scholarly journals The Impact of a Best-Practice Advisory on Inpatient Use of Piperacillin-Tazobactam

2020 ◽  
Vol 41 (S1) ◽  
pp. s406-s407
Author(s):  
Katherine Peterson ◽  
Lindsay Smith ◽  
John Ahern ◽  
Bradley Tompkins
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Significant Rise ◽  
Defined Daily Dose ◽  
Interrupted Time Series Analysis ◽  
Prescribing Trends ◽  
Significant Difference ◽  
Practice Advisory ◽  
The University ◽  
The Impact

Background: Antibiotic “time outs” have been identified as a way to decrease inappropriate use of antibiotics in hospitals.1 The University of Vermont Medical Center created a best-practice advisory (BPA) to alert clinicians to review piperacillin-tazobactam prescriptions after 72 hours (Fig. 1). Data examining the use of a BPA as a method to prompt clinicians to perform an antibiotic “time out” are limited. Objective: The purpose of our retrospective study was to evaluate the effectiveness of the BPA on the rate of piperacillin-tazobactam prescribing as measured by defined daily dose per 1,000 patient days (DDD). Methods: The BPA was integrated into the electronic health record and designed to activate once piperacillin-tazobactam has been prescribed for ≥72 hours. Under approval of the University of Vermont’s Institutional Review Board, administered data for piperacillin-tazobactam and 3 control antibiotics (cefazolin, ceftriaxone, and meropenem) were collected for 1 year prior to and 1 year following the launch of the BPA. Administered data were converted to DDD, and an interrupted time-series analysis was performed to evaluate for changes in antibiotic use. Results: The data included 7,094 patients in the preintervention group and 6,661 patients in the postintervention group. The BPA fired 1,478 times. The prescribing rate of piperacillin-tazobactam 1 year prior to the BPA was 32.34 DDD and decreased every month both before (−1.22 DDD) and after (−0.27 DDD) the BPA initiation, with no significant difference in prescribing trends (P = .10). Meropenem prescribing in the BPA era increased each month compared to the pre-BPA period (1.16 DDD; P = 0.02), whereas cefazolin use (P = .93) and ceftriaxone (P = .09) use did not significantly change. Conclusions: The data show that piperacillin-tazobactam utilization at our institution is decreasing. Considering that this trend started prior to the launch of the BPA and that rate of decline remained unchanged post-BPA, we conclude that the BPA did not further impact our piperacillin-tazobactam consumption. It is possible that other factors influencing prescribing account for the observed decline, including an institution-wide educational campaign regarding the appropriate use of broad-spectrum antibiotics that was initiated in the months prior to the BPA. The reason for the significant rise in meropenem post-BPA is unclear. This may be unrelated to the BPA; however, it requires further investigation.1. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibioticuse/healthcare/implementation/core-elements.html. Updated July 19, 2019. Accessed October 6, 2019.Funding: NoneDisclosures: None

scholarly journals Impact of the Sequence of Norepinephrine and Vasopressin Discontinuation in Patients Recovering From Septic Shock

2018 ◽  
Vol 55 (1) ◽  
pp. 26-31
Author(s):  
Benjamin E. Bredhold ◽  
Shauna D. Winters ◽  
John C. Callison ◽  
Robert E. Heidel ◽  
Lauren M. Allen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Medical Condition ◽  
Medical Center ◽  
Secondary Outcome ◽  
University Of Tennessee ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
The University ◽  
The Impact

Background: Septic shock is a serious medical condition affecting millions of people each year and guidelines direct vasopressor use in these patients. However, there is little information as to which vasopressor should be discontinued first. Objective: The objective of this study was to assess the impact of the sequence of norepinephrine and vasopressin discontinuation on intensive care unit (ICU) length of stay. Methods: This was a single-center retrospective cohort study conducted at The University of Tennessee Medical Center in Knoxville, Tennessee. Patients included in this study were adults 18 years of age and older with a diagnosis of septic shock who received norepinephrine in combination with vasopressin. Patients were excluded if norepinephrine or vasopressin were not the last 2 vasoactive agents used or if the patient expired or care was withdrawn. Measurements and Main Results: A total of 86 patients were included in this study, with 34 patients in the norepinephrine discontinued first group (NDF) and 52 in the vasopressin discontinued first group (VDF). For the primary outcome of ICU length of stay, no statistically significant difference was found between the NDF and the VDF groups (9.38 days vs 11.07 days, P = .313). The secondary outcome of the dose of norepinephrine at which vasopressin was initiated was also found to not be significant between the NDF and VDF groups (22 µg/min vs 31.1 µg/min, P = .11). The rates of hypotension within 24 hours of discontinuation of the first agent were also not significant between the NDF and VDF groups (17% vs 31%, P = .38). Conclusions: Based on the results of this study, there was significant no difference in ICU length of stay based on the sequence of discontinuation between norepinephrine and vasopressin in patients recovering from septic shock.

