scholarly journals Do Experts Understand Performance Measures? A Mixed-Methods Study of Infection Preventionists

2017 ◽  
Vol 39 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Sushant Govindan ◽  
Beth Wallace ◽  
Theodore J. Iwashyna ◽  
Vineet Chopra
Keyword(s):  
Central Line ◽  
Research Network ◽  
Quality Data ◽  
Expert Performance ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Percent Correct ◽  
Average Proportion ◽  
Healthcare Epidemiology ◽  
Data Design

OBJECTIVECentral line-associated bloodstream infection (CLABSI) is associated with significant morbidity and mortality. Despite a nationwide decline in CLABSI rates, individual hospital success in preventing CLABSI is variable. Difficulty in interpreting and applying complex CLABSI metrics may explain this problem. Therefore, we assessed expert interpretation of CLABSI quality data. DESIGN. Cross-sectional survey PARTICIPANTS. Members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) METHODS. We administered a 10-item test of CLABSI data comprehension. The primary outcome was percent correct of attempted questions pertaining to the CLABSI data. We also assessed expert perceptions of CLABSI reporting.RESULTSThe response rate was 51% (n=67).Among experts, the average proportion of correct responses was 73% (95% confidence interval [CI], 69%–77%). Expert performance on unadjusted data was significantly better than risk-adjusted data (86% [95% CI, 81%–90%] vs 65% [95% CI, 60%–70%];P<.001). Using a scale of 1 to 100 (0, never reliable; 100, always reliable), experts rated the reliability of CLABSI data as 61. Perceived reliability showed a significant inverse relationship with performance (r=–0.28;P=.03), and as interpretation of data improved, perceptions regarding reliability of those data decreased. Experts identified concerns regarding understanding and applying CLABSI definitions as barriers to care.CONCLUSIONSSignificant variability in the interpretation of CLABSI data exists among experts. This finding is likely related to data complexity, particularly with respect to risk-adjusted data. Improvements appear necessary in data sharing and public policy efforts to account for this complexity.Infect Control Hosp Epidemiol2018;39:71–76

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals Hospital epidemiologists’ and infection preventionists’ opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric

2019 ◽  
Vol 40 (05) ◽  
pp. 536-540 ◽  
Author(s):  
Raymund B. Dantes ◽  
Lilian M. Abbo ◽  
Deverick Anderson ◽  
Lisa Hall ◽  
Jennifer H. Han ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Research Network ◽  
Healthcare Associated Infection ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Abdominal Infections ◽  
Healthcare Associated

AbstractObjective:To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care.Design:Cross-sectional survey.Participants:Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.Methods:A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals.Results:A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital’s quality of care. Also, 29% of respondents’ hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line–associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone.Conclusions:Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.

Variation in Definitions and Isolation Procedures for Multidrug-Resistant Gram-Negative Bacteria: A Survey of the Society for Healthcare Epidemiology of America Research Network

2014 ◽  
Vol 35 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Marci Drees ◽  
Lisa Pineles ◽  
Anthony D. Harris ◽  
Daniel J. Morgan
Keyword(s):  
Infection Control ◽  
Online Survey ◽  
Multidrug Resistant ◽  
Research Network ◽  
Gram Negative Bacteria ◽  
Emerging Pathogens ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Gram Negative ◽  
Healthcare Epidemiology

Objective.To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.Design.Cross-sectional survey.Participants.US and international members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.Methods.Online survey that included definitions, infection control procedures, and microbiology capability related to MDR-GNB and other MDR bacteria.Results.From November 2012 through February 2013, 66 of 170 SHEA Research Network members responded (39% response rate), representing 26 states and 15 countries. More than 80% of facilities reported experience with each MDR-GNB isolate, and 78% had encountered GNB resistant to all antibiotics except colistin (62% Acinetobacter, 59% Pseudomonas, and 52% Enterobacteriaceae species). Participants varied regarding their definitions of “multidrug resistant,” with 14 unique definitions for Acinetobacter, 18 for Pseudomonas, and 22 for Enterobacteriaceae species. Substantial variation also existed in isolation practices. Although isolation was commonly used for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE), approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter. The majority of those that isolated MDR organisms also removed isolation using a wide variety of criteria.Conclusion.Facilities vary significantly in their approach to preventing MDR-GNB transmission. Although practices for MRSA and VRE are relatively standardized, emerging pathogens CRE and other MDR-GNB have highly varied definitions and management. This confusion makes communication difficult, and varied use of isolation may contribute to emergence of these organisms. Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of MDR-GNB.

