62 The Essential Need of Having Dedicated Clinical Social Workers in Both the Burn Outpatient and Inpatient Setting

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S44-S45
Author(s):  
Margaret Dines ◽  
Tyler M Smith ◽  
Anne L Lambert Wagner
Keyword(s):  
Primary Care Physicians ◽  
Psychosocial Support ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Emergency Department Visits ◽  
Inpatient Setting ◽  
Full Time ◽  
Limited Bandwidth ◽  
Burn Center ◽  
Additional Support

Abstract Introduction By providing holistic support to the entire patient, a licensed clinical social worker (LCSW) plays an essential role on a Burn Center multidisciplinary team. A majority of our burn population exhibit difficulties in navigating the complex array of psychosocial issues in regard to basic needs such as employment, food, housing, and transportation. While these needs can be addressed with inpatients, our patients who follow-up in Burn Clinic face additional challenges. A need was identified to have a dedicated LCSW in the outpatient setting. Methods As with the continued growth of inpatient admissions in our burn center, our burn clinic encountered an even higher number of new patients. With limited bandwidth, our burn LCSW was seeing both inpatient and clinic patients. Recognizing the need for additional support, the hospital’s care management department approved a full-time outpatient Burn Clinic LCSW position. Their role will include trauma screens, mental health, and psychosocial support to patients in clinic rather than providing reactive support to the most acute patients. Results In FY2019, our Burn Center admitted 501 patients across a seven-state region. Our Burn Clinic saw 1132 patients with 1932 clinic visit encounters. In addition to seeing all admitted patients, our inpatient LCSW also saw 13.7% (n=155) of the clinic patients and had 175 documented encounters. Furthermore, 16.6% (n=188) of these clinic patients had a form of Medicaid Health Insurance. Conclusions The capacity to provide access and resources to our patients has been limited to the time of one LCSW. By hiring a dedicated Burn Clinic LCSW, we will be able to increase our patients’ abilities to navigate barriers, while limiting unnecessary hospital resources with Emergency Department visits and readmissions. The clinic LCSW will assist by finding primary care physicians, transportation and housing needs, applying for disability, and accessing community resources such as our SOAR support group.

scholarly journals Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0041
Author(s):  
Alfred Atanda ◽  
Kathryn Leyden ◽  
Medical Student
Keyword(s):  
Patient Satisfaction ◽  
Knee Pain ◽  
Sports Medicine ◽  
Clinic Visit ◽  
Background Information ◽  
Full Time ◽  
Visit Time ◽  
Medicine Clinic ◽  
Exam Room ◽  
Room Time

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

scholarly journals Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Felix S. Hussenoeder ◽  
Erik Bodendieck ◽  
Franziska Jung ◽  
Ines Conrad ◽  
Steffi G. Riedel-Heller
Keyword(s):  
Outpatient Setting ◽  
Work Life ◽  
Work Life Balance ◽  
Full Time ◽  
Life Balance ◽  
Specific Factors ◽  
Physician Mental Health ◽  
Outpatient Settings ◽  
Subsequent Patient

Abstract Background Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. Methods In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. Results Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. Conclusions Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

scholarly journals Death, hospitalization, emergency department visits and out-patient visits in patients with heart failure in contemporary practice: results from the prospective Europeam 9069-patient ARIADNE registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.H Lund ◽  
U Zeymer ◽  
A.L Clark ◽  
V Barrios ◽  
T Damy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Nyha Class ◽  
Class Ii ◽  
Emergency Department Visits ◽  
Funding Source ◽  
Office Visits ◽  
Private Company ◽  
Contemporary Practice

Abstract Background In Europe, heart failure (HF) is managed in variable settings and frequently in office-based practice. In HF with reduced ejection fraction (HFrEF) there is now extensive evidence based therapy, but implementation is inconsistent, variable and overall inadequate. The Assessment of Real lIfe cAre –Describing EuropeaN hEart failure management (ARIADNE) registry aimed to assess in detail how outpatients with HFrEF are managed in Europe in contemporary practice. Methods ARIADNE was a prospective non-interventional registry of patients with HFrEF (NYHA class II-IV) treated by office-based cardiologists or selected primary care physicians (recognized as HF specialists) in a real world setting. Patients were enrolled in 687 centres in 17 European countries, and studied at baseline and after 6 and 12 months. Key pre-specified outcomes were deaths, hospitalizations, emergency department visits, and office visits, and their primary reasons. Results Over 20 months, we enrolled 9069 patients; median age 69 (19–96) years, 24% women, with 30% older than 75 years, 61% NYHA class II, with a median EF 35% (30–40%). Over a median follow-up of 353 (1–631) days, 382 patients (4.3%) died, with 171 cardiovascular deaths (1.9%). The rates of total hospitalizations overall, for HF, and for non-HF cardiovascular reasons were 19.3, 8.1, and 4.8 per 100 patient years, respectively; and rates of emergency department visits overall, for HF reasons, and for non-HF CV reason were 7.7, 1.6, and 1.8, respectively. The number of HF office visits were on average 1.0 per patient. Conclusions In this large multinational HFrEF registry with detailed data on cause-specific outcomes and health care utilization, incidence of death was low and outpatient HF visits were few, but incidence of HF and CV hospitalization and emergency department visits was high. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis AG, Switzerland

