scholarly journals An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

2019 ◽  
Vol 11 (02) ◽  
pp. e49-e53
Author(s):  
Amanda L. Ely ◽  
Mark Goerlitz-Jessen ◽  
Ingrid U. Scott ◽  
Erik Lehman ◽  
Tabassum Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Corneal Injury ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

scholarly journals Validation of Factors Affecting the Outcome of Cardiopulmonary Arrest in a Large, Urban, Academic Medical Center

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Dafna Koldobskiy ◽  
Soleyah Groves ◽  
Steven M. Scharf ◽  
Mark J. Cowan
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Arrest ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Time Of Day ◽  
Factors Affecting ◽  
University Of Maryland ◽  
Academic Medical ◽  
The University

Background. Recent studies of risks in cardiopulmonary arrest (CPA) have been performed using large databases from a broad mix of hospital settings. However, these risks might be different in a large, urban, academic medical center. We attempted to validate factors influencing outcomes from CPA at the University of Maryland Medical Center (UMMC). Methods. Retrospective chart review of all adult patients who underwent CPA between 2000 and 2005 at UMMC. Risk factors and outcomes were analyzed with appropriate statistical analysis and compared with published results. Results. 729 episodes of CPA were examined during the study period. Surgical patients had better survival than medical or cardiac patients. Intensive care unit' (ICU) patients had poor survival, but there was no difference on monitored or unmonitored floors. Respiratory etiologies survived better than cardiac etiologies. CPR duration and obesity were negatively correlated with outcome, while neurologic disease, trauma, and electrolyte imbalances improved survival. Age, gender, race, presence of a witness, presence of a monitor, comorbidities, or time of day of CPA did not influence survival, although age was associated with differences in comorbidities. Conclusions. UMMC risk factors for CPA survival differed from those in more broad-based studies. Care should be used when applying the results of database studies to specific medical institutions.

scholarly journals Overweight and Obesity Among Adults Identifying on the Transgender Spectrum in Newark, NJ Between 2018 and 2020: A Retrospective Chart Review

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1244-1244
Author(s):  
Joachim Sackey ◽  
Michelle DallaPiazza ◽  
Sari Bentsianov ◽  
Diana Finkel
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Overweight And Obesity ◽  
Future Research ◽  
Obesity Class ◽  
Academic Medical ◽  
White Majority ◽  
Hormone Use

Abstract Objectives To assess levels of overweight and obesity among transgender adults receiving care in an academic medical center in Newark, NJ between 2018 and 2020. Methods We performed a retrospective review of electronic medical records of transgender adults (≥18 years) receiving care in an academic medical center in Newark, NJ from 2018 through 2020. We used CDC Body Mass Index (BMI) cut-offs to determine overweight or obesity. Results Of the 159 patients included in this study, the median age was 28 years (range 18–75 years), 47.8% were Black, 27.4% were LatinX and 24.8% were White. Majority (89.3%) were receiving gender-affirming hormones and 69.2% identified as transfeminine. One-third (34.6%) were current smokers, 35.2% had a diagnosis of depression and/or anxiety and 23.3% were living with HIV. BMI was not associated with gender identity, race, hormone use, smoking, HIV status, depression and/or anxiety. A higher proportion of transfeminine participants (31.8%) were HIV positive compared to 4.1% of those identifying as transmasculine. Median BMI of the sample was 26kg/m2, 26.4% were overweight and 32.7% obese. Of the 32.7% who were obese, 12.6% were classified as obesity class 1, 10.7% as obesity class 2, and 9.4% as obesity class 3. Conclusions In this retrospective chart review, almost 60% of all transgender adults were either overweight or obese. Future research is needed to further explore potential clinical implications of elevated weight, as well as the medical, social, psychological, and health behavior factors associated with overweight and obesity among transgender individuals. Funding Sources None.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care

2018 ◽  
Vol 160 (2) ◽  
pp. 339-342 ◽  
Author(s):  
Elizabeth A. Hobbs ◽  
Joshua A. Hanson ◽  
Robert G. Nicholas ◽  
Benjamin R. Johnson ◽  
Karen A. Hawley
Keyword(s):  
Patient Care ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pediatric Malignancy ◽  
Academic Medical ◽  
The Mean ◽  
Pathologic Analysis ◽  
Mean Charge

Objective This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Study Design Retrospective chart review from 2005 through 2016. Setting Academic medical center. Subjects and Methods Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. Results From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Conclusions Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

Understanding the state of pharmacogenomic testing for thiopurine methyltransferase within a large health system

2020 ◽  
Vol 21 (6) ◽  
pp. 411-418
Author(s):  
Adam Root ◽  
Randall Johnson ◽  
Ann McGee ◽  
Hui-Jie Lee ◽  
Siyun Yang ◽  
...  
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Wild Type ◽  
Current State ◽  
Academic Medical ◽  
Study Results ◽  
Normal Metabolism ◽  
Unadjusted Analysis

Aim: To investigate the current state of TPMT testing at a single-academic medical center. Methods: Single-center, retrospective chart review for patients newly prescribed a thiopurine. Data collection and evaluation included the prevalence and timing of TPMT testing, correct dosage adjustment if applicable, and incidence of myelosuppression. Results: 121 patients (71%) received TPMT testing. Out of the tested patients, 110 (90.9%) were designated as wild-type with normal metabolism. Dosing modification was appropriate in applicable patients. In unadjusted analysis, there was a lower incidence of myelosuppression among patients who were tested versus those who were not (16.5 vs 36.7%). Conclusion: Based on the study results, TPMT testing opportunities exist for nearly 30% of patients. Testing may reduce the incidence of myelosuppression.

scholarly journals 1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S668
Author(s):  
Ann-Marie Idusuyi ◽  
Maureen Campion ◽  
Kathleen Belusko
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Therapeutic Goals ◽  
Academic Medical ◽  
Progress Notes ◽  
Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

Abstract 208: Effects of Gender and BMI on Comorbidities in Patients With Non Hemorrhagic Stroke

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael Ashamalla ◽  
Justin Pieper ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Mikhail Torosoff
Keyword(s):  
Hemorrhagic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Obesity Paradox ◽  
Morbidly Obese ◽  
Academic Medical ◽  
Conflicting Evidence ◽  
Stage Renal Disease ◽  
End Stage

Background: There is conflicting evidence concerning the obesity paradox in stroke patients. We sought to examine the relationship between gender, BMI, and prevalence of comorbidities in patients with non-hemorrhagic stroke. Materials and Methods: Retrospective chart review was performed in 996 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided according to gender and specific BMI groups according to the National Institute of Health. This study was approved by the institutional IRB. Results: Patients with BMI from 0-18.5 and 18.5-24.9 were more likely to be female (63.2% and 58.4% p<.05). Whereas patients with BMI over 25-30 and 30-35 were more likely to be male (60.82% and 59.2% p<.05). Morbidly obese patients (BMI>35) were equally likely to be men or women. In men higher BMI correlated with presentation at younger age. Diabetes was most prevalent in patients with BMI over 35 (40% males, 44% females, p<.05). In females, HTN was associated with BMI 30-34.5 and 35+ (80.5% and 73.3%, P<.05). Males showed a similar though non-significant trend. The prevalence of end stage renal disease, systemic atherosclerosis, and PVD was not significantly correlated with BMI in either gender. Conclusion: Gender and BMI significantly affect associated comorbidities in patients with non-hemorrhagic stroke, possibly suggestive of unique gender specific disease mechanisms. Additional studies investigating the effect of gender and BMI on diagnostic evaluation and treatment of patients with non-hemorrhagic stroke are warranted.

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