scholarly journals Development and Implementation of a COVID-19 Disease Response Protocol at a Large Academic Medical Center

2020 ◽  
pp. 1-4
Author(s):  
Meshell Maxam ◽  
Kailynn J. DeRonde ◽  
Ana D. Vega ◽  
Dimitra Skiada ◽  
Christine A. Vu ◽  
...  
Keyword(s):  
Health System ◽  
Early Recognition ◽  
Medical Center ◽  
Health Care Systems ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Routine Care ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Disease Response

ABSTRACT In response to the rapid spread of novel coronavirus disease 2019 (COVID-19), health-care systems should establish procedures for early recognition and management of suspected or confirmed cases. We describe the various steps taken for the development, implementation, and dissemination of the interdisciplinary COVID-19 protocol at Jackson Health System (JHS), a complex tertiary academic health system in Miami, Florida. Recognizing the dynamic nature of COVID-19, the protocol addresses the potential investigational treatment options and considerations for special populations. The protocol also includes infection prevention and control measures and routine care for suspected or proven COVID-19 patients.

Comparison of rates of adherence to oral chemotherapy medications filled through an internal health-system specialty pharmacy vs external specialty pharmacies

2020 ◽  
Vol 77 (14) ◽  
pp. 1118-1127
Author(s):  
Colleen C McCabe ◽  
Meagan S Barbee ◽  
Marley L Watson ◽  
Alyssa Billmeyer ◽  
Collin E Lee ◽  
...  
Keyword(s):  
Health System ◽  
Multiple Regression ◽  
Patient Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Primary Objective ◽  
Wilcoxon Test ◽  
Tumor Type ◽  
Specialty Pharmacy

Abstract Purpose The primary objective of the study described here was to compare rates of patient adherence to anticancer medications filled at an internal health system specialty pharmacy (HSSP) vs external specialty pharmacies. The primary outcome was the medication possession ratio (MPR), and the secondary outcomes included proportion of days covered (PDC), and time to treatment (TTT). Methods A retrospective chart review was conducted to compare the MPR, PDC, and TTT for patients who received oral anticancer therapy using prescriptions claim data. A t test or Wilcoxon test was used to explore the effect of demographic and other factors on adherence and TTT. A multiple regression model with backward elimination was used to analyze significant factors to identify covariates significantly associated with the outcomes. Results Of the 300 patients screened for study inclusion, 204 patients whose records had complete MPR and PDC data and 164 whose records had TTT data were included in the analysis. There were significant between-group differences in mean MPR and mean PDC with patient use of the HSSP vs external pharmacies (1.00 vs 0.75 [P < 0.001] and 0.95 vs 0.7 [P < 0.001], respectively). Pharmacy type (P = 0.024) and tumor type (P = 0.048) were significantly associated with TTT. Conclusion The multiple regression analysis indicated that oncology patients who filled their anticancer medication precriptions at an internal HSSP at an academic medical center had significantly higher adherence, as measured by MPR and PDC, and quicker TTT than those who filled their prescriptions at an external specialty pharmacy.

Abstract 227: Cover Up- It's a Code Blue: Protecting Staff without Compromising Patient Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Shae Saint Amour ◽  
Brigid Kiley ◽  
Matthew DeMarco ◽  
Jane Sederstrom ◽  
Ayan Sen ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Easy Access ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Discharge Rates ◽  
Safety Officer ◽  
Get With The Guidelines ◽  
And Control

Introduction: During the COVID-19 pandemic, hospitals across the globe have been challenged with following the chain of survival with Get With The Guidelines (GWTG) metrics of time to epinephrine, CPR and early defibrillation while ensuring resuscitation teams are protected with recommended PPE. Healthcare organizations are seeking innovative processes to implement PPE during resuscitation events (codes) while maintaining a timely response. Hypothesis: Utilization of for PPE for Airborne Precautions for all resuscitation events can be achieved without compromising patient outcomes or GWTG metrics. Methods: In collaboration with Infection Prevention and Control (IPAC), the Resuscitation Subcommittee at an academic medical center developed a modified airborne PPE workflow for both inpatient and outpatient resuscitation events. For staff safety, all patients are considered as COVID-19 positive during a code response. Identifying timely donning and doffing techniques of PPE as paramount for maintaining GWTG metrics, a Safety Officer was implemented as an additional member of the code team. The role of the Safety Officer is to assist with the PPE process and to monitor code team compliance. Other measures implemented included attaching PPE supply bags to all code carts for easy access, adding viral filters on the bag valve masks, conducting educational mock code events, and providing online resources for staff. To measure process outcomes, pre COVID-19 pandemic GWTG metrics, mortality, and survival to discharge rates were compared with COVID-19 metrics utilizing the modified airborne PPE workflow. Conclusions: Despite additional use of PPE, the hospital has maintained patient outcomes and adhered to the GWTG resuscitation measures of time to epinephrine, CPR and defibrillation while ensuring the utmost safety of the code team during the COVID-19 pandemic. Table 1: GWTG-Award Measures *Preliminary Results

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.