High-Resolution Esophageal Manometry in the Inpatient Setting: A Tertiary Referral Center Experience

2021 ◽  
pp. 263451612110351
Author(s):  
Catiele Antunes ◽  
Elinor Zhou ◽  
Jad Abimansour ◽  
Daniella Assis ◽  
Olaya I. Brewer Gutierrez ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Resolution ◽  
Esophageal Manometry ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Additional Intervention ◽  
Lower Likelihood ◽  
Oral Diet

High-resolution esophageal manometry (HRM) is frequently used in the outpatient setting, but its role in the inpatient setting is unknown. We conducted a retrospective study of patients who underwent inpatient or outpatient HRM. Few differences were noted between groups and 28% of inpatients had an additional intervention. Tolerance of oral diet and diabetes were associated with a lower likelihood of additional intervention. Ultimately, the inpatient HRM group had unique characteristics and few subsequent interventions.

Abstract P841: The Impact of a Dedicated Pediatric Stroke Discharge Plan Upon Parent Preparedness for Clinic: Before and After the Start of Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Cindy Nederveld ◽  
Vivian Thompson ◽  
Jacqueline Murray ◽  
Jennifer L Armstrong ◽  
Megan Barry ◽  
...  
Keyword(s):  
Multidisciplinary Care ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Pediatric Stroke ◽  
Chi Square ◽  
Discharge Plan ◽  
Before And After ◽  
Appointment Time ◽  
Chi Square Analysis ◽  
The Impact

Background: The Colorado Pediatric Stroke Program provides comprehensive, multidisciplinary care for pediatric stroke patients and their families. The team, which includes dedicated inpatient and outpatient nurse coordinators, instituted a plan to support the transition from the inpatient to outpatient setting. Purpose: A survey was used to determine family preparedness for clinic and ease of scheduling their appointment. The data were collected before and after enacting remote scheduling and telehealth visits due to the COVID-19 pandemic. Methods: Our team provided educational materials and an outpatient appointment time to families at time of discharge starting in 2019. In January 2020, the stroke clinic staff surveyed parents and guardians about their preparedness for clinic. Telehealth encounters were initiated due to COVID-19 in March 2020, with staff conducting RedCAP surveys by telephone. The survey measured several components of visit preparedness and satisfaction including: understanding of diagnosis, reason for referral prior to clinic visit, familiarity with the stroke team prior to clinic visit, and ease in appointment scheduling. We compared results before and after March 2020 via two-tailed chi-square analysis or two-tailed Fischer’s test. Results: Prior to telehealth, families favorably reported responses with 92% (47/52) knowing the reason for referral, 86% (42/49) receiving educational material prior to clinic, and 84% (42/50) reporting familiarity with our team. All patients (50/50) reported that scheduling was easy. Only scheduling ease had a significant change during the pandemic, with 11% (2/11) of patients reporting difficulties with scheduling after starting telehealth ( P=0.03 ). Conclusion: Childhood stroke is a disease with significant morbidity and mortality, requiring close follow-up care. Families report robust preparedness for clinic after the implementation of a comprehensive discharge plan. Although small numbers, remote scheduling and telehealth transition may present previously unseen barriers to scheduling during the pandemic. During abrupt changes in clinical operations additional scheduling resources may be needed to ensure continuity of care.

A 6-Year Experience of Laser Treatments for Burn Scars in a Regional Burn Center—Safety, Efficacy, and Quality Improvement

2020 ◽  
Author(s):  
Christopher Q Zhang ◽  
Christina Gogal ◽  
Trent Gaugler ◽  
Sigrid Blome-Eberwein
Keyword(s):  
Common Adverse Effect ◽  
Treatment Method ◽  
Outpatient Setting ◽  
Modest Improvement ◽  
Burn Scar ◽  
Moderate Sedation ◽  
Burn Center ◽  
Average Improvement ◽  
Study Results ◽  
Laser Treatments

