scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

2018 ◽  
Vol 15 ◽  
pp. 31
Author(s):  
Nila S. Radhakrishnan ◽  
Margaret C. Lo ◽  
Rohit Bishnoi ◽  
Subhankar Samal ◽  
Robert Leverence ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Systems Of Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
Case Review ◽  
Failure To Rescue ◽  
Internal Medicine Residents ◽  
Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

scholarly journals Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

2019 ◽  
Vol 40 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Satish Munigala ◽  
Rebecca Rojek ◽  
Helen Wood ◽  
Melanie L. Yarbrough ◽  
Ronald R. Jackups ◽  
...  
Keyword(s):  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Interrupted Time Series ◽  
Vital Role ◽  
Order Sets ◽  
Urine Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of changes to urine testing orderables in computerized physician order entry (CPOE) system on urine culturing practices.Design:Retrospective before-and-after study.Setting:A 1,250-bed academic tertiary-care referral center.Patients:Hospitalized adults who had ≥1 urine culture performed during their stay.Intervention:The intervention (implemented in April 2017) consisted of notifications to providers, changes to order sets, and inclusion of the new urine culture reflex tests in commonly used order sets. We compared the urine culture rates before the intervention (January 2015 to April 2016) and after the intervention (May 2016 to August 2017), adjusting for temporal trends.Results:During the study period, 18,954 inpatients (median age, 62 years; 68.8% white and 52.3% female) had 24,569 urine cultures ordered. Overall, 6,662 urine cultures (27%) were positive. The urine culturing rate decreased significantly in the postintervention period for any specimen type (38.1 per 1,000 patient days preintervention vs 20.9 per 1,000 patient days postintervention; P < .001), clean catch (30.0 vs 18.7; P < .001) and catheterized urine (7.8 vs 1.9; P < .001). Using an interrupted time series model, urine culture rates decreased for all specimen types (P < .05).Conclusions:Our intervention of changes to order sets and inclusion of the new urine culture reflex tests resulted in a 45% reduction in the urine cultures ordered. CPOE system format plays a vital role in reducing the burden of unnecessary urine cultures and should be implemented in combination with other efforts.

Interactive iBook-Based Patient Education in a NeuroTrauma Clinic

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 787-794 ◽  
Author(s):  
Ronald Sahyouni ◽  
Amin Mahmoodi ◽  
Amir Mahmoodi ◽  
Ramin R Rajaii ◽  
Bima J Hasjim ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Educational Interventions ◽  
The United States ◽  
Outpatient Setting ◽  
Educational Material ◽  
Patient Knowledge ◽  
Academic Medical ◽  
Baseline Knowledge

Abstract BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material. OBJECTIVE To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules. METHODS Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P &lt; .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P &lt; .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P &lt; .01, 95% CI). CONCLUSION Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

Effect of Female and Male Body Mass index on Cumulative Live Birth Rates in the Freeze-all Strategy

2021 ◽  
Author(s):  
Xi Shen ◽  
Yating Xie ◽  
Di Chen ◽  
Wenya Guo ◽  
Gang Feng ◽  
...  
Keyword(s):  
Live Birth ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Live Birth Rate ◽  
Male Body ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
The Impact ◽  
High Bmi

Abstract Context The impact of parental overweight/obese on cumulative live birth rate in IVF/ICSI using a freeze-all strategy is still unknown. Objective To explore the effect of parental BMI on CLBR in a freeze-all strategy over 1.5 years. Design A retrospective study. Setting Tertiary-care academic medical center Patients or Other Participants 23482 patients (35289 FET cycles) were divided into four groups according to Asian BMI classification. Intervention(s) None. Main Outcome Measure(s) CLBR. Results Female overweight/obesity had the lower tendency in CLBR (groups1-4: optimistic: 69.4%, 67.9%, 62.3%, and 65.7%; conservative: 62.9%, 61.1%, 55.4%, and 57.6%) and the prolonged time (groups 1-4: 11.0, 12.2, 15.9, and 13.8 months for 60% CLBR in optimistic method; 8.7, 9.5, 11.7, 11.0 months for 50% CLBR in conservative method). The same trend with less extent was also observed in male BMI groups. When combining parental BMI, “parental overweight/obesity” had lower CLBR and longer time for reaching CLBR&gt;50% (optimistic: 4.5 months for 60% CLBR; conservative: 3 months for 50% CLBR), the next was “only female high BMI” (optimistic: 2.1 months for 60% CLBR; conservative: 1.7 months for 50% CLBR), while “only male high BMI” couldn’t influence these. Conclusions Our results firstly showed that the priorities of parental BMI, female BMI and male BMI on affecting the 1.5-year CLBR in freeze-all strategy, and the postponed time to reach up the certain CLBR (60% in optimistic, 50% in conservative) for overweight and obese patients was only several months, not so uncertain and long as losing weight.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

scholarly journals Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions

2021 ◽  
Author(s):  
Stephana Cherak ◽  
Allison Brown ◽  
Rahim Kachra ◽  
Kira Makuk ◽  
Sanjana Sudershan ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Well Being ◽  
World Health ◽  
Undergraduate Medical Students ◽  
Cross Sectional ◽  
Diversity And Inclusion ◽  
Education Report ◽  
Novel Coronavirus ◽  
Health Organization ◽  
The Impact

