scholarly journals Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how?

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
E Tanner ◽  
A P S Munro ◽  
J Gray ◽  
H Green ◽  
M Rutter ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Significant Proportion ◽  
Cost Savings ◽  
Healthcare Organizations ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Antibiotic Management ◽  
Short Courses ◽  
The Impact ◽  
Common Infections

Abstract Background Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues. Objectives A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections. Methods All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018). Results A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018. Conclusions Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.

Telemedicine in paediatric emergency care: A systematic review

2021 ◽  
pp. 1357633X2110101
Author(s):  
Aditi Mitra ◽  
Rubina Veerakone ◽  
Kathleen Li ◽  
Tyler Nix ◽  
Andrew Hashikawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Emergency Care ◽  
Cost Savings ◽  
Process Measures ◽  
Paediatric Emergency ◽  
Paediatric Emergency Care ◽  
Therapeutic Decision Making ◽  
The Impact

Introduction The impact of telemedicine on the access and quality of paediatric emergency care remains largely unexplored because most studies to date are focused on adult emergency care. We performed a systematic review of the literature to determine if telemedicine is effective in improving quality of paediatric emergency care with regards to access, process measures of care, appropriate disposition, patient-centred outcomes and cost-related outcomes. Methods We developed a systematic review protocol in accordance with PRISMA (Preferred Reporting Items for Systematic Review) guidelines. We included studies that evaluated the impact of synchronous and asynchronous forms of telemedicine on patient outcomes and process measures in the paediatric emergency care setting. Inclusion criteria were study setting, study design, intervention type, age, outcome measures, publication year and language. Results Overall, 1.9% (28/1434) studies met study inclusion and exclusion criteria. These studies revealed that telemedicine increased accuracy of patient assessment in the pre-clinical setting, improved time-to disposition, guided referring emergency department (ED) physicians in performing appropriate life-saving procedures and led to cost savings when compared to regular care. Studies focused on telepsychiatry demonstrated decreased length of stay (LOS), transfer rates and improved patient satisfaction scores. Discussion Our comprehensive review revealed that telemedicine enhances paediatric emergency care, enhances therapeutic decision-making and improves diagnostic accuracy, and reduces costs. Specifically, telemedicine has its most significant impact on LOS, access to specialized care, cost savings and patient satisfaction. However, there was a relative lack of randomized control trials, and more studies are needed to substantiate its impact on morbidity and mortality.

PACS Quality Dimensions

2010 ◽  
pp. 140-153
Author(s):  
Carrison K.S. Tong ◽  
Eric T.T. Wong
Keyword(s):  
Process Analysis ◽  
Radiology Department ◽  
Success Factor ◽  
Healthcare Organizations ◽  
Adult Intensive Care Unit ◽  
It Systems ◽  
Number Of Factors ◽  
Other Information ◽  
The Impact

A large number of studies have attempted to identify the factors that contribute to good PACS quality, such as that shown by Reiner et al (2003). Results from these studies (Bauman, 2000; Ralston, 2000) reveal that the success of PACS requires healthcare organizations and managers to adequately address various types of challenges: technological (e.g., integration with other information systems), managerial (e.g., project management), organizational (e.g., availability of resources), behavioural (e.g., change management), and political (e.g., alignment among key participants). Most investigations have considered a single, or at best, a small number of factors contributing to a fragmented view of PACS success. Broadly, these studies may be classified into those that consider the impact of PACS on radiologists’ workload and productivity (Gale, 1999), those that consider its clinical implications (Hertzberg, 2000) and those associated with performance of the radiology department (Hayt, 2001). Rather than measuring the quality of the PACS performance, other researchers have preferred to focus on the quality of the information, that the system produces, primarily in the form of images and reports. For instance, Lou et al. (1997) considered the data integrity and completeness of acquired images. Quality of images in terms of timeliness, accuracy, completeness, and so forth, was also considered to be a key success factor in several evaluative studies (Cox, 2002; Pavlicek, 1999; Pilling, 2003; Blado, 2002). Indeed, Cox’s work was part of a wider evaluation exercise undertaken to assess the impact of the introduction of a PACS on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of the research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems and adequate IT support. In short, once this expanded, but rather fragmented view of PACS success is recognized, it is not surprising to find that there are so many different measures of PACS quality in the literature depending upon which aspect of PACS the researcher focused his or her attention.