Abstract Laser treatments have long been used as a treatment method for burn scars. Since 2012, more than 1800 laser treatments were performed at Lehigh Valley Health Network Burn Center, far exceeding any previous cohort in studies exploring laser treatments for burn scars. Although previous research has looked at improving scar appearance and physiology with laser treatments, very few have focused on safety. The purpose of the study was to determine whether laser treatments are a safe treatment option for burn scars. Four hundred and fourteen patients who had undergone at least one laser treatment in the outpatient burn center since 2012 were analyzed. Electronic medical records (EPIC) were reviewed. The data were entered in REDCap and later exported to Microsoft Excel and R Studio for statistical analysis. Most of the complications found were related to the moderate sedation during the procedures and were mild, ie, nausea. The most common adverse effect was prolonged recovery time, which can affect practice flow. The overall postoperative complication rate for laser treatments with and without moderate sedation was minimal at 2.2% and 1.4%, respectively. Pain during and after the procedure averaged 3.9 and 1.7, respectively, on a 1 to 10 scale. The Vancouver Scar Scale showed modest improvement in scar appearance over time with an average improvement of 1.4. The high variability of the Vancouver Scar Scale observed in this series underlines its lack of sensitivity. The study results show that laser treatments for burn scars in the outpatient setting generally are safe for patients in need of burn scar intervention. Some practice flow adjustments need to be taken into consideration when offering these procedures in an outpatient setting.

scholarly journals Family-Centered Approach to Monitoring Children’s Development in a Paediatric Outpatient Setting: Feasibility Study from Pakistan

2021 ◽  
Author(s):  
Muneera A. Rasheed ◽  
Waliyah Mughis ◽  
Kinza N Elahi ◽  
Babar S. Hasan
Keyword(s):  
Service Providers ◽  
Psychosocial Support ◽  
Tertiary Care ◽  
Wait Time ◽  
Well Being ◽  
Parent Report ◽  
Outpatient Setting ◽  
Theory Of Change ◽  
Care Hospital ◽  
Family Centered

Abstract Background: The purpose of the study was to design and test the feasibility of a recent guideline of family-centered psychosocial support as an approach to developmental monitoring in a pediatric outpatient setting.Methods: The patient experience team at a private tertiary care hospital leveraged an on-going patient and family-centric initiative in the service to implement the intervention. The intervention delivery model was designed using the theory of change model and entailed the following i) the service providers: paediatricians but with support from psychology trainee volunteers to address time constraints; ii) monitoring form: Survey of Well-Being of Young Children (SWYC) being feasible and designed for regular developmental monitoring as parent report; iii) family support intervention: the Care for Child Development module to enhance parent-child interactions given team’s successful experience with inpatient children; iv) timing: utilize wait time to also enhance families’ experience and v) reinforcement: reinforced by the paediatrician in the consultation visit to capitalize on the established rapport and relationship with families. All families with children under 5 years 5 months of age in selected clinics (acute care, complex care, developmental issues) were eligible. The study was evaluated for acceptability and implementation feasibility. Families were interviewed about their experience; trainees provided a written narrative while physicians provided feedback on email. These were thematically analyzed using an inductive approach.Results: A total 182 families were administered the SWYC with 54% children detected for further review on cognitive milestones and 76% on social-emotional milestones. Forty-eight families were interviewed regarding their experience with the intervention. They reported the monitoring process to be useful and important for them as parents indicating acceptability. Paediatricians and trainees found the intervention to be important for parents and children’s health also requesting further understanding about child’s functioning. The trainees further expressed the experience to be significant for their own learning.Conclusion: The authors conclude that the intervention model for a family-centric approach to monitoring was acceptable to the families and the service providers. The intervention when implemented using a robust behaviour change framework can enhance feasibility.

Upper and Middle Lobe Atelectasis

Chest Imaging ◽  
2019 ◽  
pp. 93-97
Author(s):  
Christopher M. Walker
Keyword(s):  
Lung Cancer ◽  
Main Bronchus ◽  
Lower Lobe ◽  
Outpatient Setting ◽  
Middle Lobe ◽  
Inpatient Setting ◽  
Central Mass ◽  
Contrast Enhanced Ct ◽  
Left Hemidiaphragm ◽  
Contrast Enhanced

Upper and middle lobe atelectasis discusses the radiographic and computed tomography (CT) manifestations of upper and middle lobe atelectasis. The most common radiographic signs of right upper lobe atelectasis include upward and medial displacement of the minor fissure, superior displacement of adjacent structures such as the hilum and main bronchus, and ipsilateral shift of the mediastinal structures. The S sign of Golden results from a centrally obstructing lung cancer as the cause of the atelectasis and manifests as a reverse S configuration of the minor fissure outlined by atelectatic lung and central mass. Left upper lobe atelectasis manifests with a veil-like opacity on frontal radiography with leftward shift of upper mediastinal structures such as the trachea and upward shift of the left main bronchus and left hemidiaphragm. The Luftsichel sign or air crescent sign may be seen and represents the hyperexpanded superior segment of the left lower lobe outlining the transverse aortic arch. Lobar atelectasis in the inpatient setting is most commonly secondary to an obstructing mucus plug. Lobar atelectasis in the outpatient setting is often a heralding sign of a centrally obstructing lung cancer and should be further evaluated with contrast-enhanced CT and/or bronchoscopy.

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