Image-Guided Sinus Surgery: Lessons Learned from the First 1000 Cases

OBJECTIVE: To study physician utilization and experience with image-guidance technology for sinus surgery. STUDY DESIGN AND SETTING: Retrospective review of the first 1000 image-guided sinus operations performed by 42 surgeons at an academic medical center. RESULTS: Utilization of image-guidance systems showed a dramatic increase in both number of cases performed and surgeons who used this equipment (70.6% and 92.8%, respectively) during the first 2 years of its availability. Surgical volume subsequently decreased by a mean of 9.3% per year, whereas the number of surgeons using this technology plateaued. The majority of surgeons continued to perform image-guided surgery throughout the study period for selected cases. The knowledge base gained from this experience can best be summarized as a series of lessons learned. CONCLUSION: It is likely that the availability and utilization of image-guidance systems for sinus surgery will continue to increase in the future. Physicians who learn to use this new technology must do so with an appreciation for both its potential benefits and pitfalls.

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Patient Centered Medical Home transformation at an academic medical center

Journal of Hospital Administration ◽

10.5430/jha.v5n1p34 ◽

2015 ◽

Vol 5 (1) ◽

pp. 34

Author(s):

Randy Wexler ◽

Jennifer Lehman ◽

Mary Jo Welker

Keyword(s):

Family Medicine ◽

Patient Outcomes ◽

Medical Home ◽

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Patient Centered Medical Home ◽

Model Of Care ◽

Patient Centered ◽

Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

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Vancomycin Area Under the Curve Dosing and Monitoring at an Academic Medical Center: Transition Strategies and Lessons Learned

Journal of Pharmacy Practice ◽

10.1177/0897190019834369 ◽

2019 ◽

Vol 33 (6) ◽

pp. 774-778 ◽

Cited By ~ 4

Author(s):

Eric R. Gregory ◽

Donna R. Burgess ◽

Sarah E. Cotner ◽

Jeremy D. VanHoose ◽

Alexander H. Flannery ◽

...

Keyword(s):

Technology Development ◽

Medical Center ◽

Academic Medical Center ◽

Area Under The Curve ◽

Kidney Injury ◽

Lessons Learned ◽

Academic Medical ◽

Transition Strategies ◽

Evaluation Stage ◽

Information Technology Development

Due to the inconsistent correlation of vancomycin trough concentrations with 24-hour area under the curve (AUC) and a desire to reduce rates of vancomycin-associated acute kidney injury, an institutional guideline was implemented by the Antimicrobial Stewardship Team in September 2017 to monitor vancomycin using AUC. Three stages were utilized to organize the process: preparation, implementation, and evaluation. The preparation stage was used to present literature to key stakeholders, and pharmacy meetings focused on the development of a dosing and monitoring guideline. Along with institution-wide education, the implementation stage included information technology development and support. The evaluation stage was comprised of quality improvement and clinical research. Future plans include dissemination of the results and analyses. Numerous lessons were learned due to barriers experienced during the process, but the transition was successful.

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Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy

Hospital Pharmacy ◽

10.1177/0018578718823735 ◽

2019 ◽

Vol 54 (3) ◽

pp. 170-174

Author(s):

Brian L. Erstad ◽

Tina Aramaki ◽

Kurt Weibel

Keyword(s):

Health System ◽

Health Systems ◽

Integration Method ◽

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Faculty Members ◽

Pharmacy Services ◽

Academic Medical ◽

High Level

Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in the process of undergoing integration. Method: This report describes the merger of an academic medical center and large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college of pharmacy and a health system’s pharmacy services. Results: Overarching pharmacy issues to consider include having an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research, and clinical service activities, having focused discussions between college and health system pharmacy administrators on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical faculty members affected by the merger. Conclusion: The integration of a college of pharmacy and a large health system during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and post-merger discussions between college and health system pharmacy administrators that include a strategic planning component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial collaboration.