scholarly journals Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach

2021 ◽  
pp. jech-2021-216732
Author(s):  
Marta Estrela ◽  
Tânia Magalhães Silva ◽  
Eva Rebelo Gomes ◽  
Maria Piñeiro ◽  
Adolfo Figueiras ◽  
...  
Keyword(s):  
Mental Health ◽  
Time Series ◽  
Elderly Women ◽  
Health Sector ◽  
Interrupted Time Series ◽  
Defined Daily Dose ◽  
Prescription Data ◽  
Interrupted Time Series Analysis ◽  
Prescribing Trends ◽  
The Impact

BackgroundThe COVID-19 pandemic has had a significant impact on the population’s mental health. However, its impact on the consumption of anxiolytics, sedatives, hypnotics and antidepressants remains to be evaluated. Hence, this article aims to assess the prescription trends of these drugs in Portugal, from January 2018 to March 2021, while critically examining whether the COVID-19 pandemic had an impact on these prescription trends or not.MethodsA nationwide interrupted time-series analysis of the prescription data of anxiolytics, sedatives, hypnotics and antidepressants in outpatient setting of the public health sector was conducted. The data encompassed the defined daily dose per month, age range and sex and were analysed following a segmented regression approach.ResultsThe pandemic preceded an immediate reduction in the prescription of anxiolytics, sedatives and hypnotics for children and adolescents. However, an increasing trend throughout the pandemic has been noted in the prescription of these drugs, especially among adults aged 65 years or above. A drop in antidepressant prescription was observed as an immediate effect of the pandemic among male and female adolescents and elderly women. From March 2020 to March 2021, a decreasing prescription trend has been noted among men.ConclusionsWhen analysing specific genders and age ranges, differences can be noted, in terms of both immediate impact and prescribing trends throughout 1 year of the COVID-19 pandemic. The impact of the pandemic on mental health and its association with the consumption trends of psychoactive drugs, and with the access to mental health treatments, should be further assessed.

The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis

2020 ◽  
Vol 16 ◽  
Author(s):  
Diala Alawneh ◽  
Moustafa Younis ◽  
Majdi S. Hamarshi
Keyword(s):  
Diabetic Ketoacidosis ◽  
Best Practice ◽  
Intervention Group ◽  
Post Intervention ◽  
Management Algorithm ◽  
Significant Difference ◽  
Before And After ◽  
Practice Advisory ◽  
The Impact ◽  
Post Intervention Group

Background: According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved. Methods: A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed. Results: A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group 14.8 (±7.7) vs 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3. The incidence of hypoglycemia was lower in the post-intervention group n=4 (3%) vs 17 (10%), p=0.024. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both groups (p>0.05). Conclusions: The BPA introduced in our DKA management algorithm successfully reduced total time on insulin and the incidence of hypoglycemia.

scholarly journals Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

2021 ◽  
Author(s):  
Chang Park ◽  
Kapil Sugand ◽  
Arash Aframian ◽  
Catrin Morgan ◽  
Nadia Pakroo ◽  
...  
Keyword(s):  
Best Practice ◽  
Neck Of Femur ◽  
Health Crisis ◽  
Femur Fractures ◽  
Time Period ◽  
Vulnerable Patients ◽  
Significant Difference ◽  
Usual Residence ◽  
Hip Trauma ◽  
The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

Abstract 102: Adding Computed Tomography Angiography (CTA) to the Acute Stroke Evaluation: A Single-center Experience

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Matthew E Ehrlich ◽  
Heather L Turner ◽  
Lillian J Currie ◽  
Max Wintermark ◽  
Bradford B Worrall ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Medical Center ◽  
Single Center Experience ◽  
Intracranial Vessel ◽  
Vessel Imaging ◽  
Stroke Team ◽  
Significant Difference ◽  
Increase Risk ◽  
Baseline Creatinine ◽  
The University

