Universal quantitative neuromuscular blockade monitoring at an academic medical center – a multimodal analysis of the potential impact on clinical outcomes and total cost of care

2021 ◽  
pp. 100184
Author(s):  
Lori-Ann Edwards ◽  
Nam Ly ◽  
Jonathan Shinefeld ◽  
Gordon Morewood
Keyword(s):  
Clinical Outcomes ◽  
Neuromuscular Blockade ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Of Care ◽  
Total Cost ◽  
Multimodal Analysis ◽  
Academic Medical ◽  
Potential Impact

scholarly journals Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

2020 ◽  
Vol 41 (6) ◽  
pp. 1120-1125
Author(s):  
C.W.C. Huang ◽  
A. Ali ◽  
Y.-M. Chang ◽  
A.F. Bezuidenhout ◽  
D.B. Hackney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Spine Mri

scholarly journals Spanning the canyon between stem cell transplantation and palliative care

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 484-489 ◽  
Author(s):  
Eric Roeland ◽  
Grace Ku
Keyword(s):  
Palliative Care ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hematologic Malignancies ◽  
Cost Of Care ◽  
Academic Medical

Abstract Stem cell transplantation (SCT) and palliative care (PC) may initially appear to be distant extremes in the continuum of care of patients with hematologic malignancies, opposed by multiple obstacles preventing their integration. Rather, we will posit that both fields share many similarities and have much to learn from one another. PC has increasing relevance in cancer care given recent studies that link PC to improved quality-of-life, survival, and decreased cost of care. Understanding modern conceptualizations of PC and its role within SCT is key. Through the report of a single academic medical center experience with an integrated SCT and PC model over the last decade, we will discuss future opportunities for strengthening collaboration between SCT and PC. PC in SCT should be considered from the day of diagnosis and tied to need, not to prognosis.

scholarly journals Comparison of Resident, Advanced Practice Clinician, and Hospitalist Teams in an Academic Medical Center: Association with Clinical Outcomes and Resource Utilization

2020 ◽  
Vol 15 (12) ◽  
pp. 709-715
Author(s):  
Stacy A JOhnson ◽  
Claire E Ciarkowski ◽  
Katie L Lappe ◽  
David R Kendrick ◽  
Adrienne Smith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Resource Utilization ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Total Direct Cost ◽  
Advanced Practice ◽  
Interhospital Transfer ◽  
Academic Medical ◽  
Inpatient Medicine

BACKGROUND: Academic medical centers have expanded their inpatient medicine services with advanced practice clinicians (APCs) or nonteaching hospitalists in response to patient volumes, residency work hour restrictions, and recently, COVID-19. Reports of clinical outcomes, cost, and resource utilization differ among inpatient team structures. OBJECTIVE: Directly compare outcomes among resident, APC, and solo hospitalist inpatient general medicine teams. DESIGN: Retrospective cohort study using multivariable analysis adjusted for time of admission, interhospital transfer, and comorbidities that compares clinical outcomes, cost, and resource utilization. SUBJECTS: Patients 18 years or older discharged from an inpatient medicine service between July 2015 and July 2018 (N = 12,716). MAIN MEASURES: Length of stay (LOS), 30-day readmission, inpatient mortality, normalized total direct cost, discharge time, and consultation utilization. KEY RESULTS: Resident teams admitted fewer patients at night (32.0%; P < .001) than did APC (49.5%) and hospitalist (48.6%) teams. APCs received nearly 4% more outside transfer patients (P = .015). Hospitalists discharged patients 26 minutes earlier than did residents (mean hours after midnight [95% CI], 14.58 [14.44-14.72] vs 15.02 [14.97-15.08]). Adjusted consult utilization was 15% higher for APCs (adjusted mean consults per admission [95% CI], 1.00 [0.96-1.03]) and 8% higher for residents (0.93 [0.90-0.95]) than it was for hospitalists (0.85 [0.80-0.90]). No differences in LOS, readmission, mortality, or cost were observed between the teams. CONCLUSION: We observed similar costs, LOS, 30-day readmission, and mortality among hospitalist, APC, and resident teams. Our results suggest clinical outcomes are not significantly affected by team structure. The addition of APC or hospitalist teams represent safe and effective alternatives to traditional inpatient resident teams.

scholarly journals Integrity of clinical information in computerized order requisitions for diagnostic imaging

2018 ◽  
Vol 25 (12) ◽  
pp. 1651-1656 ◽  
Author(s):  
Ronilda Lacson ◽  
Romeo Laroya ◽  
Aijia Wang ◽  
Neena Kapoor ◽  
Daniel I Glazer ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
Clinical Decision ◽  
Accurate Diagnosis ◽  
Institutional Review Board ◽  
Institutional Review ◽  
Academic Medical ◽  
Potential Impact ◽  
Kappa Agreement

