scholarly journals Evaluation of a hybrid antimicrobial restriction process at a large academic medical center

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Jesse D. Smith ◽  
Linh H. Nguyen ◽  
Tamara Krekel ◽  
Jerrica Waggoner ◽  
David J. Ritchie ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Academic Medical

Abstract We conducted a retrospective review of a hybrid antimicrobial restriction process demonstrating adherence to appropriate use criteria in 72% of provisional-only orders, in 100% of provisional orders followed by ID orders, and in 97% of ID-initiated orders. Therapy interruptions occurred in 24% of provisional orders followed by ID orders.

scholarly journals Appropriate use criteria adoption for PCI at an academic medical center

2018 ◽  
Vol 39 (47) ◽  
pp. 4136-4138
Author(s):  
Ahmad Younes ◽  
Jennifer S Hoff ◽  
Alexandria M Bojansky ◽  
Ankur Kalra
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Academic Medical

Abstract 258: Adherence To The AHA / ACCF / SCAI / ASE /ASNC - 2012 Appropriate Use Criteria For Diagnostic Cardiac Catheterization In An Academic Medical Center.

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
SHANMUGAM UTHAMALINGAM ◽  
Taraka V Gadiraju ◽  
Jennifer Frederici ◽  
Khawar Maqsood ◽  
Ankur Gupta ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Stress Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
New York State ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Non Invasive ◽  
Diagnostic Cardiac Catheterization ◽  
Academic Medical

Objective: To examine the adherence to the published appropriate use criteria (AUC) for diagnostic cardiac catheterization (DCC) in an academic medical center. Background: In May 2012, the American Heart Association and other subspecialty societies have developed AUC for DCC to address the growing rational use of cardiac catheterization in delivering high quality health care. The application of all the subsets of AUC indications to examine the adherence of cardiologists in academic center has not been well studied. Methods: We retrospectively examined a random sample of 499 patients who underwent DCC in our institution between January 1, 2013 to June 30, 2013, seven months after the publication of AUC for DCC; and classified as appropriate, uncertain and inappropriate categories according to the AUC. Indications not addressed in the AUC were considered unclassified. Results: The mean age of the study population was 65 (± 13) years with 67% males. Distribution of DCC according to AUC is shown in Table-1. Most DCC were appropriate (93%; n= 462), 6% (n=31) were uncertain and none were inappropriate. Approximately 1% (n=6) DCC were unclassifiable and all had known obstructive coronary artery disease (CAD) with worsening or limiting symptoms without non invasive stress testing and did not meet criteria for unstable angina. About one quarter (22%; n= 21/86) of DCC performed for patients in the suspected CAD with or without prior non invasive stress testing group were uncertain, 78% (n= 65/86) were appropriate and none were inappropriate. Most DCC (92%) were performed by interventional cardiologists (Figure 1). Conclusions: Most DCCs performed at this academic hospital are adherent with AUC criteria, however variability exists by indication and provider type. Unclassified patients as mentioned above who got referred for DCC by treating cardiologists led to a significant change in their management plan, thereby suggesting these group of patients which currently do not fit to any subset AUC criteria need consideration for further subset AUC categorization. About 22% of the DCC performed in the suspected CAD group were uncertain, none were inappropriate which make our results prominently discordant to recent findings observed among DCC procedures performed for suspected CAD in New York State.

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals APPROPRIATE USE OF STRESS ECHOCARDIOGRAPHY AT AN ACADEMIC MEDICAL CENTER IN A PUBLIC FUNDED HEALTHCARE SYSTEM

2014 ◽  
Vol 63 (12) ◽  
pp. A1233
Author(s):  
Kevin Levitt ◽  
Jeremy Edwards ◽  
Chi-Ming Chow ◽  
Howard Leong-Poi ◽  
Zakariya Albinmousa ◽  
...  
Keyword(s):  
Healthcare System ◽  
Stress Echocardiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Appropriate Use ◽  
Academic Medical

Comparison of two different intravenous serotonin antagonists used for chemotherapy-induced nausea and vomiting prophylaxis in patients treated with moderately emetogenic risk regimens: A retrospective analysis from a large academic medical center

2020 ◽  
Vol 26 (8) ◽  
pp. 1964-1969
Author(s):  
Melissa Gamble ◽  
Elisabeth Carroll ◽  
Garth C Wright ◽  
Ashley E Glode
Keyword(s):  
Retrospective Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Moderately Emetogenic Chemotherapy ◽  
Prophylactic Regimen ◽  
Nccn Guidelines ◽  
Institutional Review ◽  
Academic Medical

Introduction Chemotherapy-induced nausea and vomiting (CINV) can be a serious and debilitating adverse effect that is highly feared by cancer patients. For patients receiving moderately emetogenic chemotherapy regimens at our institution in the ambulatory infusion center, palonosetron was selected as the preferred serotonin (5-HT3) antagonist for CINV prophylaxis per the 2016 NCCN Guidelines, when a neurokinin1 antagonist was not included in the prophylactic regimen. The purpose of this study was to evaluate the efficacy of dexamethasone and palonosetron versus granisetron for the prevention of CINV in patients receiving moderately emetogenic chemotherapy regimens. Methods This study is an Institutional Review Board-approved, single-center retrospective review of electronic health records including patients who received moderately emetogenic chemotherapy regimens with CINV prophylaxis with dexamethasone and either palonosetron or granisetron. Results A total of 268 eligible patients were included in the study. Eighty-eight patients received palonosetron and 180 patients received granisetron as their 5-HT3 receptor antagonist between October 31, 2014 and October 31, 2016. There were no statistically significant differences between the two antiemetic groups for the primary outcome of presence of any change in day 1 intravenous prophylactic antiemetics. Nine (10.23%) palonosetron patients and 15 (8.33%) granisetron patients required a change in their day 1 intravenous prophylactic antiemetics ( P = 0.610). Conclusions Despite palonosetron’s better efficacy, longer half-life, and higher binding affinity, the results of this retrospective review demonstrates that the choice of serotonin antagonist, palonosetron or granisetron, did not result in a change in day 1 intravenous prophylactic antiemetics or antiemetic outpatient medications for patients undergoing moderately emetogenic chemotherapy regimens.

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