Objective: To evaluate the safety and utility of CTA acquisition during initial acute stroke evaluation. We hypothesized CTA would not increase risk of renal injury or delay therapy. Design/Methods: We performed a pilot study of CTA acquisition in the acute stroke evaluation at the University of Virginia Medical Center in the first three quarters of 2014. We extracted data from Acute Stroke Team Leader consultations with additional chart review. We collected door-to-CT read times, door-to-needle times, baseline creatinine (Cr) values on presentation, and Cr values 24-48 hours after stroke alert evaluation. Differences in means of these variables were compared between those receiving CTA versus non-contrasted head CT (NCHCT) only. Additionally, we captured CTA results immediately relevant to treatment decisions. Results: Of 289 patients, 157 had CTA completed while 132 had only NCHCT. In the CTA group, 18 patients (11.5%) were treated with IV tissue plasminogen activator (tPA) compared to 11 (8.3%) in the NCHCT group, with no significant difference between groups (p=0.377). There was no difference between mean door-to-CT-read times between the NCHCT (43.07 minutes) and CTA (41.46 minutes) groups (p=0.70). Likewise, there was no significant difference in mean door-to-needle times between the NCHCT (81.36 minutes) and CTA (68.11 minutes) groups (p=0.577). There was a difference between mean Cr values on presentation (1.39mg/dL NCHCT, 1.06mg/dL CTA; p=0.004), but there was no difference between the groups at 24-48 hours (p=0.059) and no difference between the mean change in Cr values (p=0.489). No patients developed a new requirement for hemodialysis. CTA imaging revealed 14 patients with vascular anomalies, and 53 patients with severe stenosis or occlusion of a major cervical or intracranial vessel. One patient in the CTA group and none in the NCHCT group had intravascular intervention. Conclusions: Overall, CTA during acute stroke evaluations were safe and may offer clinical utility, without delaying evaluation or therapy delivery. Additional cost of acute CTA acquisition is negligible given it replaces MRA typically performed later, following admission, as standard vessel imaging. Further prospective study is required.

Facilitating educational opportunities and raised self-esteem in disadvantaged young people in South East Wales: Effects of the Junior Rock Music Academy widening participation programme

2021 ◽  
Vol 5 (1) ◽  
pp. 71-87 ◽  
Author(s):  
Jane Ellis
Keyword(s):  
Young People ◽  
Rock Music ◽  
Age Groups ◽  
Self Esteem ◽  
Significant Rise ◽  
Widening Participation ◽  
Structured Interviews ◽  
Social And Emotional ◽  
Significant Difference ◽  
The Impact

This study examined the effects of the Junior Rock Music Academy (JRMA) on participants’ (N = 39) confidence and self-esteem. The JRMA was a widening participation Saturday music programme developed to reduce the influences of poverty on educational underachievement for young people (10–18 years) from poorer families across South East Wales. Participants’ confidence and self-esteem scores reported a significant rise, with no significant difference reported between genders or age groups. Participants (N = 5), programme tutors (N = 3) and participant parents/guardians (N = 4) were interviewed using semi-structured interviews to establish the fidelity of the structure and content of the intervention. The impact of JRMA on the psychosocial, cultural and emotional characteristics of participants and their parents/guardians as barriers to educational attainment and preparedness to thrive in education are discussed; these include enhanced cognitive development, social and emotional skills and learner motivation.

Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

2019 ◽  
Vol 40 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Charlotte Brewer ◽  
Micah Beachy ◽  
Elizabeth Lyden ◽  
Tammy Winterboer ◽  
...  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Poisson Model ◽  
Panel Testing ◽  
Period 2 ◽  
Gastrointestinal Pathogen ◽  
Pathogen Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design:We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.Setting:Midwest academic medical center.Participants:Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention:A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.Results:During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.Conclusions:A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

The failure of non‐binding declarations to achieve university sustainability

2007 ◽  
Vol 8 (3) ◽  
pp. 301-316 ◽  
Author(s):  
S.A. Bekessy ◽  
K. Samson ◽  
R.E. Clarkson
Keyword(s):  
Best Practice ◽  
Small Scale ◽  
Structured Interviews ◽  
Pilot Studies ◽  
Content Type ◽  
Institute Of Technology ◽  
University Leaders ◽  
The University ◽  
The Impact ◽  
Insight Into

