scholarly journals Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shayan Moosa ◽  
Lindsay Bowerman ◽  
Ellen Smith ◽  
Mindy Bryant ◽  
Natalie Krovetz ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Population ◽  
Medical Center ◽  
Academic Medical Center ◽  
Readmission Rates ◽  
Academic Medical ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

scholarly journals Effect of Obesity on Complications in Short-Scar Breast Reduction: A Retrospective Study of 236 Consecutive Patients

2018 ◽  
Vol 26 (4) ◽  
pp. 238-243
Author(s):  
Eleanor Rose Goldwasser Tomczyk ◽  
Ava Chappell ◽  
Nathaniel Erskine ◽  
Mustafa Akyurek
Keyword(s):  
Adverse Outcome ◽  
Medical Center ◽  
Reduction Mammaplasty ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Positive Trend ◽  
Academic Medical ◽  
Significant Difference ◽  
Short Scar

Background: Prior studies have examined the relationship between obesity and adverse outcomes after reduction mammaplasty, suggesting a correlation between increasing body mass index (BMI) and postoperative complications. However, there is little data published regarding such correlation with respect to short-scar technique. Methods: A total of 236 patients underwent short-scar mammaplasty with a superomedial pedicle from 2008 to 2014. The procedure was performed by a single surgeon at an academic medical center. Adverse outcomes included delayed healing, major wounds, nipple necrosis, fat necrosis, seroma, hematoma, infection, revision, and dog ear deformities. Univariate and multivariate logistic regression analyses were used to calculate crude and adjusted odds ratios for the association of BMI category with the development of any adverse outcome. Results: Patients were grouped by the following BMI categories: <25 kg/m2 (n = 27), 25 to <30 kg/m2 (n = 71), 30 to <35 kg/m2 (n = 73), 35 to <40 kg/m2 (n = 45), and >40 kg/m2 (n = 20). The mean follow-up period was 260 days. The total complication rate in each group was 22.2%, 23.9%, 27.4%, 33.3%, and 45.0%, respectively. Although the proportion of patients experiencing at least 1 adverse outcome increased across the ascending BMI categories ( P trend = .145), there was no statistically significant difference between the groups. Conclusion: This study of 236 patients who underwent short-scar reduction mammaplasty found a positive trend in the incidence of adverse outcomes as BMI increased. However, this was not statistically significant.

scholarly journals The Influence of Household Income on Survival following Posterior Fossa Tumor Resection at a Large Academic Medical Center

2020 ◽  
Author(s):  
Rachel Blue ◽  
Donald K. Detchou ◽  
Ryan Dimentberg ◽  
Kaitlyn Shultz ◽  
Michael Spadola ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Brain Tumor ◽  
Posterior Fossa ◽  
Household Income ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Academic Medical ◽  
Significant Difference

Abstract Objectives The present study examines the effect of median household income on mid- and long-term outcomes in a posterior fossa brain tumor resection population. Design This is a retrospective regression analysis. Setting The study conducted at a single, multihospital, urban academic medical center. Participants A total of 283 consecutive posterior fossa brain tumor cases, excluding cerebellar pontine angle tumors, over a 6-year period (June 09, 2013–April 26, 2019) was included in this analysis. Main Outcome Measures Outcomes studied included 90-day readmission, 90-day emergency department evaluation, 90-day return to surgery, reoperation within 90 days after index admission, reoperation throughout the entire follow-up period, mortality within 90 days, and mortality throughout the entire follow-up period. Univariate analysis was conducted for the whole population and between the lowest (Q1) and highest (Q4) socioeconomic quartiles. Stepwise regression was conducted to identify confounding variables. Results Lower socioeconomic status was found to be correlated with increased mortality within 90 postoperative days and throughout the entire follow-up period. Similarly, analysis between the lowest and highest household income quartiles (Q1 vs. Q4) demonstrated Q4 to have significantly decreased mortality during total follow-up and a decreasing but not significant difference in 90-day mortality. No significant difference in morbidity was observed. Conclusion This study suggests that lower household income is associated with increased mortality in both the 90-day window and total follow-up period. It is possible that there is an opportunity for health care providers to use socioeconomic status to proactively identify high-risk patients and provide additional resources in the postoperative setting.

Abstract 149: Distance From an Academic Medical Center: Implications on Medicare Penalties

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Colin McMahon ◽  
Rachel Sylvester ◽  
Ben Froehlich ◽  
Steve Erickson ◽  
Eva Kline-Rogers ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
National Average ◽  
Treatment Programs ◽  
Readmission Rates ◽  
Coronary Syndrome ◽  
Academic Medical ◽  
Significant Difference ◽  
Receive Treatment ◽  
Zip Code

