scholarly journals Perioperative, Single-Surgeon Experience in Cerebrovascular Bypass Procedures at Academic Medical Center and Community Hospital

2018 ◽  
Vol 05 (03) ◽  
pp. 173-176
Author(s):  
Kathleen W. Nissman ◽  
Ali R. Zomorodi ◽  
Dhanesh K. Gupta ◽  
Ishwori Dhakal ◽  
Yi-Ju Li ◽  
...  
Keyword(s):  
Community Hospital ◽  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Neurosurgical Procedures ◽  
Academic Medical ◽  
Tertiary Center ◽  
Significant Difference ◽  
Surgeon Experience

Abstract Background Little evidence exists for superiority of neurosurgical outcomes from care subspecialization. Outcomes of a single neurosurgeon after complex vascular neurosurgery in an academic medical center were compared against those in a community hospital. Methods In this retrospective analysis of extracranial-intracranial vascular bypass operations performed between July 1, 2013 and February 1, 2015, cases were identified by cross-referencing the electronic medical record with the surgeon's own records. Pre-, intra-, and postoperative variables were abstracted from cases performed at a tertiary center and a community hospital. Dichotomous postoperative data recorded included extubation in the operating room (OR), readmission, and survival to discharge, and length of stay was also analyzed. Due to small sample size and low readmission rate, Firth's penalized likelihood tests were incorporated in the logistic regression model for parameter estimation and testing. Results A total of 28 hemispheres in 26 patients were included: 18 hemispheres in 16 patients at the tertiary center and 10 hemispheres in 9 patients at the community hospital. Differences were found in operative time (tertiary mean: 7.21 + 2.5 hours, community mean: 5.19 + 0.9 hours, p = 0.0074) and readmission to the tertiary center (p = 0.078). However, significant difference was observed only for anesthetic type (more likely to include remifentanil and propofol at the tertiary center, p = 0.0104). Conclusion Subspecialty care alone may be insufficient to enhance outcome after complex neurosurgical procedures.

Abstract 248: Initiation and Assessment of Timekeeping Roles During In-Hospital Cardiac Arrests to Track Rhythm Checks and Epinephrine Dosing

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Conor Crowley ◽  
Peter Clardy ◽  
Jessica McCannon ◽  
Rebecca Logiudice
Keyword(s):  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Post Intervention ◽  
Epinephrine Administration ◽  
Team Members ◽  
Minute Post ◽  
Chaotic Nature ◽  
Strongly Agree

Introduction: Compliance to ACLS cardiac arrest algorithm is low and associated with worse outcomes from in-hospital cardiac arrests (IHCA). Reasons for non-compliance include reduced communication due to chaotic nature of IHCAs and difficulty timing epinephrine administration and rhythm check intervals. Hypothesis: Delegating two separate code team members for rhythm and epinephrine timing will increase adherence to ACLS algorithm during IHCAs. Methods: This is a pre-post interventional study of IHCAs at a single academic medical center. Two stopwatches were placed on all code carts and two new timekeeping roles were created. Education was provided to staff regarding the alteration of existing code team member roles for the use of stopwatches. Algorithm adherence was analyzed pre and post implementation of timekeeper roles. Deviation from the 2-minute rhythm check or 3-5-minute epinephrine administration was counted as one deviation. Anonymous surveys were delivered to evaluate providers perceived benefits of timekeeper roles for IHCAs. Results: Data from 13 pre intervention IHCAs were compared to 12 IHCAs post intervention. The initial rhythm was PEA/asystole in 69% pre-intervention vs 83% post intervention. Prior to implementation 82 deviations vs. 11 deviations post implementation occurred (p=0.006). The mean time until first dose of epinephrine was administered pre intervention was 2.3 ± 3.3 minutes vs 0.4 ±1 minute post. Pre-implementation ROSC rate was 53.8% vs. 66.7% post intervention. Surveys were delivered to 100% of code team members post intervention, with a 79% response rate. Surveys demonstrate providers felt time keeping roles made it easier to track epinephrine administration and rhythm checks. On a Likert scale, 78% of providers “strongly agree” that the use of timekeeping roles and devices improved code team communication. Conclusion: Two separate timekeeper roles during IHCAs improved algorithm compliance, code team function and communication, and was favored by code team members. Timekeeper roles may be associated with improved rates of ROSC and less time until the first dose of epinephrine is administered. This study is limited by its small sample size, single center and requires validation.

scholarly journals Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shayan Moosa ◽  
Lindsay Bowerman ◽  
Ellen Smith ◽  
Mindy Bryant ◽  
Natalie Krovetz ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Population ◽  
Medical Center ◽  
Academic Medical Center ◽  
Readmission Rates ◽  
Academic Medical ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

scholarly journals Returns to Operating Room After Neurosurgical Procedures in a Tertiary Care Academic Medical Center: Implications for Health Care Policy and Quality Improvement

