Contemporary Patient Characteristics and Referral Patterns to a Pulmonary Hypertension Clinic at an Academic Medical Center

Abstract Background and study aims Incomplete colonoscopy may occur as a result of colon angulation (adhesions or diverticulosis), endoscope looping, or both. Specialty endoscopes/devices have been shown to successfully complete prior incomplete colonoscopies, but may not be widely available. Radiographic or other image-based evaluations have been shown to be effective but may miss small or flat lesions, and colonoscopy is often still indicated if a large lesion is identified. The purpose of this study was to develop and validate an algorithm to determine the optimum endoscope to ensure completion of the examination in patients with prior incomplete colonoscopy. Patients and methods This was a prospective cohort study of 175 patients with prior incomplete colonoscopy who were referred to a single endoscopist at a single academic medical center over a 3-year period from 2012 through 2015. Colonoscopy outcomes from the initial 50 patients were used to develop an algorithm to determine the optimal standard endoscope and technique to achieve cecal intubation. The algorithm was validated on the subsequent 125 patients. Results The overall repeat colonoscopy success rate using a standard endoscope was 94 %. The initial standard endoscope specified by the algorithm was used and completed the colonoscopy in 90 % of patients. Conclusions This study identifies an effective strategy for completing colonoscopy in patients with prior incomplete examination, using widely available standard endoscopes and an algorithm based on patient characteristics and reasons for prior incomplete colonoscopy.

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Determining Inappropriate Medication Alerts from “Inaccurate Warning” Overrides in the Intensive Care Unit

Applied Clinical Informatics ◽

10.1055/s-0038-1642608 ◽

2018 ◽

Vol 09 (02) ◽

pp. 268-274 ◽

Cited By ~ 4

Author(s):

Christine Rehr ◽

Adrian Wong ◽

Diane Seger ◽

David Bates

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Drug Allergy ◽

Medical Center ◽

Inappropriate Medication ◽

Academic Medical Center ◽

Patient Characteristics ◽

Valuable Resource ◽

Provider Behavior ◽

Academic Medical

Objective This article aims to understand provider behavior around the use of the override reason “Inaccurate warning,” specifically whether it is an effective way of identifying unhelpful medication alerts. Materials and Methods We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug–drug interactions (DDI). Override appropriateness was analyzed by two independent reviewers using predetermined criteria. Results A total of 268 of 26,501 ICU overrides (1.0%) used the reason “Inaccurate warning,” with 93 of these overrides associated with our included alert types. Sixty-one of these overrides (66%) were identified to be appropriate. Twenty-one of 30 (70%) dose alert overrides were appropriate. Forty of 48 drug-allergy alert overrides (83%) were appropriate, for reasons ranging from prior tolerance (n = 30) to inaccurate ingredient matches (n = 5). None of the 15 DDI overrides were appropriate. Conclusion The “Inaccurate warning” reason was selectively used by a small proportion of providers and overrides using this reason identified important opportunities to reduce excess alerts. Potential opportunities include improved evaluation of dosing mechanisms based on patient characteristics, inclusion of institutional dosing protocols to alert logic, and evaluation of a patient's prior tolerance to a medication that they have a documented allergy for. This resource is not yet routinely used for alert tailoring at our institution but may prove to be a valuable resource to evaluate available alerts.

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Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

American Journal of Critical Care ◽

10.4037/ajcc2014678 ◽

2014 ◽

Vol 23 (2) ◽

pp. 160-165 ◽

Cited By ~ 12

Author(s):

Pamela L. Smithburger ◽

Randall B. Smith ◽

Sandra L. Kane-Gill ◽

Philip E. Empey

Keyword(s):

