The impact of incorporating early rapid influenza diagnosis on hospital occupancy and hospital acquired influenza

2019 ◽  
Vol 40 (8) ◽  
pp. 897-903 ◽  
Author(s):  
Lior Nesher ◽  
Gal Tsaban ◽  
Jacob Dreiher ◽  
Kenneth V.I. Rolston ◽  
Gal Ifergane ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Early Discharge ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Before And After ◽  
Medical Wards ◽  
Hospital Acquired ◽  
Occupancy Rates ◽  
The Impact ◽  
Hospital Occupancy

AbstractObjective:To assess the impact of incorporating early rapid influenza diagnosis on antimicrobial usage, nosocomial influenza transmission, length of stay, and occupancy rates among hospitalized patients.Setting:A 1,100 bed tertiary-care hospital in southern Israel.Methods:We implemented early rapid detection of influenza with immediate communication of results. Using Orion methods, we compared the 2017–2018 influenza season to the prior season in our hospital and to the 2017–2018 occupancy rates at other Israeli hospitals.Results:During the intervention season, 5,006 patients were admitted; 1,824 were tested for influenza, of whom 437 (23.9%) were positive. In the previous season, 4,825 patients were admitted; 1,225 were tested and 288 (23.5%) were positive. Time from admission to test report decreased from 35.5 to 18.4 hours (P < .001). Early discharge rates significantly increased, from 21.5% to 41.6% at 36 hours, from 37.2% to 54.5% at 48 hours, and from 66% to 73.2% at 72 hours. No increase in repeat ER visits, readmission, or mortality rates was observed. Hospital occupancy decreased by 10% compared to the previous year and was 26% lower than the national rate. Hospital-acquired influenza cases were reduced from 37 (11.4%) to 12 (2.7%) (P < .001). Antibiotic usage was reduced both before and after notification of test results by 16% and 12%, respectively.Conclusions:Implementing this intervention led to earlier discharge of patients, lower occupancy in medical wards, reduced antibiotic administration, and fewer hospital-acquired influenza events. This strategy is useful for optimizing hospital resources, and its implementation should be considered for upcoming influenza seasons.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

scholarly journals Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

2019 ◽  
Vol 8 (8) ◽  
pp. 1902
Author(s):  
Sumit Kumar Gupta ◽  
Siddhartha Ghosh
Keyword(s):  
Tertiary Care ◽  
Relevant Information ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Beta Lactam ◽  
Cross Sectional ◽  
Before And After ◽  
Surgery Department

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

scholarly journals The Impact of a Pediatric Antibiotic Standard Dosing Table on Dosing Errors

2013 ◽  
Vol 18 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Mohammed A. Aseeri
Keyword(s):  
Pediatric Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Care Hospital ◽  
Implementation Phase ◽  
Before And After ◽  
The Impact ◽  
Standardization Policy ◽  
Antibiotic Dosing

OBJECTIVE The goal of this study was to compare the rate of dosing errors for antibiotic orders in pediatric patients before and after the implementation of an antibiotic standard dosing table with precalculated dosage for different weight ranges at a tertiary care hospital. METHODS A retrospective study of 300 antibiotic prescriptions for pediatric patients in three different settings (ambulatory care, inpatient, and emergency department) at a tertiary care hospital assessed the appropriateness of antibiotic dosing. The need for an antibiotic dosing standardization policy was identified after finding that more than 30% of patients experienced a dose variation of ±10% of the recommended daily dose. An antibiotic dosing standardization policy was implemented with an antibiotic standard dosing table for different weight ranges, and a hospital wide-education program was conducted to increase awareness of this new practice and its benefits. Three months after implementation, a random sampling of 300 antibiotic prescriptions collected from the same settings as the pre-intervention period was evaluated for compliance with the new policy and its effect on the number of antibiotic dosing errors. RESULTS Six hundred prescriptions were included in this study (300 in the pre-implementation phase and 300 in the post-implementation phase). Patient characteristics were similar in both groups in terms of sex, age, and weight. Physician compliance with the antibiotic dosing standardization policy after its implementation was 62%. The dosing standardization policy reduced the rate of dosing errors from 34.3% to 5.06% (p=0.0001), and weight documentation on the antibiotic prescription improved from 65.8% to 85.7% (p=0.0001). CONCLUSIONS Implementation of an antibiotic dosing standardization policy significantly reduced the incidence of dosing errors in antibiotics prescribed for pediatric patients in our hospital.

