scholarly journals IMPLEMENTING A GERIATRIC FRACTURE PROGRAM IN A PLURALISTIC ENVIRONMENT REDUCES LENGTH OF STAY AND TIME TO SURGERY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S740-S740
Author(s):  
Sonja L Rosen ◽  
Kathy Breda ◽  
Carol Lin ◽  
Jeanne Black ◽  
Jae Lee ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Geriatric Fracture ◽  
Time To Surgery ◽  
Private Practitioners ◽  
Program Success ◽  
Wilcoxon Rank Sum Test ◽  
Standardized Treatment

Abstract Geriatric-orthopaedic co-management models have been demonstrated to improve patient outcomes, but are typically implemented in closed, non-pluralistic medial systems. The Cedars-Sinai Geriatric Fracture Program (GFP) was developed through collaboration amongst a multi-disciplinary group. Cedars-Sinai is an academic medical center with a pluralistic medical staff that includes faculty, several hospitalist groups, and private practitioners. The GFP was introduced in July 2018 as a quality improvement pilot to provide standardized treatment for geriatric fracture patients. We hypothesized GFP enrollment would reduce time to surgery (TTS) and length of stay (LOS). Geriatric fracture patients were prospectively enrolled from July -December 2018. The Wilcoxon Rank- Sum test was used to compare TTS and LOS between the two patient groups. A p < 0.05 was considered significant. 190 operative fractures in patients over 65 years-old were prospectively followed.56 (30%) were enrolled in the GFP, 54 (28%) were admitted to other hospitalist groups (OH), and 80 (42%) were managed by their primary care physician (PCP). There were no demographic differences between groups. Patients enrolled in the GFP had a significantly shorter LOS compared to the OH and PCP groups (4 days v 5 days v 5 days, p = 0.039) as well as a significantly shorter TTS (19.7hrs v 22.4 hrs vs 23.3 hrs, p = 0.037). Our data shows that a multi-disciplinary geriatric fracture program can be successfully implemented in a complex pluralistic environment resulting in improved patient metrics. Adherence to evidence-based protocols and close multidisciplinary teamwork are critical to program success.

scholarly journals Impact of Inactive Empiric Antimicrobial Therapy on Inpatient Mortality and Length of Stay

2006 ◽  
Vol 50 (10) ◽  
pp. 3355-3360 ◽  
Author(s):  
Kimberly K. Scarsi ◽  
Joe M. Feinglass ◽  
Marc H. Scheetz ◽  
Michael J. Postelnick ◽  
Maureen K. Bolon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Inpatient Mortality ◽  
In Vitro Susceptibility ◽  
Empiric Antimicrobial Therapy

ABSTRACT The consequences of inactive empiric antimicrobial therapy are not well-described and may cause prolonged hospitalization or infection-related mortality. In vitro susceptibility results for 884 patients hospitalized at an academic medical center with gram-negative bloodstream infections (GNBI) from 2001 to 2003 were matched to antimicrobial orders within 24 h of culture. Clinical characteristics, organism, inpatient mortality, and length of stay after culture for patients with GNBI were compared between patients receiving active versus inactive empiric antimicrobial therapy. A total of 14.1% of patients with GNBI received inactive empiric therapy, defined as no antimicrobial therapy within 24 h of the culture active against the identified organism based on in vitro microbiology reports. Patients who received inactive therapy were more likely to be younger, to be infected with Pseudomonas aeruginosa, to have a nosocomial infection, and to receive antimicrobial monotherapy but less likely to be bacteremic with Escherichia coli or to have sepsis (P < 0.05). There were no significant differences in mortality between patients receiving active versus inactive empiric therapy (16.1% versus 13.6%, respectively) or in length of stay after positive culture (11.5 days versus 12.6 days, respectively). Only 45 patients had greater than 2 days of exposure to inactive therapy; however, 8/30 patients (26.7%) who never received active antimicrobial therapy died while in the hospital. Inactive empiric therapy was more common in healthier patients. Inactive antimicrobial therapy in the first 24 h did not significantly impact average outcomes for GNBI among hospitalized patients but may have caused harm to specific individuals.

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

scholarly journals Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

2019 ◽  
Vol 10 ◽  
pp. 215013271984051 ◽  
Author(s):  
Gregory M. Garrison ◽  
Rachel L. Keuseman ◽  
Christopher L. Boswell ◽  
Jennifer L. Horn ◽  
Nathaniel T. Nielsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Service ◽  
Academic Medical ◽  
The Family ◽  
Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

scholarly journals How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

2021 ◽  
Author(s):  
John C. Penner ◽  
Karen E. Hauer ◽  
Katherine A. Julian ◽  
Leslie Sheu
Keyword(s):  
Internal Medicine ◽  
Qualitative Study ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Care Physician ◽  
Inpatient Setting ◽  
Continuity Clinic ◽  
Clinic Setting ◽  
And Task

Abstract Introduction To advance in their clinical roles, residents must earn supervisors’ trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision. Methods In this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018–June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust. Results Sixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care. Discussion The continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents’ provision of between-visit care may improve resident continuity clinic learning and patient care.

scholarly journals Effect of Regional Medical Campus Education on Student Pursuit of Primary Care Specialties

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Casey P. Collins ◽  
John F. McCarthy
Keyword(s):  
Primary Care ◽  
Residency Program ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
University Of Washington ◽  
Primary Care Residency ◽  
Regional Medical ◽  
Primary Care Specialty