Background: On March 11, 2020 the World Health Organization declared the novel coronavirus SARS-CoV-2 disease (COVID-19) a global pandemic. We sought to understand impact of COVID-19 on learner wellness at a large tertiary care academic institution to inform the future development of learner wellness interventions during the COVID-19 pandemic. Methods: A cross-sectional, internet-based survey collected quantitative and qualitative data from learners April-June 2020. Descriptive statistics and univariate analyses were reported for quantitative data. Open-ended, qualitative responses were analyzed deductively using thematic analysis. Results: Twenty percent of enrolled learners in that faculty of medicine (540/2741) participated including undergraduate [Bachelor’s] students (25.7%), graduate [science] students (27.5%), undergraduate medical students (22.8%), and postgraduate resident physicians (23.5%). We found that learner wellness across all stages of training was negatively impacted and the ways in which learners were impacted varied as a result of their program's response to the COVID-19 pandemic. Conclusions: Learners in health sciences and medical education report worsening well-being because of the programs and the systems in which they function with the added burden of the COVID-19 pandemic. Future interventions would benefit from a holistic framework of learner wellness while engaging in systems thinking to understand how individuals, programs and respective systems intersect. The importance of acknowledging equity, diversity and inclusion, fostering psychological safety and engaging learners as active participants in their journey during a pandemic and beyond are key elements in developing wellness interventions.

scholarly journals Evaluation and optimization of take-home naloxone in an academic medical center

2019 ◽  
Vol 9 (2) ◽  
pp. 105-109
Author(s):  
Jordan Cooler ◽  
Clint A. Ross ◽  
Sophie Robert ◽  
Lauren Linder ◽  
Ann Marie Ruhe ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Pilot Project ◽  
The United States ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Pharmacy Staff ◽  
Educational Videos

Abstract With the United States in the midst of an opioid overdose epidemic, efforts to reduce overdose deaths have increased. Expanding access to the opioid antagonist naloxone can combat the epidemic. A pilot project in a psychiatric hospital resulted in the development of a screening tool in the electronic medical record (EMR) to help pharmacists identify adult inpatients at high risk of opioid overdose. Pharmacists can facilitate these patients being discharged with take-home naloxone. The purpose of this project was to optimize the screening tool for nonpsychiatric adult inpatient areas. Prior to implementation, a team of pharmacists familiar with the screening tool and take-home naloxone met with stakeholders to assess need for modification of the tool, determine barriers to implementation, and provide insight into the new service. In addition to expanding the tool into nonpsychiatric areas, a morphine-equivalents calculator was developed to identify patients receiving at least 100 mg of morphine equivalents per day to capture an additional at-risk population. Four short educational videos were developed to provide training to pharmacists. Initial performance of the screening tool was evaluated in general medicine patients over a 5-day period. Out of 44 admissions, 8 (18.2%) screened positive. The majority of those patients (5/8, 62.5%) screened positive for morphine equivalents greater than 100 mg. Anecdotally, the educational videos have been well received by pharmacy staff. Opioid overdose risk factors can be applied to nonpsychiatric inpatients for screening purposes in the EMR. Educational videos can be used to disseminate information to pharmacists on take-home naloxone and opioid overdose.

The Changing Health Care Environment: Implications for Residency Training

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_3) ◽  
pp. 795-804 ◽  
Author(s):  
Seth Frazier ◽  
Daniel Hyman ◽  
Steven Altschuler
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Delivery System ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Pediatric Care ◽  
Health Care Environment ◽  
The Impact

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

Utility of Dual Skin Tests to Evaluate Tuberculin Skin Test Reactions of 10 to 14 mm in Healthcare Workers

2003 ◽  
Vol 24 (11) ◽  
pp. 821-824 ◽  
Author(s):  
Bryan J. Marsh ◽  
Joshua San Vicente ◽  
C. Fordham von Reyn
Keyword(s):  
Occupational Health ◽  
Skin Test ◽  
Healthcare Workers ◽  
Medical Center ◽  
Skin Testing ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Health Department ◽  
The United States ◽  
Skin Tests

AbstractObjective:To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs).Design:Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10-to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening.Setting:A single tertiary-care academic medical center.Participants:Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD.Results:Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (± 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant.Conclusion:A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.

scholarly journals Do You Know What Your Scribe Did Last Spring? The Impact of COVID-19 on Medical Scribe Workflow

2020 ◽  
Vol 11 (05) ◽  
pp. 807-811
Author(s):  
Jeffrey A. Gold ◽  
James Becton ◽  
Joan S. Ash ◽  
Sky Corby ◽  
Vishnu Mohan
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
New Paradigm ◽  
Virtual Care ◽  
Academic Medical ◽  
Wide Range ◽  
Secondary Outcomes ◽  
Medical Scribes ◽  
The Impact

Abstract Objective To understand the impact of the shift to virtual medicine induced by coronavirus disease 2019 (COVID-19) has had on the workflow of medical scribes. Design This is a prospective observational survey-based study. Setting This study was conducted at academic medical center in the United States. Participants Seventy-four scribes working in ambulatory practices within an academic medical center. Interventions All medical scribes received a survey assessing their workflow since beginning of COVID-19 restrictions. Primary and Secondary Outcomes To assess the current workflow of medical scribes since transition to virtual care. Secondary outcomes are to assess the equipment used and location of their new workflow. Results Fifty-seven scribes completed the survey. Overall 42% of scribes have transitioned to remote scribing with 97% serving as remote scribes for remote visits. This workflow is conducted at home and with personal equipment. Of those not working as scribes, 46% serve in preclinic support, with a wide range of EHR-related activities being reported. The remaining scribes have been either redeployed or furloughed. Conclusion The rapid transition to virtual care brought about by COVID-19 has resulted in a dramatic shift in scribe workflow with the adoption of a previously unreported workflow of remote scribing for virtual care. Additional work is now needed to ensure these new workflows are safe and effective and that scribes are trained to work in this new paradigm.

Sign in / Sign up

Export Citation Format

Share Document