scholarly journals 603. Evaluating the Effects of Centers for Medicare & Medicaid Services Sepsis Core Measure in a Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
So Kim ◽  
Peter Ty
Keyword(s):  
Length Of Stay ◽  
Improve Patient Care ◽  
Prescribing Patterns ◽  
Hospital Length Of Stay ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Negative Consequences ◽  
Treatment Standards ◽  
Core Measure ◽  
Core Measures

Abstract Background Sepsis is the leading cause of morbidity and mortality in hospitals, accounting for 30% of deaths in the emergency department. In 2001, Rivers et al. found that early goal-directed therapy (EGDT) led to significant mortality benefits, which ultimately prompted United States Centers for Medicare and Medicaid Services (CMS) to mandate EGDT in hospitals through its implementation of sepsis core measures. CMS core measures are intended to facilitate the broad implementation of evidence-based treatment standards, and while voluntary, non-compliance is associated with negative consequences to both quality and financial metrics for participating hospitals. However, while quality measures are implemented to ultimately improve patient care, its effects on the healthcare system can also include negative unanticipated consequences. This study seeks to characterize the effect of the CMS sepsis core measure on sepsis identification, antimicrobial utilization, and nd specific prescribing patterns. Methods This is a retrospective cohort review of 175 randomly selected patients greater than and equal to 18 years of age with admitting diagnosis of sepsis, severe sepsis, and septic shock from January 2013 to December 2018. Medical charts were reviewed for relevant data. Results Comparing ED antibiotic prescribing patterns between pre-and post-Sepsis CMS Core Measures, there was no statistical difference in total antibiotics usage and the initiation of broad antibiotics. There was a decreased time to the first antibiotic, an increase in receiving Normal Saline boluses post-Sepsis CMS Core Measures. Conclusion 1. No significant changes were seen in ED antibiotic prescribing behaviors with regard to volume and spectrum 2. ED time to antibiotic administration was significantly faster after the implementation of CMS Core Measures. Also, there was a significant positive shift in time to fluid bolus, fluid selection, and fluid volume 3. Significantly decreased ICU length of stay after implementation of CMS Core Measures possibly associated with above behavior changes 4. No outcomes benefits (mortality, hospital length of stay) realized after implementation of CMS Core Measures Disclosures All Authors: No reported disclosures

scholarly journals Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin

2021 ◽  
Vol 1 (S1) ◽  
pp. s31-s32
Author(s):  
Amanda Gusovsky ◽  
David Burgess ◽  
Donna Burgess ◽  
Emily Slade ◽  
Chris Delcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Length Of Hospital Stay ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None

scholarly journals Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

2019 ◽  
Vol 8 (8) ◽  
pp. 1902
Author(s):  
Sumit Kumar Gupta ◽  
Siddhartha Ghosh
Keyword(s):  
Tertiary Care ◽  
Relevant Information ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Beta Lactam ◽  
Cross Sectional ◽  
Before And After ◽  
Surgery Department

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

Does Timely Antibiotic Administration Decrease Hospital Length of Stay in Chorioamnionitis?

2014 ◽  
Vol 123 ◽  
pp. 47S
Author(s):  
Pooja D. Doehrman ◽  
Laurie Erickson ◽  
Judith Adams ◽  
Melissa Molyneux
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antibiotic Administration

scholarly journals Evaluation of Antibiotic Prescribing Patterns in Paediatric Dental Patients: Cross - Sectional Epidemiological Study

2021 ◽  
Vol 25 (2) ◽  
pp. 122-128
Author(s):  
Tugba Yigit ◽  
Sibel Ezberci ◽  
Burcu Gucyetmez Topal
Keyword(s):  
Dental Trauma ◽  
Prescribing Patterns ◽  
Professional Experience ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Cross Sectional ◽  
Oral Infections ◽  
First Choice ◽  
General Dentists ◽  
Dental Infections

Summary Background/Aim: The purpose of this study was to investigate the antibiotic prescribing patterns for the treatment of paediatric oral infection, dental trauma and prophylaxis among dentists in Turkey. Material and Methods: A total of 206 paediatric dentists, including general dentists, paediatric dentists and specialist dentists, participated in this cross-sectional study. The questionnaire included questions about the number of paediatric patients treated and antibiotics prescribed, the most commonly prescribed antibiotic for oral infections and the clinical conditions under which antibiotics were prescribed. The participants’ ages, workplaces and professional experience were also evaluated. Results: The majority of the participants were paediatric dentists (45.1%) and general dentists (42.7%). For the management of dental infections, most dentists prescribed penicillin (94.7%). Their foremost prescription choices for the presence of an anaerobic infection were metronidazole (48.5%) and penicillin (32%). For dental trauma, the most common antibiotic-prescribed cases were avulsion and contaminated wounds, followed by alveolar fracture. Antibiotics were prescribed as a first choice for dental infections and dental infections of anaerobic origin, with no significant differences between professional experience or dental specialty in the dentists (p > 0.05). Practitioners belonging to Ministry of Health dental centres significantly differed from all other groups in preferring the antibiotic cephalosporin for dental infections of anaerobic origin. Conclusions: Adherence to published guidelines for antibiotic prescriptions for anaerobic dental infections and dental trauma was low. Clearer, more specific guidelines and increased post-graduate education could lead to a reduction in the negative consequences of this issue’s resultant over-prescribed antibiotics.