Australian osteopaths as non-medical prescribers: comparison of healthcare practitioner characteristics from a nationally representative survey

2020 ◽  
Vol 26 (5) ◽  
pp. 417
Author(s):  
Brett Vaughan ◽  
Michael Fleischmann ◽  
Kylie Fitzgerald ◽  
Sandra Grace ◽  
Paul Orrock ◽  
...  
Keyword(s):  
Diagnostic Imaging ◽  
Patient Management ◽  
Secondary Analysis ◽  
Research Network ◽  
Scope Of Practice ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Future ◽  
Practice Based Research ◽  
Nationally Representative

The study aimed to compare the characteristics of Australian osteopaths who definitely agree that prescribing scheduled medicines is part of their future scope of practice with those who do not. A secondary analysis of a cross-sectional survey of osteopaths from an Australian practice-based research network was undertaken. Demographic, practice and treatment characteristics were identified using inferential statistics and backward linear regression modelling. Over one-quarter (n=257, 25.9%) of the total participants (n=992) indicated that they ‘definitely’ agree that osteopaths should seek prescription rights. Adjusted odds ratios (OR) suggested these osteopaths were more likely to engage in medication discussions with patients (OR 1.88), frequently manage migraines (OR 1.68) and seek increased practice rights for referrals to medical specialists (OR 2.61) and diagnostic imaging (OR 2.79). Prescribing as part of the future scope of practice for Australian osteopaths is associated with patient management (medication discussions) and practice characteristics (increased referral rights for specialists and diagnostic imaging) that warrant additional investigation. Understanding of the practice, clinical and patient management characteristics of Australian osteopaths who see prescribing as part of the future scope of practice informs the case for regulatory and health policy changes for prescribing scheduled medicines.

Intensity and treatment of symptoms in 3,030 palliative care patients: A cross-sectional survey of the EAPC Research Network

2018 ◽  
Vol 5 (1) ◽  
pp. 11 ◽  
Author(s):  
Eivor Alette Laugsand, PhD-student ◽  
Stein Kaasa, MD ◽  
Franco De Conno, MD ◽  
Geoffrey Hanks, MD ◽  
Pål Klepstad, MD
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Specific Treatment ◽  
Research Network ◽  
Poor Sleep ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Symptom Intensity ◽  
Who Pain Ladder ◽  
Prescription Practice

Objective: This study aimed to describe intensity and treatment of symptoms other than pain in European palliative care units.Patients: A total of 3,030 patients, including 2,064 that used an opioid, were included from 143 palliative care centers, in 21 European countries.Results: Pain was treated with analgesics corresponding to the WHO pain ladder step I (n = 374), II (n = 497), and III (n = 1,567). Frequencies of symptoms observed as moderate or severe were for generalized weakness (50 percent), fatigue (48 percent), anxiety (28 percent), anorexia (26 percent), constipation (18 percent), focal weakness (18 percent), depression (18 percent), and dyspnoea (15 percent). When comparing WHO-groups, cancer diagnoses, metastasis sites, countries, and genders, we found that some of the symptom intensities and treatments differed significantly between subgroups. A majority of patients used drugs for symptom management. Still, more than one-third of patients assessed to have moderate or severe constipation did not receive any treatment. The corresponding numbers for depression, confusion, nausea, vomiting, or anxiety were approaching 40 percent and for poor sleep about 50 percent. Prescription practice of antiemetics, laxatives, and psychotropic drugs varied widely between countries both in terms of preparation and percent of patients receiving a specific treatment.Conclusions: This survey shows that clinically relevant symptoms are frequent and that one-third to half of the patients with a symptom observed as moderate or severe do not receive any treatment aimed to reduce the symptom intensity. Several symptoms and treatments differed between WHO-groups, cancer diagnoses, metastasis locations, countries, and genders. Prescription practice varied between countries both in terms of medication administered and percent of patients receiving specific treatment.