Investigations on Seam Quality in Laser Beam Welding of Contaminated, Zinc Coated Sheets

2005 ◽  
Vol 6-8 ◽  
pp. 187-194 ◽  
Author(s):  
A. Blankl ◽  
Manfred Geiger
Keyword(s):  
Laser Beam ◽  
Laser Beam Welding ◽  
Zinc Coating ◽  
Cost Savings ◽  
Production Costs ◽  
High Porosity ◽  
Welding Seam ◽  
Welding Operation ◽  
The Impact

The customers’ demand for high quality and low cost products with rising functionality forces the enterprises to cost savings. In production these cost savings can be accomplished by simplification or omission of handling operations in the process chain. In laser beam welding of stamped sheet metals a previous cleaning of the sheets is usually necessary to guarantee a sufficient seam quality at a lap joint. Due to the recent trend towards low use of lubricants in forming operations the question arises, whether this process could be avoided in order to lower the production costs. The disadvantage of this measure would be a degradation of the seam quality. This reduction shows up in a falling strength of the weld due to inclusions and pore formation. This paper deals with the impact of different types of contaminations on the quality of laser welding. Therefore several liquid (oils) and solid (metallic and non-metallic) contaminants are examined. Zinc coated sheets are investigated too, because a zinc contamination arises with these sheets in the welding operation. The zinc coating evaporates because of the high temperature and this leads to a high porosity in the welding seam. In both cases also the height of the gap between the two sheets is varied in order to investigate its influence on the weld. To reduce the effort of the investigations, but not the accuracy of the results, the laboratory trials were supported by the methods of design of experiments. After the welding operation, the quality of the welding seam is evaluated by means of its mechanical properties and tightness. The results of the investigations are discussed and the developed solution strategies are presented.

scholarly journals IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA

2021 ◽  
pp. 20-23
Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Study Data ◽  
Defined Daily Dose ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Daily Dose ◽  
The Impact ◽  
Method Show

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.

scholarly journals Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252407
Author(s):  
Daniel Doyle ◽  
Gerald McDonald ◽  
Claire Pratt ◽  
Zahra Rehan ◽  
Tammy Benteau ◽  
...  
Keyword(s):  
Decision Support ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Support Tool ◽  
Survey Tool ◽  
Before And After ◽  
The Impact

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

scholarly journals 159. Characterization of Suboptimal Discharge Antimicrobial Prescriptions and Effect of Inpatient Audit and Feedback on Quality of Antimicrobial Prescribing

