scholarly journals 76. Optimizing Clinical Outcomes in Geriatric Patients through a Multidisciplinary Hospital Antimicrobial Stewardship Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S56-S56
Author(s):  
James Mauro ◽  
Saman Kannangara ◽  
Roman A Tuma
Keyword(s):  
Antimicrobial Stewardship ◽  
Hospital Readmission ◽  
Geriatric Patients ◽  
Hospital Readmissions ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Day Hospital ◽  
Intervention Period ◽  
Stewardship Program ◽  
Definitive Therapy

Abstract Background Antimicrobial Stewardship Programs (ASP) aim to ensure the appropriate use of antibiotics. There is limited literature evaluating ASP outcomes in hospitalized geriatric patients who are at higher risk for developing Clostridium difficile infection (CDI) or other adverse outcomes. The primary objective of this study was to determine if ASP efforts in this age group decreases the rate of 30-day hospital readmissions due to reinfection or development of CDI, hospital length of stay (LOS) and mortality. Methods A retrospective chart review was performed to compare the rates of 30-day hospital readmissions because of reinfection or development of CDI in patients 65 years and older who received ASP interventions between January and June 2017. A control group of patients 65 years and older who received antibiotics between January and June 2015 (pre-ASP) was analyzed for comparison. We also assessed their mortality rate and LOS. Patients were included if they received antibiotics for pneumonia (PNA), urinary tract infection (UTI), acute bacterial skin and skin structure infection (ABSSSI) and complicated intra-abdominal infection (cIAI). The ASP team consisted of an infectious diseases physician and a clinical pharmacist who met daily to review patients on broad spectrum antibiotics. ASP interventions consisted of de-escalation of empiric or definitive therapy, change in duration of therapy or discontinuation of therapy. Results Overall, 834 patients (540 control; 294 intervention) were included. The 30-day hospital readmission rate for all infection types decreased during the intervention period (19.6% vs 4.8%, P=0.0001). Both the development of CDI during hospital stay and 30-day readmission due to CDI during the intervention period decreased (2.6% vs 0.34%, P=0.019). There was no statistically significant decrease in 30-day hospital readmissions in the PNA (58.5% vs. 35.7%, P=0.11), UTI (18.9% vs. 35.7%, P=0.15), ABSSSI (12.3% vs. 21.4%, P=0.34) or cIAI (10.4% vs 7.1%, P=0.14) arms. There was no statically significant change in LOS (7.50 days vs 7.26 days, P=0.48) or mortality (9.6% vs 6.5%, P=0.12). Conclusion Multidisciplinary ASP efforts significantly reduced 30-day hospital readmission rates and development of CDI in hospitalized patients 65 years and older. Disclosures All Authors: No reported disclosures

scholarly journals Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e052755
Author(s):  
Filipa Pereira ◽  
Henk Verloo ◽  
Taushanov Zhivko ◽  
Saviana Di Giovanni ◽  
Carla Meyer-Massetti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Drug Regimen ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Day Hospital ◽  
Medical Conditions ◽  
Older Inpatients ◽  
Drug Regimens

ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

scholarly journals 2003. Vancomycin Discontinuation Is Supported by-negative Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) in Patients with Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S671-S672
Author(s):  
Katherine A Pleasants ◽  
Karly Low ◽  
Sara A Lucas ◽  
Audrey Kivlehan ◽  
Ronald G Washburn
Keyword(s):  
Diagnostic Test ◽  
Rapid Diagnostic Test ◽  
Hospital Readmission ◽  
Hospital Length Of Stay ◽  
Causative Organism ◽  
Day Hospital ◽  
Intervention Phase ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Significant Difference

