults at Virginia Commonwealth University Medical Center (VCU), an urban academic medical center, was 6.7 days vs 4.2 days. The 30-day readmission rate was 33.7%. We have previously presented results of a year-long pilot CM and CHW intervention for five of VCU's highest adult SCD utilizers, measured by calendar year (CY) 2015 VCU charges (Sop, et al., Blood 2017). Comparing CYs 2015 and 2016, there were numeric improvements in inpatient discharges, 30-day readmissions, 3-Day Emergency Department (ED) returns, ED discharges, outpatient visits, inpatient days, and total VCU charges. Herein, we show results of an extension of the pilot to evaluate responsivity to change over time: whether these improvements were lost among these same patients in the subsequent year (CY 2017) with diminished CM due to loss of funding, and whether they recurred in CY 2018, when CM was more robust as a result of new, more stable funding. Methods: Using the VCU charge and utilization database, we compared the above utilization variables for the five highest CY 2015 utilizers in CYs 2018, 2017, 2016 and 2015. The five original patients included 2 males and 3 females aged between 25-31 years old. One of the females passed away in 2016. Results: There was a trend toward numerically lower utilization during the two CM and CHW years (2016 and 2018), compared to the two diminished CM years (2015 and 2017). Inpatient discharges, inpatient days, and total charges see-sawed according to the intensity of intervention, going down during the year of the initial intervention, rising during the year after intervention, and going down again with resumption of intervention. However, there were notable exceptions: 30-day re-admissions were the lowest in 2017 a diminished intervention year; 3-day ED returns were flat throughout; ED discharges declined throughout, and; outpatient visits rose throughout. Conclusions: These pilot results must be interpreted with caution, since the sample was very small, and interventions were not standardized or randomized, so that secondary trends could be excluded. We found that, after diminution in 2017 of an initial CM and CHW intervention in 2016, several of the initial 2015-to-2016 improvements in academic medical center utilization for five high-utilizing adult SCD patients deteriorated. Subsequently, these improvements recurred when CM and CHWs were reapplied in 2018. We also found that other utilization improvements were sustained despite diminution or resumption of the intervention. This pilot result lays the groundwork for larger, more rigorous CM and CHW Table Disclosures Smith: Novartis: Consultancy, Honoraria. Lipato:Novartis: Honoraria.

Abstract 19252: Ideal Cardiovascular Health and Employee Productivity

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Steven Driver ◽  
Anita Panjwani ◽  
Bonnie Spring ◽  
Donald M Lloyd-Jones ◽  
Norrina Allen
Keyword(s):  
Cardiovascular Health ◽  
Emotional Health ◽  
Medical Center ◽  
Academic Medical Center ◽  
Fiscal Year ◽  
Employee Productivity ◽  
Healthy Weight ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
Optimal Health

Introduction: The AHA has defined ideal cardiovascular health (CVH) as the simultaneous presence of 4 optimal health behaviors (not smoking, eating a healthy diet, meeting physical activity goals, and maintaining a healthy weight) and 3 optimal health factors (lower blood pressure, blood sugar, and cholesterol). An association between ideal CVH and employee productivity has not yet been established. Objectives: In this study, we sought to investigate whether employees with high CVH are more productive than employees with moderate or low CVH. Methods: In fiscal year 2015, an academic medical center offered health risk appraisal surveys (HRAs) to its 6,500 employees. Completion rates have been >90% to date (n=6,144). Ideal, intermediate, and poor levels for each of the 7 components listed above were calculated from HRA responses according to standard AHA definitions and assigned values of 2, 1, and 0 respectively. An overall CVH score was calculated for each respondent from the sum of individual component scores with a range of 0-14 (low 0-7 points, moderate 8-10, and high 11-14). Productivity was measured by responses related to missed work days due to illness (absenteeism) and days employees came to work but did not feel at their best (presenteeism). In this cross-sectional analysis, we used logistic regression to compare productivity responses between employees with high, moderate, and low CVH adjusting for race and sex (age was unavailable due to employee privacy concerns). Results: Overall, 35% of employees were in high CVH, 58% moderate, and 6% low. The odds of missing at least one workday due to illness during a two-week period were 67% lower among employees with high CVH compared to employees with low CVH (adjusted OR 0.33; 95% CI, 0.20-0.56). The odds of reporting that physical or emotional health problems made it difficult to concentrate on work at least half the time were 85% lower among employees with high CVH compared with low CVH (adjusted OR 0.15; 95% CI, 0.07-0.33). Conclusions: Self-reported higher CVH was strongly associated with better employee productivity as measured by fewer sick days and better concentration at work. These results support the notion that helping employees stay healthy may represent a valuable near-term strategy for employers.