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S190-S190
Author(s):  
Lauren M Puckett ◽  
Laura Bio ◽  
Sean Cornell ◽  
Torsten Joerger ◽  
Hayden T Schwenk ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
National Guidelines ◽  
Dose Frequency ◽  
Free Standing ◽  
Antimicrobial Prescribing ◽  
Amoxicillin Clavulanate ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Approximately 30% of children are discharged from the hospital with an antimicrobial prescription; nearly a third of these prescriptions are suboptimal. Although the best approach to antimicrobial stewardship of discharge prescriptions remains uncertain, prospective audit and feedback (PAF) has improved inpatient antimicrobial use. We aimed to identify and characterize suboptimal discharge antimicrobial prescribing and assess the impact of inpatient PAF on the quality of discharge antimicrobial prescribing at a free-standing children’s hospital. Methods A retrospective review of enteral discharge antimicrobial prescriptions between 12/1/20-5/31/21 and parenteral antimicrobial prescriptions sent to our hospital’s infusion pharmacy between 3/1/21-5/31/21 was performed to determine if suboptimal or not. A prescription was determined to be suboptimal if the antimicrobial choice, dose, frequency, duration, formulation, or indication was not consistent with institutional and/or national guidelines. Data collection included the antimicrobial, indication, and prescribing medical service. Prescriptions were evaluated for a corresponding inpatient PAF for the same drug and indication and then stratified based on inpatient PAF completion. Results A total of 1192 discharge prescriptions for 698 unique patients over 834 hospital encounters were reviewed. Overall, 243 (20%) prescriptions were identified as suboptimal; reasons were duration (16%), dose (8%), frequency (5%), or antimicrobial choice, formulation, or route (≤1%). Prescriptions for cephalexin had the highest rate of suboptimal prescribing (80/167, 48%), followed by amoxicillin-clavulanate (89/203, 44%). A corresponding inpatient PAF was identified for 675 (57%) of discharge antimicrobial prescriptions. Inpatient PAF prior to discharge resulted in fewer suboptimal discharge prescriptions for the same antimicrobial (8% vs. 36%, p < 0.001). Conclusion Antimicrobial prescribing at inpatient discharge was suboptimal in 1 of every 5 prescriptions. Inpatient PAF was associated with improved antimicrobial prescribing at hospital discharge. Antimicrobial stewardship programs should continue to explore ways to capture and intervene on antimicrobials prescribed at discharge. Disclosures Hayden T. Schwenk, MD, MPH, Nothing to disclose

scholarly journals Hospital Information Systems (HIS) in the Examination Rooms and Wards: Doctors Perceived Positive Impact on Quality of Care and Patient Safety

2018 ◽  
Vol 7 (2.29) ◽  
pp. 871 ◽  
Author(s):  
Lizawati Salahuddin ◽  
Zuraini Ismail ◽  
. .
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Information Systems ◽  
Positive Impact ◽  
Healthcare Services ◽  
Hospital Information Systems ◽  
Structured Interviews ◽  
Healthcare Organizations ◽  
The Impact

Hospital Information Systems [HIS] is developed to support healthcare organizations in providing efficient, quality, and safe healthcare services. The objective of this study is to identify and describe doctors’ perspective on the impact of HIS use in the examination rooms and wards on quality of care and patient safety. Semi-structured interviews were carried out with thirty one doctors from three Malaysian government hospitals. Thematic qualitative analysis was performed by using ATLAS.ti to deduce the relevant themes. HIS were commonly believed to improve quality of care and patient safety in terms of : [1] accessibility of patients’ record, [2] efficient patient-care, [3] well-structured report viewing, [4] less missing patients’ records, [5] legibility of patients’ records, and [6] safety features. In conclusion, the use of HIS in examination rooms and wards suggests to improve the quality of care and patient safety.  

The association of baseline anxiety and depression with overall survival (OS) in colorectal cancer (CRC).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 706-706
Author(s):  
Pierre Y. Cheung ◽  
Tian Yang Darren Liu ◽  
Jason D. Kim ◽  
Winson Y. Cheung
Keyword(s):  
Quality Of Life ◽  
Cancer Survival ◽  
Cox Regression ◽  
Significant Proportion ◽  
Vital Statistics ◽  
Anxiety And Depression ◽  
Psychosocial Wellbeing ◽  
Patient Reported ◽  
The Impact