Abstract Background A negative nasal MRSA PCR test has a 98–99.6% sensitivity in confirming that MRSA is not the causative organism associated with pneumonia in hospitalized patients. Evidence supporting the clinical utility of nasal MRSA PCR testing in the Veteran patient population is limited, with no identified publications to date. The purpose of this project was to share outcomes associated with implementation of nasal MRSA PCR testing in the Veteran population to guide duration of vancomycin therapy. Methods This retrospective cohort quality initiative compared treatment of pneumonia that included vancomycin during a pre-Antimicrobial Stewardship Program (ASP) intervention phase (August 2013–February 2014) to an active ASP intervention phase (August 2017–March 2019). ASP intervention consisted of utilization of a negative nasal MRSA PCR as a rapid diagnostic test to support discontinuation of vancomycin prior to microbiologic culture results. Retrospective chart review evaluated vancomycin days of therapy (DOT), hospital length-of-stay (LOS), 30-day hospital readmission, and 30-day mortality. Patients admitted to the intensive care unit during the identified hospitalization were excluded. Results The average vancomycin DOT significantly declined by 1.08 days when comparing the pre-ASP intervention phase (N = 25) to the ASP-intervention phase (N = 47) (3.6 vs. 2.52 days, respectively; P = 0.0088). Mean hospital LOS decreased by 1.5 days (6.04 vs. 4.54 days, respectively, P = 0.0885). There was no significant difference in 30-day hospital readmission rate (12% vs. 8.5%) or 30-day mortality rate (12% vs. 10%). Conclusion Vancomycin DOT was reduced by 30% (1.08 days) and hospital LOS was reduced by 24.8% (1.5 days) in patients with pneumonia during a Vet. Affairs medical center’s utilization of negative nasal MRSA PCR testing to support vancomycin discontinuation. This project highlights the role of nasal MRSA PCR as a rapid diagnostic test to aid in diminishing empiric vancomycin usage and its associated toxicities. Disclosures All authors: No reported disclosures.

Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis

2021 ◽  
pp. 089719002110212
Author(s):  
Brandy Williams ◽  
Justin Muklewicz ◽  
Taylor D. Steuber ◽  
April Williams ◽  
Jonathan Edwards
Keyword(s):  
Hospital Readmission ◽  
Average Length ◽  
Hospital Readmissions ◽  
Standard Of Care ◽  
Economic Outcomes ◽  
Day Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Average Length Of Stay ◽  
Observational Cohort ◽  
The Difference

Background: Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy. Methods: This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Adult patients 18 years and older treated for acute uncomplicated cellulitis between February 2015 to December 2018 were eligible for inclusion. Information was obtained from hospital and billing department records. Patients were assigned to either inpatient SoC or outpatient oritavancin cohorts for comparison. Results: 1,549 patients were included in the study (1,348 in the inpatient SoC cohort and 201 in the outpatient oritavancin cohort). The average length of stay for patients admitted was 3.6 ± 1.5 days. The primary outcome of 30-day hospital readmission or admission due to cellulitis occurred in 49/1348 (3.6%) patients in the inpatient SoC cohort versus 1/201 (0.5%) in the outpatient oritavancin cohort (p = 0.02). The difference between costs and reimbursement was improved in the outpatient oritavancin group (p < 0.001). Conclusion: Outpatient oritavancin for acute uncomplicated cellulitis was associated with reduction in 30-day hospital readmissions or admissions compared to inpatient SoC. Beneficial economic outcomes for the outpatient oritavancin cohort were observed. Additional studies are required to confirm these findings.

scholarly journals Effective Antibiotic Conservation by Emergency Antimicrobial Stewardship During a Drug Shortage

2016 ◽  
Vol 38 (3) ◽  
pp. 356-359 ◽  
Author(s):  
Kevin Hsueh ◽  
Maria Reyes ◽  
Tamara Krekel ◽  
Ed Casabar ◽  
David J. Ritchie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Antimicrobial Stewardship ◽  
Hospital Length ◽  
Antimicrobial Drug ◽  
Hospital Length Of Stay ◽  
Antimicrobial Stewardship Program ◽  
Drug Shortage ◽  
Stewardship Program ◽  
Formulary Restriction

We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged.Infect Control Hosp Epidemiol 2017;38:356–359

The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

2018 ◽  
Vol 39 (12) ◽  
pp. 1400-1405 ◽  
Author(s):  
Erika M. C. D’Agata ◽  
Curt C. Lindberg ◽  
Claire M. Lindberg ◽  
Gemma Downham ◽  
Brandi Esposito ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Prescribing Patterns ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Positive Effects ◽  
Antimicrobial Prescribing ◽  
Stewardship Program ◽  
Dialysis Facilities

AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

scholarly journals Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

2019 ◽  
Vol 10 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Brian L. Dial ◽  
Valentine R. Esposito ◽  
Richard Danilkowicz ◽  
Jeffrey O’Donnell ◽  
Barrie Sugarman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Multivariable Logistic Regression Analysis ◽  
Day Hospital ◽  
Readmission Rates ◽  
Factors Associated ◽  
Asa Score ◽  
Surgery Patient ◽  
Extended Length

Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced Pharmacy Practice Experience Students

2018 ◽  
Vol 33 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Nghi (Andy) Bui ◽  
Mobolaji Adeola ◽  
Rejena Azad ◽  
Joshua T. Swan ◽  
Kathryn S. Agarwal ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Pharmacy Practice ◽  
Pharmacy Students ◽  
Day Hospital ◽  
Practice Experience