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Lessons Learned: Mitigating the Challenges of Urgently Threatening Antibiotic Resistant Pathogens in a Large Academic Medical Center

American Journal of Infection Control ◽

10.1016/j.ajic.2020.06.080 ◽

2020 ◽

Vol 48 (8) ◽

pp. S36

Author(s):

Carli A. Viola-Luqa

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Antibiotic Resistant ◽

Academic Medical

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4142 Implementation of Consent-to-Contact (CTC) initiative at an Academic Medical center: Initial operationalization and lessons learned

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.238 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 73-73

Author(s):

Chin Chin Lee ◽

Helenmarie M. Blake ◽

Carlos A. Canales ◽

Stephen J. DeGennaro ◽

Ishwar Ramsingh ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Initial Study ◽

Lessons Learned ◽

Eligibility Criteria ◽

Academic Medical ◽

Study Teams ◽

The University ◽

Demographic Distribution ◽

Research Studies

OBJECTIVES/GOALS: The objectives of this presentation are to discuss 1) the implementation of Consent to Contact at an Academic Medical Center; 2) the access to lists of potential participants by study teams; and 3) the challenges and adjustments made to the initial conceptualized process. METHODS/STUDY POPULATION: Participant recruitment is critical to the success of all research studies. It is particularly challenging when investigators do not have a patient population from which to recruit. Thus, the University of Miami launched the CTC initiative in 2016 to facilitate study recruitment. Study investigators can request access to a registry of participants who agreed to be contacted and meet the initial study eligibility criteria. A multidisciplinary Operational Committee provides oversight and regulates access to the CTC registry. RESULTS/ANTICIPATED RESULTS: The registry has over 110K patients who have agreed to be contacted for eligible research studies. The demographic distribution of the patients in the registry mirrors the diversity of the UHealth population. As of January 2018, when the registry became available to the research community, 25 study teams from different departments, including the All of Us Research Program, have requested potential participant lists. The process of requesting access to patient lists is adapted to studies’ needs, with particular reference to sensitive populations, such as HIV/AIDS, substance abuse, etc. Results on utilization and satisfaction of the CTC initiative are being collected and will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTC initiative allows UHealth patients to opt-in to the registry for research studies. The Operational Committee continues to monitor the successful consent of patients to participate in individual research studies and improving the request process.

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Retrospective Analysis of Patients With Acute Invasive Fungal Rhinosinusitis in a Single Tertiary Academic Medical Center: A 10-Year Experience

American Journal of Rhinology and Allergy ◽

10.1177/1945892419896233 ◽

2019 ◽

Vol 34 (3) ◽

pp. 324-330

Author(s):

Gennadiy Vengerovich ◽

Kristen A. Echanique ◽

Ki Wan Park ◽

Christine Wells ◽

Jeffrey D. Suh ◽

...

Keyword(s):

Medical Management ◽

Medical Center ◽

Academic Medical Center ◽

Sinus Surgery ◽

Open Approach ◽

Presenting Symptoms ◽

Fungal Rhinosinusitis ◽

Acute Invasive Fungal Rhinosinusitis ◽

Academic Medical ◽

Invasive Fungal Rhinosinusitis

Background Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive, potentially fatal disease that can spread rapidly to the orbit and intracranial structures causing significant mortality and morbidity. Objective In this study, we present a 10-year experience from a tertiary academic medical center of patients presenting with AIFRS. Data on presentation, mortality rate, comorbidities, surgical, and medical management were analyzed. Methods A retrospective chart review was performed in a tertiary academic medical center of patients with AIFRS from January 2009 through February 2019. Data collected included demographics, presenting symptoms, comorbidities, immunosuppression status, endoscopic and imaging findings, orbital and intracranial complications, surgical and medical management, as well as outcomes and mortality. Results A total of 34 patients were identified. In our series, mortality was noted to be 61.8%, excluding patients who were lost to follow-up. The most common presenting symptoms included facial pain, ophthalmologic complaints, headaches, and proptosis. Only 4 of the 34 patients did not undergo surgical intervention, as they were not deemed surgical candidates; they all succumbed to their disease. Twenty-six of the 30 surgical patients (86.7%) underwent endoscopic sinus surgery, 8 underwent an open approach (26.7%), while 7 patients underwent orbital exenteration (23.3%). All patients had surgical pathology consistent with AIFRS. Fungal species isolated from culture included Aspergillus, Mucor/ Rhizopus, Candida, Cunninghamella Scedosporium boydii, Paecilomyces, and Scopulariopsis. Medical therapies included intravenous amphotericin B, caspofungin, posaconazole, voriconazole, isavuconazole, and micafungin. Conclusion AIFRS was associated with 61.8% mortality in our series of 34 patients over the past 10 years. Early diagnosis, as well as rapid and aggressive surgical and medical management, is necessary for optimal outcomes in this devastating disease.

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