The Impact of Hospital Accreditation on the Patients Satisfaction of Haemodialysis Department Services

2018 ◽  
Vol 6 (8) ◽  
pp. 384
Author(s):  
Zuber Mujeeb Shaikh
Keyword(s):  
Patient Satisfaction ◽  
Health Care Quality ◽  
Tertiary Care ◽  
Care Quality ◽  
Care Hospital ◽  
Significant Difference ◽  
Before And After ◽  
The Impact ◽  
Survey Questionnaires

The quality of hospital Haemodialysis Department Service is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. Objectives: To study the impact of National Accreditation Board for Hospitals & Healthcare Providers (NABH) Accreditation, India on Haemodialysis Department Service patient satisfaction. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital at Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower patient satisfaction rate of the hospital Haemodialysis Department Services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (Ho) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question in the questionnaire. Study Design: The closed ended questionnaire was developed considering the Haemodialysis Department Services and incorporated the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients' families for completion upon using the Haemodialysis Department Services two months before and two months after the accreditation. The data were collected in order to cover all three shifts of the Haemodialysis Department Services. Study Population: Simple random sampling method was selected, the researcher had involved all conscious patients (clinical conditions) from all age groups. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: At the 5 % level of significance, the t-test results indicate that there is a significant difference in the responses between before (M=51.11, SD=21.89) and after accreditation (M=58.56, SD=17.28) with p-value <0.001. The mean satisfaction score has improved from before accreditation compared to after accreditation.

The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital

2018 ◽  
Vol 40 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Timothy D. MacLaggan ◽  
Christopher P. Le ◽  
Kristen A. Iverson ◽  
Chelsey L. Ellis ◽  
Jacques Allard ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Chart Review ◽  
Tertiary Care ◽  
Audit And Feedback ◽  
Dramatic Improvement ◽  
Care Hospital ◽  
Before And After ◽  
The Impact

AbstractObjectiveThe aim of this study was to assess the impact of a urinary tract infection (UTI) management bundle to reduce the treatment of asymptomatic bacteriuria (AB) and to improve the management of symptomatic UTIs.DesignBefore-and-after intervention study.SettingsTertiary-care hospital.PatientsConsecutive sample of inpatients with positive single or mixed-predominant urine cultures collected and reported while admitted to the hospital.MethodsThe UTI management bundle consisted of nursing and prescriber education, modification of the reporting of positive urine cultures, and pharmacists’ prospective audit and feedback. A retrospective chart review of consecutive inpatients with positive urinary cultures was performed before and after implementation of the management bundle.ResultsPrior to the implementation of the management bundle, 276 patients were eligible criteria for chart review. Of these 276 patients, 165 (59·8%) were found to have AB; of these 165 patients with AB, 111 (67·3%) were treated with antimicrobials. Moreover, 268 patients met eligibility criteria for postintervention review. Of these 268, 133 patients (49·6%) were found to have AB; of these 133 with AB, 22 (16·5%) were treated with antimicrobials. Thus, a 75·5% reduction of AB treatment was achieved. Educational components of the bundle resulted in a substantial decrease in nonphysician-directed urine sample submission. Adherence to a UTI management algorithm improved substantially in the intervention period, with a notable decrease in fluoroquinolone prescription for empiric UTI treatment.ConclusionsA UTI management bundle resulted in a dramatic improvement in the management of urinary tract infection, particularly a reduction in the treatment of AB and improved management of symptomatic UTI.

The Impact of Hospital Accreditation on the Patient Satisfaction of In-Patient Department Services

2018 ◽  
Vol 6 (8) ◽  
pp. 368
Author(s):  
Zuber Mujeeb Shaikh
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Care Delivery ◽  
Tertiary Care ◽  
Care Hospital ◽  
Significant Difference ◽  
Before And After ◽  
The Impact ◽  
Survey Questionnaires ◽  
Patient Department

Patient satisfaction is as important as other clinical health measures and is a chief means of assessing the strength of health care delivery. The current competitive environment has driven health care organisations to concentrate on patient satisfaction as a means to acquire and keep market share. If you don’t recognise what your strengths and weaknesses are, you can’t compete effectively. Objectives: To study the impact of National Accreditation Board for Hospitals & Healthcare Providers (NABH) Accreditation, India on the patient satisfaction of In-Patient Department Services. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital in Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower satisfaction rate in in-patient department services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (H0) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question of the questionnaire. Study Design: The closed ended questionnaire was developed considering the in-patient services process by incorporating the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients for completion upon discharge two months before and two months after the accreditation. Study Population: Simple random sampling method was selected, and the researcher had involved conscious patients of all age groups and gender. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: It is very evident from this research that at the 5 % level of significance, the chi-square test indicates that there is a significant difference in the satisfaction with respect to the overall experience in the hospital between before the accreditation group and after accreditation group with p-value <0.001.The responses of satisfaction has improved from N=421 (Satisfied=245, Highly satisfied= 176) from N=241 (Satisfied = 124, Highly satisfied= 117).