Abstract T MP81: Are 30-Day Stroke Readmissions Preventable?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ann M Leonhardt ◽  
Curtis G Benesch
Keyword(s):  
Readmission Rate ◽  
Pay For Performance ◽  
Medical Center ◽  
Academic Medical Center ◽  
Median Number ◽  
Fiscal Year ◽  
Case Review ◽  
Contributing Factors ◽  
Bundled Payments ◽  
Phone Calls

Introduction: Stroke has a high risk of recurrence and known complications. The expected readmission rate and number of preventable readmissions are difficult to determine. We sought to identify preventable readmissions at an academic medical center in anticipation of CMS pay-for-performance inclusion of 30-day readmission rate as a quality measure. Methods: Fiscal year 2013 readmissions data were obtained from the Office of Clinical Practice Evaluation. Administrative readmissions were removed and individual chart reviews completed for NIHSS, clinical diagnosis at readmission, and potential contributing factors. Cases were evaluated by a Nurse Practitioner and Neurologist specializing in stroke to determine if the readmission was preventable. Consensus was reached on all cases. Results: The 30-day readmission rate was 7.47% with 48 readmissions in 46 patients. When compared to all ischemic stroke patients, the readmitted patients were younger (mean age 56 yrs vs 68 yrs) with higher LOS (median 8 days vs 4 days) and comparable NIHSS (mean 8.5 vs 8.8). Stroke or TIA accounted for 7 (14.6%) readmissions. Median number of days to readmission was 7.5, with 47.8% of readmissions occurring within 7 days. Case review determined 27 (56.3%) not to be preventable, 8% were questionable. Outpatient evaluation may have prevented 9 (18.8%), 6.3% were felt to be initial coding errors and should have been removed from the original sample; 10.4% (5) reflected care at the hospital level. Conclusions: Based on case reviews at our institution less than half of readmissions are preventable, with only about 10% reflecting aspects of a patient’s inpatient care. Categorizing preventable readmissions into administrative, hospital, or outpatient related will assist in development of a plan for readmission reduction. Through collaboration with health information management those patients with unclear coding will be reviewed and revised. Phone calls within 7 days for patients discharged home have increased in regularity. Future planning for participation in Medicare bundled payments for stroke may encourage more collaboration with SNF and Rehabilitation facilities, allowing for evaluation without hospital admission.

Identification of Rate-Limiting Steps in the Provision of Thrombolytics for Acute Ischemic Stroke

2016 ◽  
Vol 30 (6) ◽  
pp. 606-611 ◽  
Author(s):  
Elise L. Metts ◽  
Abby M. Bailey ◽  
Kyle A. Weant ◽  
Stephanie B. Justice
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Sample ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Turnaround Time ◽  
Ct Scanner ◽  
Physician Consultation

Background: Tissue plasminogen activator (tPA) is the only pharmacotherapy shown to improve outcomes in acute ischemic stroke. The American Heart Association (AHA) recommends a door-to-needle (DTN) time of <60 minutes in at least 50% of patients presenting with acute ischemic stroke. Objective: The purpose of this study was to analyze the possible barriers that may delay tPA administration within the emergency department (ED) of an academic medical center. Methods: A retrospective chart review was conducted from February 2011 to October 2013. Patients were included if they were admitted through the ED with a diagnosis of acute ischemic stroke and received tPA. Results: Of the 130 patients who met inclusion criteria, 43.1% received tPA in ≤60 minutes. Several factors were identified to be significantly different in those with a DTN time of >60 minutes—time to ED physician consultation, neurologist arrival, blood sample acquisition, and result time ( P < .05 for all comparisons). Correlation analysis demonstrated several independent variables associated with DTN time of ≤60 minutes—time from admission to ED physician consultation, receipt of computed tomography (CT) scan, blood sample acquisition, laboratory results, and neurology service arrival ( P < .05 for all comparisons). Conclusion: The findings from this study highlight the importance of prompt physician evaluation, direct transfer to the CT scanner, and a quick turnaround time on laboratory values. The development of protocols to ensure the rapid receipt of tPA therapy should focus on limiting any potential delay these steps may cause.

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