Background: Older adults with cognitive impairment may have difficulty understanding and complying with medical or medication instructions provided during hospitalization which may adversely impact patient outcomes. Objective: To evaluate the prevalence of cognitive impairment among patients aged 65 years and older within 24 hours of hospital admission using Mini-Cog™ assessments performed by advanced pharmacy practice experience (APPE) students. Methods: Students on APPE rotations were trained to perform Mini-Cog™ assessments during routine medication education sessions from February 2017 to April 2017. The primary end point was the prevalence of cognitive impairment indicated by a Mini-Cog™ score of ≤3. Secondary end points were the average number of observed Mini-Cog™ practice assessments required for APPE students to meet competency requirements, caregiver identification, and 30-day hospital readmissions. Results: Twelve APPE students completed the training program after an average of 4.4 (standard deviation [SD] = 1.0) graded Mini-Cog™ assessments. Of the 1159 admissions screened, 273 were included in the analysis. The prevalence of cognitive impairment was 55% (n = 149, 95% confidence interval [CI]: 48%-61%). A caregiver was identified for 41% (n = 113, 95% CI: 35%-47%) of patients, and 79 patients had a caregiver present at bedside during the visit. Hospital readmission within 30 days of discharge was 15% (n = 41, 95% CI: 11%-20%). Conclusion: Cognitive impairment could substantially impair a patient’s ability to comprehend education provided during hospitalization. Pharmacy students can feasibly perform Mini-Cog™ assessments to evaluate cognitive function, thereby allowing them to tailor education content and involve caregivers when necessary.

scholarly journals Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? — A case-historical control study

2021 ◽  
pp. 1-10
Author(s):  
Dennis Kim Chung Mo ◽  
Ken Kin Ming Lau ◽  
Donna Mei Yee Fung ◽  
Bosco Hon Ming Ma ◽  
Titanic Fuk On Lau ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Geriatric Patients ◽  
Historical Control ◽  
Hospital Length Of Stay ◽  
Lower Percentage ◽  
Control Group ◽  
Study Group ◽  
Rehabilitation Hospital

Objective: To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training. Methods: A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals. Results: With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ([Formula: see text]) and significant higher MBI scores ([Formula: see text] deviation, median; Study group: [Formula: see text] points, 51 points; Control group: [Formula: see text] points, 43 points; [Formula: see text]) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: [Formula: see text] points, 7 points; Control group: [Formula: see text] points, 6 points; [Formula: see text]) and MBI scores (Study group: [Formula: see text] points, 68 points; Control group: [Formula: see text] points, 64 points; [Formula: see text]) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: [Formula: see text] days, 7 days; Control group: [Formula: see text] days, 6 days; [Formula: see text]). The average LOS in rehabilitation hospital (Study group: [Formula: see text] days, 20 days; Control group: [Formula: see text] days, 23 days; [Formula: see text]) and total in-patient LOS (Study group: [Formula: see text] days, 26 days; Control group: [Formula: see text] days, 28 days; [Formula: see text]) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, [Formula: see text]). Conclusion: Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.

scholarly journals The Contribution of Pharmacogenetic Drug Interactions to 90-Day Hospital Readmissions: Preliminary Results from a Real-World Healthcare System

2021 ◽  
Vol 11 (12) ◽  
pp. 1242
Author(s):  
Sean P. David ◽  
Lavisha Singh ◽  
Jaclyn Pruitt ◽  
Andrew Hensing ◽  
Peter Hulick ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Hospital Admission ◽  
Drug Interactions ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Day Hospital ◽  
Limited Data ◽  
Study Population ◽  
The Relationship ◽  
Univariate Analyses

Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there are limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010 to 2020 in a study population (N = 10,104) who underwent sequencing with a 14-gene pharmacogenetic panel. The presence of at least one pharmacogenetic indicator for a medication prescribed within 30 days of hospital admission was considered a gene-x-drug interaction. Multivariable logistic regression analyzed the association between one or more gene-x-drug interactions with 90-day readmission. There were 2211/2354 (93.9%) admitted patients who were prescribed at least one CPIC medication. Univariate analyses indicated that the presence of at least one identified gene-x-drug interaction increased the risk of 90-day readmission by more than 40% (OR = 1.42, 95% confidence interval (CI) 1.09–1.84) (p = 0.01). A multivariable model adjusting for age, race, sex, employment status, body mass index, and medical conditions slightly attenuated the effect (OR = 1.32, 95% CI 1.02–1.73) (p = 0.04). Our results suggest that the presence of one or more CPIC gene-x-drug interactions increases the risk of 90-day hospital readmission, even after adjustment for demographic and clinical risk factors.

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