scholarly journals Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control

2019 ◽  
Vol 69 (Supplement_3) ◽  
pp. S178-S184 ◽  
Author(s):  
Linh T Phan ◽  
Dayana Maita ◽  
Donna C Mortiz ◽  
Susan C Bleasdale ◽  
Rachael M Jones
Keyword(s):  
Healthcare Workers ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infection Prevention And Control ◽  
Job Roles ◽  
Respiratory Therapists ◽  
Contact Patterns ◽  
Environmental Surfaces ◽  
Viral Respiratory Infections

Abstract Background Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites. Methods Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists. Results The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs’ self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (P < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (P < .05). Conclusions HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.

scholarly journals Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy

2019 ◽  
Vol 54 (3) ◽  
pp. 170-174
Author(s):  
Brian L. Erstad ◽  
Tina Aramaki ◽  
Kurt Weibel
Keyword(s):  
Health System ◽  
Health Systems ◽  
Integration Method ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Faculty Members ◽  
Pharmacy Services ◽  
Academic Medical ◽  
High Level

Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in the process of undergoing integration. Method: This report describes the merger of an academic medical center and large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college of pharmacy and a health system’s pharmacy services. Results: Overarching pharmacy issues to consider include having an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research, and clinical service activities, having focused discussions between college and health system pharmacy administrators on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical faculty members affected by the merger. Conclusion: The integration of a college of pharmacy and a large health system during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and post-merger discussions between college and health system pharmacy administrators that include a strategic planning component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial collaboration.

Assessing the Educational Efficacy of the Patient Pamphlet, Treatment Options for Avascular Necrosis of the Hip

2014 ◽  
Vol 7 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Michelle J. Lespasio ◽  
Anthony J. Guarino
Keyword(s):  
Avascular Necrosis ◽  
Domain Knowledge ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Racial Diversity ◽  
Basic Knowledge ◽  
Mixed Analysis ◽  
Academic Medical ◽  
Educational Efficacy

The primary purpose of this study was to assess the educational efficacy of the pamphlet Treatment Options for Avascular Necrosis of the Hip for patients with avascular necrosis (AVN). This pamphlet was designed to provide patients with information on 3 domains: (a) basic knowledge of AVN, (b) understanding of the risk factors associated with AVN, and (c) awareness of current AVN treatment options. The sample was composed of 20 AVN patients reflecting the racial diversity of the Eastern urban academic medical center. Fourteen (70%) of the patients were aware of their AVN diagnosis, and 13 (65%) reported of having conducted research on AVN. Prior to the presentation of the pamphlet, the AVN Assessment Inventory, a 13-item true/false test assessing the three domains, was answered by the patients (see Appendix A). The principal investigator presented to the sample the educational pamphlet for their review and the AVN Assessment Inventory for their answers once again. Results of the 2 (Time: pre/post) × 3 (Domain: knowledge, risks, treatment) × 2 (Diagnosed: yes/no) × 2 (Prior research: yes/no) mixed analysis of variance (ANOVA) supported the educational efficacy of the patient pamphlet Treatment Options for Avascular Necrosis of the Hip. Implications of this study are discussed.

scholarly journals 327. Assessment of Bacterial Co-infection Rates and Antibiotic Exposure in COVID-19 Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S269-S269
Author(s):  
Adam J Luetkemeyer ◽  
Nick Bennett ◽  
Laura Aragon ◽  
Jeannette Ploetz ◽  
Sarah E Boyd
Keyword(s):  
Health System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Infection Rates ◽  
Targeted Interventions ◽  
Days Of Therapy ◽  
Secondary Outcomes ◽  
Length Of Therapy

Abstract Background COVID-19 pandemic data suggest risk for bacterial co-infection upon hospital presentation remain extremely low. Despite low co-infection rates, antibiotics are prescribed for most patients. Current data are limited regarding institutional-specific change in antibiotic use over the course of the pandemic. Given the low rates of co-infections, Saint Luke’s Health System’s COVID-19 Treatment Taskforce developed a COVID-19 evaluation and treatment order set which included procalcitonin (PCT) . As co-infection literature emerged, active education was provided, and order sets were modified to provide passive education regarding co-infection rates. We aimed to assess antibiotic practice changes as data and strategies to influence use evolved during the pandemic. Methods This was a multi-center, single health-system retrospective cohort study. Ten community hospitals and 1 academic medical center were included in analysis. Inclusion criteria were age ≥18 years, admitted during April or September 2020 and had a positive COVID-19 result on admission. Patients were excluded if they were readmitted for COVID-19 related issues. Both primary and secondary outcomes were analyzed from the first 7 days after admission. The primary outcome was rate of respiratory bacterial co-infections. This was determined through sputum and blood cultures, urinary antigens including Streptococcus pneumoniae and Legionella, and PCT. Secondary outcomes included rate of antibiotic use, antibiotic days of therapy (DOT), length of therapy, and antibiotic use trends. Baseline Characteristics Results A total of 294 patients were included with 69 patients in April 2020 and 225 in September 2020. Primary and secondary results are shown in Table 2. Rate of culture-confirmed bacterial co-infection when examining April 2020 was 4.38% and 4.44 % in September 2020. Antibiotic uses, antibiotic DOT, and length of therapy were all significantly lower in September 2020 compared to April 2020. Conclusion Our results show bacterial co-infections were extremely low in our health system. Despite positive trends in antibiotic use, prescribing remained high. More targeted interventions to decrease antibiotic exposure in COVID-19 patients are needed. Disclosures All Authors: No reported disclosures

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