Intensive Care ◽

Medical Center ◽

Academic Medical Center ◽

Multiple Logistic Regression Analysis ◽

Patient Characteristics ◽

Specific Patient ◽

Academic Medical ◽

Adequate Sedation ◽

Effective Sedation ◽

At Home

Background Dexmedetomidine, a selective α2-adrenergic receptor agonist, is increasingly used as a sedative in intensive care despite variations in patients’ responses. Objectives To determine the effectiveness of dexmedetomidine as a sedative and specific patient characteristics that play a role in adequate sedation with dexmedetomidine. Methods A 6-month, pilot, prospective observational study was performed in a medical intensive care unit at an academic medical center. Patients receiving dexmedetomidine were followed up until use of the drug was stopped and they were classified as nonresponders or responders. Effective sedation was defined as a score of 3 to 4 on the Sedation Agitation Scale after the administration of dexmedetomidine. Patient characteristics, laboratory values, home and inpatient medications, and dexmedetomidine dosing information were collected to identify predictors of clinical response. Results During the 6-month study period, 38 patients received dexmedetomidine. The drug was ineffective as a sedative in 19 patients (50%) and effective in 11 (29%). Effectiveness could not be assessed in 8 patients because of clinical confounders. According to standard multiple logistic regression analysis, successful sedation was more likely in patients with a lower score on the Acute Physiology and Chronic Health Evaluation II (Odds Ratio [OR] 0.81; 95% CI, −0.39 to −0.03) and patients who took antidepressants at home (OR 10.27; 95% CI, 0.23 to 4.43) than in patients who had a higher score or did not take antidepressants at home. Conclusions Effective sedation with dexmedetomidine is variable.

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2098. Applying Antimicrobial Consumption Metrics to Characterize Inpatient Stewardship Opportunities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1778 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S709-S709

Author(s):

Brian C Bohn ◽

Elizabeth A Neuner ◽

Vasilios Athans ◽

Jill Wesolowski ◽

Thomas G Fraser ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Pharmacist Intervention ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Convenience Sample ◽

Patient Level ◽

Academic Medical ◽

Infectious Diseases Consultation

Abstract Background The purpose of this study was to evaluate antimicrobial consumption metrics as a means for differentiating patient populations and antimicrobial stewardship (AMS) opportunities. Methods This single-center, retrospective, descriptive study included all patients from January 1, 2018 to June 30, 2018 that received ≥1 day of therapy (DOT) of any antimicrobial included in the National Healthcare Safety Network Antimicrobial Use and Resistance (NHSN AUR) module. The cohort was then grouped into 4 quartiles based on DOT (Q1 lowest; Q4 highest). The primary outcome was a Lorenz Curve of DOT per patient over the study period. Secondary outcomes included a comparison of patient characteristics and number/type of AMS-related opportunities present (using a randomized convenience sample of 25 patients per quartile). AMS opportunities were defined as any unnecessary, inappropriate, or suboptimal antimicrobial use with pharmacist intervention or potential for intervention occurring 24 hours after the antimicrobial initiation. Results During the 6 month study period, 24,743 patients accounted for 163,859 days present, and 13,039 (52%) received ≥ 1 DOT. After dividing the population into quartiles of antimicrobial use, median (range) DOT were as follows: Q1 [2 (1–2)], Q2 [4 (3–4)], Q3 [7 (5–10)], Q4 [20 (11–636)] (Figure 1). The top 24% of patients according to antimicrobial use accounted for 74% of total antimicrobial DOT. Patient-level DOT data are displayed by SAAR grouping in Figure 2. In the cohort of 100 patients, differences between quartiles included Infectious diseases consultation in 76% of patients in Q4 compared with 4–24% in other quartiles, ICU admission during hospitalization in 68% in Q4 compared with 28–40% in other quartiles, and any surgical procedure in 88% in Q1 compared with 48–60% in Q2–4. The number of AMS opportunities present were 4 (0.5/1000 DOT) in Q1, 13 (1.6/1000 DOT) in Q2, 28 (1.4/1000 DOT) in Q3, and 86 (0.8/1000 DOT) in Q4. The most common type of AMS opportunity differed by quartile: inappropriate prophylaxis for Q1-3, and de-escalation in Q4. Conclusion Evaluating antimicrobial consumption from a patient-level perspective at a large academic medical center reveals heterogeneity and variable AMS opportunities across quartiles Disclosures All authors: No reported disclosures.

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