scholarly journals The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Viktoria Jungreithmayr ◽  
Andreas D. Meid ◽  
Janina Bittmann ◽  
Markus Fabian ◽  
Ulrike Klein ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Multivariable Analysis ◽  
Computerized Physician Order Entry ◽  
Care Hospital ◽  
Order Entry ◽  
Significant Difference ◽  
Before And After ◽  
Physician Order Entry ◽  
The Impact

Abstract Background The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital. Methods In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-Fscores) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-Fscores). Results The overall mean prescription-Fscore increased from 57.4% ± 12.0% (n = 1850 prescriptions) before to 89.8% ± 7.2% (n = 1592 prescriptions) after the implementation (p < 0.001). At the level of individual criteria, criteria-Fscores significantly improved in most criteria (n = 14), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-Fscores deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-Fscores which was consistent when adjusting for the confounding potential of further covariates. Conclusions While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes.

scholarly journals Latent vestibular dysfunction and its effect on quality of life in elderly individuals, the need of active screening and intervention

2018 ◽  
Vol 4 (5) ◽  
pp. 1258
Author(s):  
Himanshu Swami ◽  
Aravind B. M.
Keyword(s):  
Quality Of Life ◽  
Tertiary Care ◽  
The Elderly ◽  
Vestibular Dysfunction ◽  
Care Hospital ◽  
Dizziness Handicap Inventory ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

<p class="abstract"><strong>Background:</strong> Dizziness is a commonly reported complaint among elderly.. Among the elderly in particular, factors such as Ageing, presbycusis, diabetes, chronic kidney disease, osteopenia, and osteoporosis increase the risk. Dizziness handicap inventory is used to assess the quality of life among the individuals with vestibular dysfunction. This is also used to assess the impact of interventions for vestibular dysfunction. This study aims to estimate the prevalence of latent vestibular dysfunction among the Indian population, and the impact of interventions among the same.</p><p class="abstract"><strong>Methods:</strong> A prospective observational study was conducted at a tertiary care hospital. As per sample size estimates, 200 participants aged &gt;60 years without previous diagnosis of vestibular dysfunction were screened using appropriate tests. The quality of life of the affected individuals were assessed using Dizziness Handicap Inventory Score (DHIS) before and after intervention.  </p><p class="abstract"><strong>Results:</strong> The prevalence of latent vestibular dysfunction was found to be 23.5%. Most of them reported having moderate handicap due to the condition. Following intervention, those with moderate handicap either became normal (47.8%) or had residual mild handicap (52.2%). The mean DHIS score significantly decreased from 40.91 points during pre-intervention to 16.12 points post-intervention.</p><p class="abstract"><strong>Conclusions:</strong> Around one-fourth of the Indian elderly is found to have latent vestibular dysfunction. It has a major impact on the individual’s quality of life. Yet, screening and intervention is found to make a considerable improvement among the affected individuals.</p>

scholarly journals High cost burden and health consequences of antibiotic resistance: the price to pay

2014 ◽  
Vol 8 (09) ◽  
pp. 1096-1102 ◽  
Author(s):  
Sujith J Chandy ◽  
Girish S Naik ◽  
Veeraraghavan Balaji ◽  
Visalakshi Jeyaseelan ◽  
Kurien Thomas ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Tertiary Care ◽  
Cost Of Care ◽  
Care Hospital ◽  
Health Consequences ◽  
Suspected Sepsis ◽  
Exact Test ◽  
Median Difference ◽  
Medical Wards ◽  
The Impact

Introduction: Rising antibiotic resistance may negatively affect the health and cost of care for patients. This study aimed to determine the impact of antibiotic resistance on costs and health consequences for patients. Methodology:  A one-year observational study was conducted at Christian Medical College, Vellore, a tertiary care hospital, on patients admitted into medical wards with a preliminary diagnosis of suspected sepsis. Patients with confirmed bacteremia were analysed in two groups – resistant and susceptible – based on susceptibility of causative bacteria to the empiric antibiotics administered. Clinical data and details about costs incurred were collected from hospital records. Costs and health consequences were compared using Mann-Whitney U test and Fisher’s exact test. For median difference in costs, 95% bootstrap confidence interval was determined. Results: Overall, 220 patients were included. The median difference between resistant and susceptible groups in overall costs, antibiotic costs, and pharmacy costs was rupees (INR)/USD 41,993/700 (p = 0.001), 8,315/139 (p < 0.001) and 21,492/358 (p < 0.001), respectively. Health consequences such as intensive care admissions, complications, mortality, and length of stay were significantly higher in the resistant group as compared to susceptible group: 44% vs. 21% (p < 0.001), 56% vs. 37% (p = 0.006), 12% vs. 2% (p = 0.011), and 14 vs. 11 days (p = 0·027), respectively. Conclusions: Antibiotic resistance has a significant impact on cost and health consequences. These findings provide a key message for policymakers and other stakeholders to initiate feasible strategies to tackle resistance and reduce the burden.

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