Anesthesia-Associated Carbon Monoxide Exposures Among Surgical Patients

2001 ◽  
Vol 22 (6) ◽  
pp. 352-356 ◽  
Author(s):  
Michele L. Pearson ◽  
William C. Levine ◽  
Robert J. Finton ◽  
Charles T. Ingram ◽  
Kathleen B. Gay ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
General Anesthesia ◽  
Chemical Interaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Anesthesia Machine ◽  
Early Postoperative Period ◽  
Surgical Patients ◽  
Academic Medical ◽  
Increased Risk

AbstractObjective:To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.Design:Matched case-control study to measure carboxyhemoglobin levels.Setting:Large academic medical center.Participants:45 surgical patients who underwent general anesthesia.Results:Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.Conclusions:Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.

Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center

2009 ◽  
Vol 10 (7) ◽  
pp. 753-758 ◽  
Author(s):  
Kevin J. Finkel ◽  
Adam C. Searleman ◽  
Heidi Tymkew ◽  
Christopher Y. Tanaka ◽  
Leif Saager ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Medical Center ◽  
Academic Medical Center ◽  
Surgical Patients ◽  
Academic Medical ◽  
Obstructive Sleep

Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 801-804 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Healthcare Research ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Patient Safety Indicators ◽  
Academic Medical

Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.

Evaluation of inpatient cancer pain management at an academic medical center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 128-128
Author(s):  
Michael Mearis ◽  
Joseph Shega ◽  
Randall Knoebel
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Pain Management ◽  
Nccn Guidelines ◽  
Academic Medical ◽  
Number Of Patients ◽  
Increased Risk ◽  
Cancer Network

128 Background: The National Comprehensive Cancer Network (NCCN) guidelines on cancer pain management were developed to direct pain assessment and management. The purpose of this study was to assess whether adherence to guidelines was associated with improved outcomes. Methods: One-hundred and nine patients admitted to the inpatient hematology oncology service that received at least one dose of morphine, oxycodone, or hydromorphone were evaluated and allocated into groups based on adherence to the NCCN guidelines. Safety and achievement of analgesia (pain score ≤ 4) at 24-hours after opioid initiation were compared between the two groups. A multivariate analysis was performed to identify predictors of opioid regimens non-adherent to guidelines. Results: Sixty-four percent of patients were initiated on regimens adherent to the NCCN guidelines. 63% of patients initiated on regimens adherent to NCCN guidelines reached the endpoint of analgesia at 24 hours compared to 41% of those who were not (p = 0.028). Adverse events were infrequent (p > 0.5). Opioid tolerance was the variable most predictive of being initiated on regimens non-adherent to guideline recommendations (OR 3.1, 95% confidence interval 1.24-7.82). Conclusions: A significant number of patients presenting with cancer pain are initiated on regimens non-adherent to NCCN guidelines, leading to reduced attainment of adequate analgesia. Opioid tolerant patients are at an increased risk of inadequate analgesia, and should be identified and initiated on proper pain regimens taking home opioid usage into consideration.

scholarly journals Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System

2014 ◽  
Vol 121 (3) ◽  
pp. 501-509 ◽  
Author(s):  
Steven M. Frank ◽  
Michael J. Oleyar ◽  
Paul M. Ness ◽  
Aaron A. R. Tobian
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Substantial Reduction ◽  
Information Management System ◽  
Surgical Patients ◽  
Release System ◽  
Time Period ◽  
Academic Medical ◽  
Utilization Data ◽  
Transfusion Ratio

Abstract Background: Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs. Methods: At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe®; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. Results: Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P &lt; 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P &lt; 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. Conclusion: Implementing institution-specific, updated maximum surgical blood order schedule–directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.

scholarly journals Racial Differences in Alzheimer’s Disease Specialist Encounters are Associated with Usage of Molecular Imaging and Dementia Medications: An Enterprise-Wide Analysis Using i2b2

