A surgical team with focus on staff education in a community hospital improves outcomes, costs and patient satisfaction

Abstract Aim Epistaxis in the Covid pandemic is a concerning problem facing otolaryngologists due to high droplet concentration and increased virulence in nasal secretions. Furthermore, safe ambulation of patients reduces Covid exposure and preserves essential resources. This study assessed the implementation of ENT UK recommended altered epistaxis management during the Covid pandemic. Method Patients presenting to a medium-sized community hospital with unrelenting epistaxis had a rapid rhino (RR) inserted. Able patients were ambulated and given an appointment for RR removal. Previously all patients were admitted. A comparative retrospective analysis of patients referred with epistaxis was conducted using electronic care records from March – August 2019 versus the same period in 2020. Follow-up phone-call was also employed. Admissions, bed days, RR complications and patient satisfaction was assessed. Data was analysed student t-tests. Results A significant reduction in admissions (n = 91; P < 0.001) and bed days (n = 104; P < 0.001) was observed. Only 2 out of the 68 patients ambulated required medical assistance prior to their scheduled appointment (3%; P < 0.001). The majority of patients were satisfied (91%) and reported no bleeding (94%). No RR dislodgement occurred (0%) and most patients were pleased to avoid admission (92%). 70% of patients reported severe pain following RR insertion. Conclusions Ambulation of patients presenting to ED with unrelenting epistaxis managed with RR insertion is a safe alternative to previous practice with few complications. Furthermore, patients are largely satisfied although reported severe pain post RR insertion needs addressed. Finally, this altered management reduces contact and preserves resources as our hospitals face overwhelming pressures.

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P080: Clinical lead nurse practitioner Strathcona Community Hospital

CJEM ◽

10.1017/cem.2018.278 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S85-S85

Author(s):

D. K. Klemmer ◽

C. Ziebel ◽

N. Sharif ◽

S. Grubb ◽

S. Sookram

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Patient Satisfaction ◽

Service Delivery ◽

Nurse Practitioner ◽

Community Hospital ◽

Clinical Care ◽

Family Physicians ◽

Lost To Follow Up

Introduction: Prior to opening Strathcona Community Hospital (STCH) site leadership were tasked to develop an innovative care model. The central aim was quality improvement and patient safety optimization in the emergency department (ED) utilizing a nurse practitioner (NP) model. They developed 3 pillars: collaboration, multidisciplinary approach, and integration with the plan of improving patient satisfaction and ensuring no patient gets lost to follow up. NPs work in the STCH ED and the NP led Emergency Department Transition (EDT) Clinic in Ambulatory Care. In the ED NPs provide direct clinical care, judicious review of DI and microbiology reports, and care coordination for patients at risk of lost to follow up. The EDT clinic is an innovative NP lead clinic with the purpose of providing timely, high-quality follow up care for ED patients. Methods: Data for the service delivery indicators came from data repository and manual data collection looking at the following outcomes: timely review of DI/micro results; decreased ED visits for non-urgent/emergent issues; safe transitions in care and improved patient satisfaction. Quantitative data from service delivery, patient and surveys were analyzed using Microsoft Excel and SPSS 19. Results: From June 2016 to January 2017 ED NPs at STCH reviewed 3000 positive microbiology reports and made 517 f/u calls to those patients, and reviewed 3181 DI results. This has freed up approximately 2 hrs per day of ED physician time. When NPs were working in the ED, the number of patients who left without treatment (LWT) was approximately 50% less, and improved STCH ED wait times to be among the lowest in the Edmonton Zone. From June 2016 to January 2017, EDT NPs completed 837 patient visits; 371 letters to family physicians (FPs); 215 referrals; and connected 520 patients to a new FP. Patient satisfaction survey show 88-90% of the patients were satisfied with their care. Conclusion: NPs are integral members of the ED team at STCH, providing direct clinical care and several valuable follow up services for ED patients. The EDT clinic provides urgent follow up for ED patients unable to get a timely appointment with their FP or no access to primary care. The clinic also prevents unnecessary returns to ED, and aids to bridge ED services to family physicians or specialist. NPs are the common thread through all departments at STCH, contributing to quality improvement and high patient satisfaction.