Practices to Improve Antimicrobial Use at 47 US Hospitals the Status of the 1997 SHEA/IDSA Position Paper Recommendations

2000 ◽  
Vol 21 (4) ◽  
pp. 256-259 ◽  
Author(s):  
Rachel M. Lawton ◽  
Scott K. Fridkin ◽  
Robert P. Gaynes ◽  
John E. McGowan ◽  
Keyword(s):  
Infectious Disease ◽  
Position Paper ◽  
Antimicrobial Use ◽  
Cross Sectional Survey ◽  
Phase 3 ◽  
Infectious Disease Physician ◽  
Cross Sectional ◽  
Antimicrobial Prescribing ◽  
The Status ◽  
Healthcare Epidemiology

Objective.To determine the status of programs to improve antimicrobial prescribing at select US hospitals.Design:Cross-sectional survey.Participants and Setting:Pharmacy and infection control staff at all 47 hospitals participating in phase 3 of Project Intensive Care Antimicrobial Resistance Epidemiology.Results:All 47 hospitals had some programs to improve antimicrobial use, but the practices reported varied considerably. All used a formulary, and 43 (91%) used it in conjunction with at least one of the other three antimicrobial-use policies evaluated: stop orders, restriction, and criteria-based clinical practice guidelines (CPGs). CPGs were reported most commonly (70%), followed by stop orders (60%) and restriction policies (40%). Although consultation with an infectious disease physician (70%) or pharmacist (66%) was commonly used to influence initial antimicrobial choice, few (40%) reported a system to measure compliance with these consultations.Conclusions:In most hospitals surveyed, practices to improve antimicrobial use, although present, were inadequate based on recommendations in a Society for Healthcare Epidemiology of America and Infectious Disease Society of America joint position paper. There is room to improve antimicrobial-use stewardship at US hospitals.

scholarly journals Endoscopists attitudes on the publication of "quality" data for endoscopic procedures: a cross-sectional survey

2007 ◽  
Vol 7 (1) ◽  
Author(s):  
Sarah A Hearnshaw ◽  
Helena M Maddock ◽  
David Nylander ◽  
Martin I Prince
Keyword(s):  
Quality Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Endoscopic Procedures

Pharmacists' roles in oncology pharmacy services: Results of a global survey

2016 ◽  
Vol 23 (3) ◽  
pp. 185-194 ◽  
Author(s):  
Lisa M Holle ◽  
Christy S Harris ◽  
Alexandre Chan ◽  
Rebecca J Fahrenbruch ◽  
Bonnie A Labdi ◽  
...  
Keyword(s):  
Oral Chemotherapy ◽  
Research Network ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Survey Tool ◽  
Medication Therapy ◽  
Education Of Patients ◽  
Level Of Training ◽  
Oncology Practice ◽  
The Impact