PurposeThis paper aims to assess the impact and value of non‐binding agreements or declarations in achieving sustainability in universities.Design/methodology/approachA case study of Royal Melbourne Institute of Technology (RMIT) University is presented, analysing the reasons for lack of progress towards sustainability and evaluating best ways forward. Using a timeline and analysis of historical records for the 12 years since RMIT first engaged in the sustainability agenda, major trends in the process of implementing policies are identified. Secondly, 15 semi‐structured interviews with university leaders and key sustainability stakeholders from across the university are analysed to provide insight into how and why the university has failed to achieve sustainability.FindingsNew implications for successfully achieving sustainability arise from these findings. Accountability is a key issue, as RMIT appears to reap benefits from being signatory to declarations without achieving genuine progress. To ensure that declarations are more than simply greenwash, universities must open themselves up to scrutiny of progress to determine whether commitments have been honoured.Practical implicationsRelying on small‐scale “club” activities establishing demonstrations and raising awareness is unlikely to lead to permanent change. The evidence of RMIT's engagement with sustainability shows that, for example, even when successful pilot studies are conducted, these initiatives may do little to affect the mainstream practices of a university unless certain conditions exist. Furthermore, given the on‐paper commitments institutions have made, and the role of the university in society, small‐scale and gradual changes in university practice are a far from adequate response to the urgent sustainability imperative.Originality/valueThe initial engagement of RMIT University with the sustainability agenda 12 years ago marked it as a world leader in sustainability best‐practice. Analysing how and why such a disappointing lack of action has resulted from such promising beginnings provides insight into future directions for implementing sustainability in universities. The paper argues that considering the key responsibility of universities in leading the sustainability agenda, a more systemic and serious response is required.

The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

2013 ◽  
Vol 79 (11) ◽  
pp. 1134-1139 ◽  
Author(s):  
Kenji Inaba ◽  
Adam Hauch ◽  
Bernardino C. Branco ◽  
Stephen Cohn ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Los Angeles ◽  
Trauma Center ◽  
Medical Center ◽  
Trauma Patients ◽  
University Of Southern California ◽  
Academic Level ◽  
Significant Difference ◽  
Level I ◽  
The Impact ◽  
Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

scholarly journals Carelign: A Novel Handoff System for Medical and Surgical Consultants

2020 ◽  
Vol 12 (01) ◽  
pp. e63-e66
Author(s):  
Brian Michael Shafer ◽  
Thomasine Gorry ◽  
Paul Tapino ◽  
Subha Airan-Javia
Keyword(s):  
Medical Center ◽  
University Of Pennsylvania ◽  
Inpatient Setting ◽  
Patient Centered ◽  
System A ◽  
Item Questionnaire ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
The University ◽  
Work Management

Abstract Background Patient handoffs are ubiquitous in hospital settings. Historically, formal handoffs of patient information have been conducted in the inpatient setting mainly by primary teams, as opposed to medical and surgical consultants. Carelign is a software developed by the University of Pennsylvania Health System to function as an interdisciplinary, patient-centered handoff. While mainly utilized by primary teams for work management and transitions, it has been enhanced to include specialty consultant handoff functionality. Objective The aim of this study is to determine whether using Carelign for consultant handoffs improves clinical handoffs in comparison to the prior handoff system (a custom-built handoff report within the electronic health record) used by the Department of Ophthalmology at Penn Presbyterian Medical Center. Methods A 7-item questionnaire assessing the effectiveness, efficiency, accessibility, reliability, communication, and security of the handoff using a 1 to 5 scale was distributed to residents prior to and 6 months subsequent to the implementation of Carelign. Results Users reported a statistically significant increase in Health Insurance Portability and Accountability Act (HIPPA)-compliance (44 vs. 100%, p < 0.0001) and ability to communicate with primary teams (38 vs. 70%, p = 0.019) after implementation of Carelign. There was a trend toward significance with ease of accessing information after switching to Carelign (67 vs. 85%, p = 0.185). There was no statistically significant difference in effectiveness, efficiency, accessibility from home, or reliability of information on handoff after converting to the new system. Conclusion Carelign is perceived to be an effective tool that can be used by consulting providers to ensure HIPPA-compliance and the ability to communicate with primary teams without sacrificing effectiveness, efficiency, accessibility, or reliability.

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