Neurosurgery ◽  
2018 ◽  
Vol 84 (6) ◽  
pp. E392-E401
Author(s):  
Panagiotis Kerezoudis ◽  
Amy E Glasgow ◽  
Mohammed Ali Alvi ◽  
Robert J Spinner ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Operating Room ◽  
Health Care Policy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Neurosurgical Procedures ◽  
Care Policy ◽  
Academic Medical

Integration of an Academic Medical Center and a Community Hospital: The Brigham and Women???s/Faulkner Hospital Experience

2006 ◽  
Vol 81 ◽  
pp. 18-25
Author(s):  
Andrew J. Sussman ◽  
Jeffrey R. Otten ◽  
Robert C. Goldszer ◽  
Margaret Hanson ◽  
David J. Trull ◽  
...  
Keyword(s):  
Community Hospital ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Experience ◽  
Academic Medical

Implementation of telehealth antimicrobial stewardship through partnership of an academic medical center and a community hospital

2021 ◽  
Author(s):  
Megan E Klatt ◽  
Lucas T Schulz ◽  
Dan Fleischman ◽  
Barry C Fox ◽  
Stuart Burke ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Community ◽  
Antimicrobial Utilization ◽  
Academic Medical ◽  
Tract Infections

Abstract Purpose Small community hospitals often lack the human, financial, and technological resources necessary to implement and maintain successful antimicrobial stewardship programs now required by national regulatory and accrediting bodies. Creative solutions are needed to address this problem. Summary A 3-stage, quasi-experimental study including patients receiving antibiotics for pneumonia, skin and soft tissue infections, and urinary tract infections at a community hospital in Wisconsin from June 2013 to December 2015 was conducted. Remote telehealth prospective audit and feedback, guideline and order set management, and staff education targeting pharmacists, nurses, and physicians were provided during the 7-month intervention phase; these services were then removed for the postintervention period. Antimicrobial utilization (days of therapy [DOT] per 1,000 patient-days), hospital length of stay, and readmission and 30-day mortality rates were assessed to determine the impact of telehealth services on these outcomes. During the preintervention (baseline), intervention, and postintervention periods, 1,037 patients received antibiotics for the targeted infectious disease conditions. Patient demographics and rates of infectious disease conditions were similar among the different periods. Telehealth antimicrobial stewardship reduced broad-spectrum antibiotic use, including use of imipenem (from 83 to 31 DOT, P < 0.001), levofloxacin (from 123 to 99 DOT, P < 0.001), and vancomycin (from 104 to 85 DOT, P < 0.001), compared to utilization during the baseline period; mean (SD) length of stay also decreased (from 4.6 [2.8] days to 4.2 [2.6] days, P = 0.02). After nonrenewal of telehealth stewardship, vancomycin and piperacillin/tazobactam usage returned to or exceeded baseline levels. Conclusion The partnership between an academic medical center and a small community hospital improved antimicrobial utilization and clinical outcomes. Successful telehealth antimicrobial stewardship models should be explored further as a means to provide optimal patient care.

scholarly journals Effect of Obesity on Complications in Short-Scar Breast Reduction: A Retrospective Study of 236 Consecutive Patients

2018 ◽  
Vol 26 (4) ◽  
pp. 238-243
Author(s):  
Eleanor Rose Goldwasser Tomczyk ◽  
Ava Chappell ◽  
Nathaniel Erskine ◽  
Mustafa Akyurek
Keyword(s):  
Adverse Outcome ◽  
Medical Center ◽  
Reduction Mammaplasty ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Positive Trend ◽  
Academic Medical ◽  
Significant Difference ◽  
Short Scar

Background: Prior studies have examined the relationship between obesity and adverse outcomes after reduction mammaplasty, suggesting a correlation between increasing body mass index (BMI) and postoperative complications. However, there is little data published regarding such correlation with respect to short-scar technique. Methods: A total of 236 patients underwent short-scar mammaplasty with a superomedial pedicle from 2008 to 2014. The procedure was performed by a single surgeon at an academic medical center. Adverse outcomes included delayed healing, major wounds, nipple necrosis, fat necrosis, seroma, hematoma, infection, revision, and dog ear deformities. Univariate and multivariate logistic regression analyses were used to calculate crude and adjusted odds ratios for the association of BMI category with the development of any adverse outcome. Results: Patients were grouped by the following BMI categories: <25 kg/m2 (n = 27), 25 to <30 kg/m2 (n = 71), 30 to <35 kg/m2 (n = 73), 35 to <40 kg/m2 (n = 45), and >40 kg/m2 (n = 20). The mean follow-up period was 260 days. The total complication rate in each group was 22.2%, 23.9%, 27.4%, 33.3%, and 45.0%, respectively. Although the proportion of patients experiencing at least 1 adverse outcome increased across the ascending BMI categories ( P trend = .145), there was no statistically significant difference between the groups. Conclusion: This study of 236 patients who underwent short-scar reduction mammaplasty found a positive trend in the incidence of adverse outcomes as BMI increased. However, this was not statistically significant.

scholarly journals Integration of an Academic Medical Center and a Community Hospital: The Brigham and Women??s/Faulkner Hospital Experience