Background Oncology pharmacists are capable of providing medication therapy management (MTM) because of their level of training, practice experiences, and responsibilities. Very little data exist about their current practice, including changing roles in the multidisciplinary team, overall impact, and effects in the education of patients and healthcare professionals. Methods A 70-item survey about oncology pharmacists' activities in oral chemotherapy programs, MTM, and collaborative practice agreements (CPAs) was deployed using a web survey tool (Qualtrics, Provo, UT, USA), targeting pharmacist members of American College of Clinical Pharmacy (ACCP) Hematology/Oncology Practice and Research Network (PRN). The objective of this study was to determine oncology pharmacists' activities in areas of oral chemotherapy programs, MTM, and CPAs. A cross-sectional survey was distributed to the ACCP Hematology/Oncology PRN membership. Investigational Review Board approval was obtained. Results Of the 795 members who were sent the survey, 81 members (10%) responded; 33 respondents (47%) are involved with an oral chemotherapy program; with 42% measuring outcomes of programs. Only six pharmacists (19%) have published or presented their data. A total of 28 (35%) respondents provide MTM services, with almost half (43%) of these MTM services being dictated by CPAs. A small fraction of these pharmacists (21.4%) reported conducting quality assurance evaluations of their MTM services and three pharmacists (10.7%) reported publishing their results. Those pharmacists practicing under CPAs ( n = 28) were surveyed as to activities included in their CPA. The most common activities included adjusting medication, ordering, interpreting, and monitoring lab tests, developing therapeutic plans and educating patients. Reimbursement for providing these services was uncommon: MTM (4%), oral chemotherapy program (6%), and CPA services (11%). Reported obstacles to reimbursement included lack of understanding, administrative assistance, or time with setting up reimbursement models within the institution. Conclusion Many oncology pharmacists are participating in oral chemotherapy programs, MTM, and/or CPAs and perceived barriers were identified. Increased efforts should be directed toward prospectively reporting and assessing the impact these services have on patient care.

scholarly journals 1980. Variability in Antifungal Stewardship Strategies Among Society for Healthcare Epidemiology of America (SHEA) Research Network Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S662-S663
Author(s):  
Margaret A Fitzpatrick ◽  
Fritzie S Albarillo ◽  
Aaron Ochoa ◽  
Katie J Suda ◽  
Charlesnika T Evans
Keyword(s):  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Organ Transplant ◽  
Audit And Feedback ◽  
Research Network ◽  
Solid Organ ◽  
Antifungal Stewardship ◽  
Cross Sectional ◽  
Diverse Range ◽  
Healthcare Epidemiology

Abstract Background The incidence of invasive fungal infections (IFI) and antifungal utilization is increasing in many healthcare settings. Little is known regarding antifungal stewardship strategies within broader antimicrobial stewardship programs (ASPs). This survey aimed to identify the use of antifungal stewardship at a diverse range of hospitals. Methods A cross-sectional electronic survey of the SHEA Research Network (SRN) was completed August–September 2018 by a physician or pharmacist ASP leader. The SRN is a consortium of >100 hospitals participating in multicenter healthcare epidemiology research projects. Survey questions pertained to various aspects of antifungal stewardship, including audit and feedback, laboratory testing, and surveillance. Chi-square tested associations between ASP and hospital characteristics and use of antifungal stewardship strategies. Results 45/111 (41%) facilities responded, including 10 international sites. Most facilities are academic medical centers (64.6%) and care for stem cell (73.3%) and solid-organ transplant (80.0%) patients. Most facilities have large, well established ASPs (60.0% > 5 members; 68.9% duration ≥6 years). 43 (95.6%) facilities use antifungal stewardship strategies in their ASP; most commonly prospective audit and feedback (33/43, 73.3%) performed by a pharmacist (23/33, 71.4%). Only half of ASPs (51.1%) create guidelines for IFI management. Most (71.1%) facilities offer rapid laboratory tests to diagnose IFI, but availability of PCR for fungal speciation and antifungal susceptibility testing varies (Figure 1). 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31.0%) report data to CDC’s National Healthcare Safety Network (NHSN). ASP size, ASP duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > 0.05 for all). Conclusion Use of antifungal stewardship strategies is high at SRN hospitals, but mainly involves audit and feedback. ASPs should be encouraged to disseminate guidelines for IFI management, to promote access to laboratory-based tests for rapid and accurate IFI diagnosis, and to perform surveillance for antifungal utilization with data reporting to NHSN. Disclosures All authors: No reported disclosures.

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