2020 ◽  
pp. 1-15
Author(s):  
Charles F. Murchison ◽  
Richard E. Kennedy ◽  
Jonathan E. McConathy ◽  
Erik D. Roberson
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
African Americans ◽  
Racial Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinics ◽  
Academic Medical ◽  
Increased Risk

Background: African Americans are at increased risk for Alzheimer’s disease (AD) but barriers to optimal clinical care are unclear. Objective: To comprehensively evaluate potential racial differences in the diagnosis and treatment of AD in an academic medical center. Methods: We used the clinical informatics tool, i2b2, to analyze all patient encounters for AD or mild cognitive impairment (MCI) in the University of Alabama at Birmingham Health System over a three-year period, examining neuroimaging rates and dementia-related medication use by race and clinic site using ratio tests on contingency tables of stratified patient counts. Results: Enterprise-wide, African Americans were not underrepresented among outpatients seen for AD/MCI. However, there were differences in the clinic setting where visits occurred, with African Americans overrepresented in Geriatrics and primary care clinics and underrepresented in Memory Disorders specialty clinics. There were no racial differences in the rates at which any clinic ordered PET neuroimaging tests or dementia-related medications. However, unsurprisingly, specialty clinics ordered both PET neuroimaging and dementia-related medications at a higher rate than primary care clinics, and overall across the medical enterprise, African Americans were statistically less likely to have PET neuroimaging or dementia-related medications ordered. Conclusion: African Americans with AD/MCI were not underrepresented at this academic medical center but were somewhat less likely to have PET neuroimaging or to be on dementia-related medications, potentially in part from underrepresentation in the specialty clinics where these orders are more likely. The reasons for this underrepresentation in specialty clinics are likely multifactorial and important to better understand.

S1148 Increased Risk of Lymphoma in the Setting of IBD: Prevalence Over a Decade in a Tertiary Academic Medical Center

2009 ◽  
Vol 136 (5) ◽  
pp. A-200
Author(s):  
David Kotlyar ◽  
Wojciech Blonski ◽  
Manuel Mendizabal ◽  
Ming V. Lin ◽  
Mark Weiner ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Increased Risk

scholarly journals Occupational Exposure to SARS-CoV-2 and Risk of Infection Among Healthcare Personnel

2022 ◽  
pp. 1-13
Author(s):  
Vishal P. Shah ◽  
Laura E. Breeher ◽  
Julie M. Alleckson ◽  
David G. Rivers ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Occupational Exposures ◽  
Healthcare Personnel ◽  
Healthcare Settings ◽  
Academic Medical ◽  
Increased Risk ◽  
Medium Risk ◽  
The Impact

Abstract Objective: To assess the rate and factors associated with healthcare personnel (HCP) testing positive for SARS-CoV-2 after an occupational exposure Design: Retrospective cohort study Setting: Academic medical center with sites in Minnesota, Wisconsin, Arizona, and Florida Subjects: HCP with a high or medium risk occupational exposure to a patient or other HCP with SARS-CoV-2 Methods: We reviewed the records of HCP with significant occupational exposures from March 20th, 2020 through December 31st, 2020. We then performed regression analysis to assess the impact of demographic and occupational variables to assess their impact on the likelihood of testing positive for SARS-CoV-2 Results: A total of 2,253 confirmed occupational exposures occurred during the study period. Employees were the source for 57.1% of exposures. Overall, 101 (4.5%) HCP tested positive in the postexposure period. Of these, 80 had employee sources of exposure and 21 had patient sources of exposure. The post exposure infection rate was 6.2% when employees were the source, compared to 2.2% with patient sources. In a multivariate analysis, occupational exposure from an employee source had a higher risk of testing positive compared to a patient source (OR 3.22 95% CI (1.72-6.04)). Gender, age, high-risk exposure, and HCP role were not associated with increased risk of testing positive. Conclusions: The risk of acquiring COVID-19 following a significant occupational exposure is relatively low, even in the pre-vaccination era. Exposure to an infectious coworker carries a higher risk than exposure to a patient. Continued vigilance and precautions remain necessary in healthcare settings.

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