2005 ◽  
Vol 80 (3) ◽  
pp. 253-260 ◽  
Author(s):  
Andrew J. Sussman ◽  
Jeffrey R. Otten ◽  
Robert C. Goldszer ◽  
Margaret Hanson ◽  
David J. Trull ◽  
...  
Keyword(s):  
Community Hospital ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Experience ◽  
Academic Medical

scholarly journals Clostridium difficile infection in an academic medical center in Saudi Arabia: prevalence and risk factors

2020 ◽  
Vol 40 (4) ◽  
pp. 305-309
Author(s):  
Mai Alalawi ◽  
Seba Aljahdali ◽  
Bashaer Alharbi ◽  
Lana Fagih ◽  
Raghad Fatani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infection Prevalence ◽  
Healthcare Facilities ◽  
Broad Spectrum Antibiotics ◽  
Academic Medical ◽  
Significant Difference

ABSTRACT BACKGROUND: Clostridium difficile infection is one of the most common causes of diarrhea in healthcare facilities. More studies are needed to identify patients at high risk of C difficile infection in our community. OBJECTIVES: Estimate the prevalence of C difficile infection among adult patients and evaluate the risk factors associated with infection. DESIGN: Retrospective record review. SETTING: Tertiary academic medical center in Jeddah. PATIENTS AND METHODS: Eligible patients were adults (≥18 years old) with confirmed C difficile diagnosis between January 2013 and May 2018. MAIN OUTCOME MEASURES: Prevalence rate and types of risk factors. SAMPLE SIZE: Of 1886 records, 129 patients had positive lab results and met the inclusion criteria. RESULTS: The prevalence of C difficile infection in our center over five years was 6.8%. The mean (SD) age was 56 (18) years, and infection was more prevalent in men (53.5%) than in women (46.5%). The most common risk factors were use of proton-pump inhibitors (PPI) and broad-spectrum antibiotics. The overlapping exposure of both PPIs and broad-spectrum antibiotics was 56.6%. There was no statistically significant difference between the type of PPI ( P =.254) or antibiotic ( P =.789) and the onset of C difficile infection. CONCLUSION: The overall C difficile infection prevalence in our population was low compared to Western countries. The majority of the patients who developed C difficile infection were using PPIs and/or antibiotics. No differences were observed in the type of antibiotic or PPI and the onset of C difficile infection development. Appropriate prescribing protocols for PPIs and antibiotics in acute settings are needed. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

scholarly journals 769. Risk Factors of Central Line-associated Bloodstream Infection in an Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S481-S482
Author(s):  
Zane Conrad ◽  
Minji Kang ◽  
Elizabeth Thomas ◽  
Doramarie Arocha ◽  
Julie B Trivedi
Keyword(s):  
Risk Factors ◽  
Candida Species ◽  
Medical Center ◽  
Academic Medical Center ◽  
Central Line ◽  
University Hospital ◽  
Icu Patients ◽  
Academic Medical ◽  
Significant Difference ◽  
Line Type

Abstract Background Central line-associated bloodstream infections (CLABSI) are one of the leading healthcare-acquired infections (HAI) with significant morbidity and mortality. We aimed to identify risk factors of CLABSI at an academic medical center to determine high-risk populations and target interventions. Methods This is an observational retrospective cohort study at William P. Clements Jr. University Hospital from January 1, 2017 to December 31, 2020. Retrospective chart review was conducted to identify demographics and co-morbidities of hospitalized patients diagnosed with CLABSI as defined by National Healthcare Safety Network (NHSN). Infections due to mucosal barrier injuries were excluded. Means were compared using independent-samples T-test and proportions were compared using chi-square. Results Ninety-three CLABSI events were identified with an increase in the standardized infection ratio from 0.38 in 2017 to 0.74 in 2020 (Figure 1). Bacterial organisms were identified in 71 (76%) cases while fungal organisms were identified in 22 (24%) (Table 2). There was no significant difference in the timing of CLABSI after line insertion (p=0.09) or organism identified (p=0.61) in PICC lines (n=33, 34%) vs all other central lines (n=60, 67%). When comparing immunocompromised patients with CLABSI (n=47, 51%) vs non-immunocompromised (n=46, 50%), there was a significant difference in the indication for line (chemotherapy), but no difference was seen in the number of line days prior to event (p=0.57), line type (p=0.17), or organism identified (p=0.94). Of all CLABSI, 46% (n=43) were in the intensive care unit (ICU) with significantly more Candida species (p=0.018) identified compared to non-ICU patients with CLABSI (n= 50, 54%). Figure 1. CLABSI Rate and SIR from 2017 to 2020 by Quarter Conclusion Candida species were more likely to be found in ICU patients with CLABSI as compared to non-ICU counterparts with further investigation in the ICU population revealing lack of flushing after administration of total parenteral nutrition. Otherwise, this observational cohort of CLABSI events did not identify any difference in immunosuppression status or line type. Given this information, infection prevention efforts will continue to be directed towards proper central line maintenance and removal when no longer indicated. Disclosures All Authors: No reported disclosures

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