Background: Medicare’s Readmission Reduction program fines hospitals with readmission rates that exceed the national average; however, standardized risk adjustment models do not take into account how far people live from an institution. Larger academic medical centers may be disadvantaged by this oversight. The purpose of this study was to determine if distance travelled could be predicted by length of stay (LOS) and comorbidity. Methods: The Bridging the Discharge Gap Effectively (BRIDGE) was accessed to obtain ZIP code, LOS and to calculate the Charlson Comorbidity Index for patients referred in 2012. Mean LOS was compared to national data from the HCUP database for acute coronary syndrome (ACS), heart failure (HF), and atrial fibrillation (AF). Distance from the medical center (MC) to the center of each ZIP code was evaluated for correlation with LOS and comorbidity. Local and Distant patients were defined as patients who lived within or outside a 40 mile radius of the MC. Results: A total of 785 were included in this analysis; mean age was 66.0 + 14.3 years and 60.9% were male. Overall, ACS patients had an average LOS 1 day less than the national average, whereas HF and AF patients stayed respectively 1.6 and 1.3 days longer than the national average. There was a significant difference in mean LOS for both ACS and HF patients who lived greater than 40 miles from the MC, (p=0.014, p=0.046). Although insignificant, Distant AF patients also had a mean LOS longer than that of local patients (p=0.12). For all patients who participated in the study, and for ACS patients in particular, there was a weak, but significant, relationship between LOS and distance from the MC (All: r=.18, n=785, p< .001; ACS: r=0.25, n=217, p<0.001), Conclusions: In this sample, LOS is positively correlated with distance from the MC. Because our institution is a large referral center, those referred from a distance are those who likely cannot be managed near their homes. As seen here, more complex HF and AF patients travel greater than 40 miles to receive treatment. Programs designed to decrease readmissions, like BRIDGE, may be less effective in these referral populations who may be less likely to travel for follow-up appointments. Further study is warranted to ascertain if distance should be part of standardized risk adjusting calculations.

Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Josephine F Huang ◽  
Jennifer E Fugate ◽  
Alejandro A Rabinstein
Keyword(s):  
Ischemic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Treatment ◽  
Good Outcome ◽  
Time Period ◽  
Academic Medical ◽  
Younger Age ◽  
Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

2019 ◽  
Vol 161 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Claudia Schweiger ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Balloon Dilation ◽  
Case Series ◽  
Slide Tracheoplasty ◽  
Time Period ◽  
Academic Medical ◽  
Operative Notes ◽  
Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

scholarly journals Long-term Persistence of an Extensively Drug-Resistant Subclade of Globally Distributed Pseudomonas aeruginosa Clonal Complex 446 in an Academic Medical Center

2019 ◽  
Vol 71 (6) ◽  
pp. 1524-1531 ◽  
Author(s):  
Nathan B Pincus ◽  
Kelly E R Bachta ◽  
Egon A Ozer ◽  
Jonathan P Allen ◽  
Olivia N Pura ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Clonal Complex ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Subset ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Academic Medical ◽  
Globally Distributed

Abstract Background Antimicrobial resistance (AMR) is a major challenge in the treatment of infections caused by Pseudomonas aeruginosa. Highly drug-resistant infections are disproportionally caused by a small subset of globally distributed P. aeruginosa sequence types (STs), termed “high-risk clones.” We noted that clonal complex (CC) 446 (which includes STs 298 and 446) isolates were repeatedly cultured at 1 medical center and asked whether this lineage might constitute an emerging high-risk clone. Methods We searched P. aeruginosa genomes from collections available from several institutions and from a public database for the presence of CC446 isolates. We determined antibacterial susceptibility using microbroth dilution and examined genome sequences to characterize the population structure of CC446 and investigate the genetic basis of AMR. Results CC446 was globally distributed over 5 continents. CC446 isolates demonstrated high rates of AMR, with 51.9% (28/54) being multidrug-resistant (MDR) and 53.6% of these (15/28) being extensively drug-resistant (XDR). Phylogenetic analysis revealed that most MDR/XDR isolates belonged to a subclade of ST298 (designated ST298*) of which 100% (21/21) were MDR and 61.9% (13/21) were XDR. XDR ST298* was identified repeatedly and consistently at a single academic medical center from 2001 through 2017. These isolates harbored a large plasmid that carries a novel antibiotic resistance integron. Conclusions CC446 isolates are globally distributed with multiple occurrences of high AMR. The subclade ST298* is responsible for a prolonged epidemic (≥16 years) of XDR infections at an academic medical center. These findings indicate that CC446 is an emerging high-risk clone deserving further surveillance.

Impacting Readmission Rates and Patient Satisfaction: Results of a Discharge Pharmacist Pilot Program

2011 ◽  
Vol 46 (11) ◽  
pp. 876-883 ◽  
Author(s):  
Samaneh Tavalali Wilkinson ◽  
Pal Aroop ◽  
J. Couldry Richard
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Control Group ◽  
Unplanned Readmission ◽  
Discharge Process ◽  
Readmission Rates ◽  
The Impact

Background Readmission to a hospital within 30 days of discharge has become a key quality outcome measure. With an observed 30-day readmission rate as high as 20% and attributed costs of almost $17.4 billion a year for Medicare patients, the potential implications for patients and the entire health care system are significant. Medication-related complications have been shown to increase the risk for unplanned readmission. Pharmacists have an opportunity to impact quality and cost by risk stratifying and identify patients at high risk for hospital readmission. Objective To study the impact of a pharmacist-driven discharge counseling program for high-risk patients identified by BOOST (Better Outcomes for Older adults through Safe Transitions) criteria on 30-day readmission rates. Method This was a prospective, cohort, nonrandomized trial at a single medical-surgical unit with telemetry capability at a single academic medical center including 669 patients who were older than 18 years. Primary outcome was 30-day readmission rate. Secondary outcomes were the number and type of pharmacist interventions, cost avoidance, and patient satisfaction results. Results The readmission rate for patients counseled by a pharmacist during the discharge process was 15.7% compared to 21.6% for patients not counseled by a pharmacist on discharge (relative risk [RR] 0.728; 95% confidence interval [CI], 0.514–1.032; P = .04). The readmission rate for adult medicine patients not counseled at discharge by a pharmacist in the study was comparable to the readmission rates of a similar patient control group at 3 months and 1 year prior to the initiation of the study (18.7% and 19.1% vs 19.6%). Conclusions Pharmacists' support in the discharge process facilitated increased communication on the multidisciplinary team and resulted in a lower unplanned readmission rate for patients.

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