Abstract Objective Assess information integrity (concordance and completeness of documented exam indications from the electronic health record [EHR] imaging order requisition, compared to EHR provider notes), and assess potential impact of indication inaccuracies on exam planning and interpretation. Methods This retrospective study, approved by the Institutional Review Board, was conducted at a tertiary academic medical center. There were 139 MRI lumbar spine (LS-MRI) and 176 CT abdomen/pelvis orders performed 4/1/2016-5/31/2016 randomly selected and reviewed by 4 radiologists for concordance and completeness of relevant exam indications in order requisitions compared to provider notes, and potential impact of indication inaccuracies on exam planning and interpretation. Forty each LS-MRI and CT abdomen/pelvis were re-reviewed to assess kappa agreement. Results Requisition indications were more likely to be incomplete (256/315, 81%) than discordant (133/315, 42%) compared to provider notes (p &lt; 0.0001). Potential impact of discrepancy between clinical information in requisitions and provider notes was higher for radiologist’s interpretation than for exam planning (135/315, 43%, vs 25/315, 8%, p &lt; 0.0001). Agreement among radiologists for concordance, completeness, and potential impact was moderate to strong (Kappa 0.66-0.89). Indications in EHR order requisitions are frequently incomplete or discordant compared to physician notes, potentially impacting imaging exam planning, interpretation and accurate diagnosis. Such inaccuracies could also diminish the relevance of clinical decision support alerts if based on information in order requisitions. Conclusions Improved availability of relevant documented clinical information within EHR imaging requisition is necessary for optimal exam planning and interpretation.

scholarly journals Acinetobacter Infections and Outcomes at an Academic Medical Center: A Disease of Long-Term Care

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Jennifer Townsend ◽  
An Na Park ◽  
Rita Gander ◽  
Kathleen Orr ◽  
Doramarie Arocha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Long Term Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Isolates ◽  
University Hospital ◽  
Term Care ◽  
Academic Medical ◽  
Resistance Patterns

Abstract Background.  Our study aims to describe the epidemiology, microbial resistance patterns, and clinical outcomes of Acinetobacter infections at an academic university hospital. This retrospective study analyzed all inpatient clinical isolates of Acinetobacter collected at an academic medical center over 4 years. The data were obtained from an Academic tertiary referral center between January 2008 and December 2011. All consecutive inpatients during the study period who had a clinical culture positive for Acinetobacter were included in the study. Patients without medical records available for review or less than 18 years of age were excluded. Methods.  Records were reviewed to determine source of isolation, risk factors for acquisition, drug resistance patterns, and clinical outcomes. Repetitive sequence-based polymerase chain reaction of selected banked isolates was used to determine patterns of clonal spread in and among institutions during periods of higher infection rates. Results.  Four hundred eighty-seven clinical isolates of Acinetobacter were found in 212 patients (in 252 admissions). Patients with Acinetobacter infections were frequently admitted from healthcare facilities (HCFs) (59%). One hundred eighty-three of 248 (76%) initial isolates tested were resistant to meropenem. One hundred ninety-eight of 249 (79.5%) initial isolates were multidrug resistant (MDR). Factors associated with mortality included bacteremia (odds ratio [OR] = 1.93, P = .024), concomitant steroid use (OR = 2.87, P &lt; .001), admission from a HCF (OR = 6.34, P = .004), and chronic obstructive pulmonary disease (OR = 3.17, P &lt; .001). Conclusions.  Acinetobacter isolates at our institution are frequently MDR and are more common among those who reside in HCFs. Our findings underline the need for new strategies to prevent and treat this pathogen, including stewardship efforts in long-term care settings.

Clinical Impact of an Antibiotic Time Out Initiative at an Academic Medical Center

2020 ◽  
pp. 001857871990127
Author(s):  
Amy Parks Taylor ◽  
Kelci Coe ◽  
Kurt Stevenson ◽  
Lynn Wardlow ◽  
Zeinab El Boghdadly ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Infection Type ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Antimicrobial Use ◽  
Time Out ◽  
Academic Medical ◽  
The Impact ◽  
Homogenous Population

Background: Various strategies aimed at limiting inappropriate antimicrobial use including antibiotic time out (ATO) have been proposed to combat the development of antimicrobial resistance, yet there are limited studies that have assessed the impact of ATO on clinical outcomes. Methods: This single-center retrospective study reviewed the effect of a passive ATO strategy by comparing 100 adult patients with an ATO matched by infection type to 100 antibiotic-treated adult patients lacking an ATO note. Results: No difference in clinical outcomes was observed, however, ATO did result in improved optimization of antibiotic selection and duration, and reduction of piperacillin/tazobactam and vancomycin use. Conclusion: Further studies are warranted to evaluate the impact of ATO on clinical outcomes of a larger homogenous population with specified infectious diagnoses and clinical characteristics.

Clinical Outcomes of Acid Suppressive Therapy Use in Hematology/Oncology Patients at an Academic Medical Center

2016 ◽  
Vol 50 (7) ◽  
pp. 541-547 ◽  
Author(s):  
Rachael V. McCaleb ◽  
Arpita S. Gandhi ◽  
Stephen Michael Clark ◽  
Amber B. Clemmons
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Suppressive Therapy ◽  
Oncology Patients ◽  
Academic Medical

scholarly journals A Computerized Order Set Entry (CPOE) for Vancomycin Dosing Results in Improved Clinical Outcomes in Adult Patients Treated at an Academic Medical Center

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Sandra Susanibar-Adaniya ◽  
Kevin Kuriakose ◽  
Sunita Parajuli ◽  
Krystina Walker ◽  
Jorge Jo-Kamimoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Academic Medical ◽  
Order Set
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