706 Background: Patient-reported measures such as psychosocial wellbeing and quality of life have been reported to correlate with cancer survival, but the specific factors within these constructs that associate with outcomes remains poorly defined. Our aim was to examine the effect of baseline anxiety and depression on OS in a population-based cohort of CRC patients. Methods: Patients diagnosed with CRC in 2008, referred to any 1 of 5 regional cancer centers in British Columbia, and who completed a baseline questionnaire to evaluate anxiety and depression were reviewed. We developed a scoring system based on these patient-reported survey data to characterize intensity and subsequently categorized patients as having no, mild, moderate or severe anxiety and/or depression. Vital statistics were captured by medical records. Unadjusted Kaplan-Meier methods and multivariate Cox regression models that controlled for additional socio-demographic and clinical characteristics were constructed to correlate anxiety and depression with OS. Results: A total of 449 patients were included: median age was 66 years (range 26-92), 52% were men, and 69% were white. A significant proportion of respondents reported anxiety (58%) or depression (45%) at baseline. Among them, the majority indicated their anxiety and depressive symptoms were severe (43% and 43%, respectively). Women and those who were single or unmarried were more likely to have anxiety and depression (p<0.001 and p=0.02, respectively). In unadjusted analyses, we observed a trend where increased severity of anxiety (p=0.07) and depression (p=0.04) correlated with worse outcomes. In Cox regression that considered other prognostic factors, however, this observation failed to persist, and neither anxiety nor depression associated with OS (Table). Conclusions: The impact of psychosocial wellbeing and quality of life on CRC outcomes that have been previously described in the literature are unlikely to be mediated through baseline anxiety or depression. [Table: see text]

Long-Term Antibiotics in Bronchiectasis

2021 ◽  
Vol 42 (04) ◽  
pp. 606-615
Author(s):  
Guillermo Suarez-Cuartin ◽  
Marta Hernandez-Argudo ◽  
Lidia Perea ◽  
Oriol Sibila
Keyword(s):  
Quality Of Life ◽  
Bacterial Resistance ◽  
Bacterial Load ◽  
Significant Proportion ◽  
Exacerbation Rate ◽  
Inhaled Antibiotics ◽  
Post Hoc ◽  
The Impact

AbstractA significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on patient quality of life, lung function, and exacerbation rate has not been consistent across trials. In this regard, recent post hoc analyses of inhaled antibiotics trials in bronchiectasis patients have shown that sputum bacterial load may be a key biomarker to predict treatment response in these patients. Oral macrolides, on the other hand, have proven to reduce exacerbation frequency and improve quality of life, but potential drug-related adverse effects and the increase in bacterial resistance are relevant. This review aims to summarize current important evidence for long-term antibiotic treatment in bronchiectasis patients.

Track damage comparison between conventional and articulated trains operating on a Great Britain railways ‘classic’ mainline route and a high-speed route

2018 ◽  
Vol 233 (7) ◽  
pp. 743-761 ◽  
Author(s):  
Andy Rhodes ◽  
Geoff Hunt ◽  
Neil Harwood ◽  
Naim Kuka ◽  
Laurent Baron ◽  
...  
Keyword(s):  
Great Britain ◽  
High Speed ◽  
Significant Proportion ◽  
Cost Savings ◽  
Potential Cost ◽  
Strategic Model ◽  
Design Characteristics ◽  
Architecture And Design ◽  
The Impact

The impact of train architecture and design characteristics on track deterioration accounts for a significant proportion of the whole-life costs of operating a railway. Introducing new train fleets with an expected life in excess of 30 years means that it is important to optimise train design to minimise track deterioration, maximise track life and realise long-term cost savings. Furthermore, higher traffic tonnage (from more frequent services) and increased train acceleration and speeds will cause increasing track deterioration rates; therefore, this issue is central to managing a sustainable railway in future. The track ‘friendliness’ of a train is determined by several ‘vehicle/track interaction’ parameters: train mass, axle load, number of axles, bogie unsprung mass, traction power, suspension ride forces and speed. The Vehicle/Track Interaction Strategic Model (VTISM) can be used to analyse the effect of these parameters on track forces and the resultant track deterioration and maintenance and renewal costs. This paper describes a study undertaken using the VTISM to investigate the impact of axle loads and train architecture on vertical deterioration and costs of ballasted track on a Great Britain railways ‘classic’ mainline route (up to 125 mph) and, following VTISM upgrading and validation, a high-speed route (up to 360 km/h). It identifies where potential cost advantages may be obtained when comparing conventional trains with new, alternative train architectures.

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