Purpose To investigate whether education at a regional medical campus (RMC) affects the likelihood of University of Washington School of Medicine (UWSOM) students choosing a primary care specialty. Method Two approaches were taken to answer the study question. First, the percentage of UWSOM students who matched to a primary care residency program between 1996-2016 was compared between two groups of students: those educated at an RMC and those educated at the academic medical center (a non-RMC). Second, physician specialty data was obtained from the AMA Physician Masterfile for UWSOM graduates from 1996-2011. Physicians were again split into RMC and non-RMC groups, and the percentage of primary care physicians was compared between the two groups. This study was completed in 2016. Results Among graduates from 1996-2016, 33% (564/1707) of those educated at an RMC were matched to a primary care residency program compared to 39% (787/2003) of students educated at the non-RMC (P < 0.001). Graduates from 1996-2011 had similar likelihoods of becoming a primary care physician regardless of first year education site (37% [395/1078] versus 39% [551/1403], P = 0.18, Figure 2). Conclusions The results of this study did not support the hypothesis that the WWAMI RMCs produce more primary care physicians than the non-RMC. A greater percentage of students who attended the non-RMC matched into a primary care residency program compared to the RMC group, while the percentage of students who ultimately chose a primary care specialty was quite similar.   Financial support: Mr. Collins was supported in part for this study by the Smith Family Endowed Chair in Medicine. Ethical Approval: The University of Washington Institutional Review Board approved the acquisition and analysis of subject data. Application #52065. Approval date 5/24/2016.

scholarly journals The increasing impact of length of stay “outliers” on length of stay at an urban academic hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew H. Hughes ◽  
David Horrocks ◽  
Curtis Leung ◽  
Melissa B. Richardson ◽  
Ann M. Sheehy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Improve Patient Care ◽  
National Sample ◽  
Hospital Length Of Stay ◽  
Rare Occurrence ◽  
Data Reporting ◽  
Targeted Interventions ◽  
Hospital Capacity

Abstract Background As healthcare systems strive for efficiency, hospital “length of stay outliers” have the potential to significantly impact a hospital’s overall utilization. There is a tendency to exclude such “outlier” stays in local quality improvement and data reporting due to their assumed rare occurrence and disproportionate ability to skew mean and other summary data. This study sought to assess the influence of length of stay (LOS) outliers on inpatient length of stay and hospital capacity over a 5-year period at a large urban academic medical center. Methods From January 2014 through December 2019, 169,645 consecutive inpatient cases were analyzed and assigned an expected LOS based on national academic center benchmarks. Cases in the top 1% of national sample LOS by diagnosis were flagged as length of stay outliers. Results From 2014 to 2019, mean outlier LOS increased (40.98 to 45.11 days), as did inpatient LOS with outliers excluded (5.63 to 6.19 days). Outlier cases increased both in number (from 297 to 412) and as a percent of total discharges (0.98 to 1.56%), and outlier patient days increased from 6.7 to 9.8% of total inpatient plus observation days over the study period. Conclusions Outlier cases utilize a disproportionate and increasing share of hospital resources and available beds. The current tendency to exclude such outlier stays in data reporting due to assumed rare occurrence may need to be revisited. Outlier stays require distinct and targeted interventions to appropriately reduce length of stay to both improve patient care and maintain hospital capacity.

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.

scholarly journals PT Achievement in Public Hospitals and Its Effect on Outcomes

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 58
Author(s):  
Jessica S. Morton ◽  
Alex Tang ◽  
Michael J. Moses ◽  
Dustin Hamilton ◽  
Neville Crick ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Length Of Stay ◽  
Medical Center ◽  
Therapy Group ◽  
Academic Medical Center ◽  
Early Mobilization ◽  
The United States ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Discharge Disposition

The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. (p < 0.01) There was no difference in discharge disposition between the two groups.

Development of phase-specific breast cancer survivorship care plans (SCPs).

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 61-61
Author(s):  
Susan K. Parsons ◽  
Tracey Weisberg ◽  
Lauren Boehm ◽  
Arlene O'Rourke ◽  
Angie Mae Rodday ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Survivorship Care ◽  
Quality Health Care ◽  
Term Care ◽  
Unique Challenge ◽  
Care Plans

61 Background: There are nearly 3 million breast cancer (BC) survivors in the US. Among the recently diagnosed, accrediting organizations (e.g., Commission on Cancer) now require SCPs at the completion of curative therapy. Within the Oncology Care Model, the preparation and delivery of SCPs is recognized as one of the 13 quality metrics. SCPs, combining treatment summaries (TS) and follow-up care plans (FUCPs), assist patients and providers in the delivery of high quality long-term care. BC presents a unique challenge, as the risk of recurrence extends decades past initial treatment; adjuvant risk reduction may extend up to 15 years. Periodic FUCPs provide a mechanism to review updated information and may allow providers to catch up with longer term BC survivors whose care was delivered prior to SCPs. We explored the role of phase-specific SCPs within the heterogeneous BC survivor population. Methods: Oncologists and nurse practitioners (NPs) from the Breast Health and Survivorship Programs at Tufts MC, an academic medical center in Boston, and New England Cancer Specialists, a community-based private oncology practice in Maine--together caring for more than 2,000 BC survivors--convened to develop and test phase-specific survivorship tools. Using an adapted ASCO template for BC, TS were completed at the end of initial therapy by trained NPs. FUCPs for initial, 5-year, and 10-year visits were designed with clinical input, literature reviews, and existing guidelines. Results: FUCPs were pilot tested and refined before incorporation into the electronic health record. Further testing is planned to identify barriers to effective survivorship care, particularly involving documentation of changes in recommendations and the transition from oncologist to primary care physician. Conclusions: SCPs are critical for providing quality health care to BC survivors, but a single SCP, written at the conclusion of curative treatment, might not be sufficient to address changing needs of individuals as they progress through survivorship. Thus, phase-specific SCPs enable providers to focus on salient aspects of care that may change over time. Despite growing recognition of the value of SCPs, implementation remains a challenge across cancer programs.

Sign in / Sign up

Export Citation Format

Share Document