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Improving the “Bottom-Line”: Financial Justification for the Hospital-Based Lactation Consultant Role

Clinical Lactation ◽

10.1891/215805311807011818 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-25 ◽

Cited By ~ 2

Author(s):

Shannon Francis-Clegg ◽

Deanne T. Francis

Keyword(s):

Patient Satisfaction ◽

Cost Of Care ◽

Staff Education ◽

Bottom Line ◽

Hospital System ◽

Lactation Consultant ◽

Care And Support ◽

Depth Study ◽

Future Publication

Intermountain Healthcare’s Lactation Standards Team conducted a year-long in-depth study to evaluate their current lactation services for staffing, patient satisfaction, patient and staff education, reimbursement patterns, cost of care and lactation-failure readmissions. The attempt was to evaluate and then standardize the lactation services within their 23-hospital system and create staffing recommendations to support optimal lactation care and support. This article represents a brief summary of recommendations based on this study. Individual portions of the project with detailed process and final results/data will be submitted for future publication.

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Can the Iowa Satisfaction with Anesthesia Scale Be Used to Measure Patient Satisfaction with Cataract Care Under Topical Local Anesthesia and Monitored Sedation at a Community Hospital?

Anesthesia & Analgesia ◽

10.1213/01.ane.0000154203.00434.23 ◽

2005 ◽

Vol 100 (6) ◽

pp. 1637-1643 ◽

Cited By ~ 25

Author(s):

Donald Fung ◽

Marsha Cohen ◽

Susan Stewart ◽

Andy Davies

Keyword(s):

Patient Satisfaction ◽

Local Anesthesia ◽

Community Hospital

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Outcomes for geriatric patients evaluated in a same-day multidisciplinary central nervous system clinic for radiation oncology and neurosurgery in a community hospital setting.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24034 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24034-e24034

Author(s):

Wencesley A. Paez ◽

Rohi Gheewala ◽

Jerry J. Jaboin ◽

Charles R. Thomas ◽

Jeremy N. Ciporen ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Patient Satisfaction ◽

Radiation Oncology ◽

Patient Population ◽

Geriatric Patients ◽

Community Hospital ◽

The United States ◽

Cns Disease ◽

Cns Malignancies

e24034 Background: The geriatric cancer population is rapidly increasing in the United States. Management of geriatric patients with central nervous system (CNS) disease requires a patient-centric, multidisciplinary approach together with meticulous assessment of their outcomes, as clinical studies guiding treatment recommendations are lacking in this patient population. We have previously reported the outcomes of our multidisciplinary community hospital-based CNS clinic, RADIANS, where both radiation oncology and neurosurgery specialists simultaneously evaluate patients in a same-day, single-setting clinic. We have sought to analyze the outcomes of the geriatric patient population of our RADIANS clinic. Methods: We identified patients 65 years and older in our IRB-approved RADIANS Prospective Patient Registry for CNS Disease. Descriptive statistics were used to report patient characteristics, diagnoses, treatments and outcomes, and patient satisfaction scores. Results: Between August 2016 and February 2020, 56 patients 65 years and older (mean age 74.6, range: 65-94; 32 women and 24 men) were evaluated in the RADIANS clinic. Mean distanced traveled by patients to clinic was 43.4 miles (med = 8.3; range = 0.6-341). Patient-reported Satisfaction Score was 4.81 (0-5 Scale, 5-very satisfied). The most common referral source was medical oncology. Forty-two patients had malignant CNS disease (brain mets-18; spine mets-12; both-4; primary brain-6; primary spine-2), 14 had benign CNS disease. Post-evaluation treatment: radiation therapy (RT) only (n = 20), neurosurgery (NS) only (n = 6), both RT and NS (n = 14), and no RT/NS intervention (n = 16). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local tumor control = 39/40 (97.5%); radiation necrosis/radiation-induced myelitis = 0/34 (0.0%). Conclusions: This is the first report of outcomes in geriatric patients with CNS malignancies treated in a community hospital-based multidisciplinary clinic. We show excellent outcomes comparable to younger patients with CNS malignancies, as well as patient satisfaction and ability to travel great distances to receive multidisciplinary care.

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