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.

scholarly journals Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

2020 ◽  
Vol 75 (12) ◽  
pp. 3458-3470 ◽  
Author(s):  
Angel Chater ◽  
Hannah Family ◽  
Rosemary Lim ◽  
Molly Courtenay
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Social Influences ◽  
Public Awareness ◽  
Theoretical Domains Framework ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Prescribing Behaviour ◽  
Tract Infections

Abstract Background The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections. Objectives To identify what evidence exists regarding the influences on NMPs’ antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF). Methods The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF. Results The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences. Conclusions The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).

Abstract TP362: Stroke Order Set Utilization Improves Performance Measures and Decreases Length of Stay

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Danielle K Gritters ◽  
Tricia M Tubergen ◽  
Laurel M Packard ◽  
Muhib A Khan
Keyword(s):  
Length Of Stay ◽  
Hospital Data ◽  
Stroke Patients ◽  
Thromboembolism Prophylaxis ◽  
Stroke Registry ◽  
Order Sets ◽  
Specific Order ◽  
Core Measure ◽  
Core Measures ◽  
Order Set

Introduction: Stroke quality programs aim to ensure patients receive evidence based care by measuring patient outcomes and adherence to core measures. Site specific stroke order sets embedded in EHRs augment core measure performance. The true benefit of stroke order sets on core measure performance is still an open question. We hypothesize that utilizing stroke specific order sets increases compliance to core measures and subsequently decrease length of stay (LOS) and readmissions. Methods: A retrospective cohort study was conducted, and included 1095 stroke patients discharged between May 1, 2017 and April 30, 2018. Hospital data was extracted from The Joint Commission stroke registry and supplemented with administrative data. The primary outcome was core measure compliance and was analyzed using Chi-square and Cochran-Mantel-Haenszel tests. Results: The majority of stroke patients (1009, 92%) had a stroke admission order set. Between the order set and non-order set groups there were significant differences in age ( p =.03), stroke type ( p <.001), and EHR system ( p =0.002). The order set group had a marginal decrease in LOS (days) compared with the non-order set group, 3 and 3.9, respectively ( p =.06). Unplanned readmissions within 30-days did not differ between groups ( p =.16). For ischemic stroke, phase specific order set usage showed significantly higher core measure compliance: venous thromboembolism prophylaxis (STK1) (94.0% vs 6.0%, p =.01), antithrombotic by end of hospital day two (STK5) (96.9% vs 73.3%, p <.001), discharged on statin medication (STK6) (99.8% vs 97.5%, p =.006), stroke education (93.3% vs 47.1%, p <.001) (STK8), and national institute of health stroke scale within 12 hours of arrival (CSTK1) (95.8% vs 44.1%, p <.001). The hemorrhagic stroke population showed no significant differences between order set usage and core measure compliance. Conclusion: Use of stroke specific order sets decreased overall LOS and increased compliance to STK1, STK5, STK6, STK8, and CSTK1 core measures.

scholarly journals 213. An Analysis of the Impact of Gastrointestinal Polymerase Chain Reaction Panel Use on Antimicrobial use at a Tertiary Care Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S109-S109
Author(s):  
Zola Nlandu ◽  
Nicholas Piccicacco ◽  
Kristen Zeitler ◽  
Ripal Jariwala ◽  
Jose Montero
Keyword(s):  
Polymerase Chain Reaction ◽  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antimicrobial Use ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
The Impact

Abstract Background Gastrointestinal Polymerase Chain Reaction (GI PCR) panels are increasingly utilized in place of conventional stool testing methods. Several studies have noted GI PCR testing is associated with a reduction in antibiotic prescribing. As it relates to the appropriate timing to order this test in hospitalized patients, one study showed decreased utility when ordered more than 72 hours into admission. At Tampa General Hospital, we utilize the BioFire® FilmArray® GI PCR panel. Since implementation in March 2015, its impact on antimicrobial use has not been formally assessed. Our aim was to evaluate the impact of the GI PCR panel and determine its usefulness as a potential tool for antimicrobial stewardship. Methods We conducted an IRB approved retrospective chart review in adult patients admitted to our institution who were ordered the GI PCR panel between 1/1/2018 and 12/31/19. Our primary objective was to assess antimicrobial prescribing patterns; secondary objectives included determining the quantity of tests ordered after 72 hours of admission and inpatient length of stay. Results Our initial chart review of 50 patients who were ordered the GI PCR panel revealed 60 % (n = 30) females with an overall median age of 55 years (interquartile range (IQR): 40.75,66.75). GI PCRs were ordered a median of 1 day into the hospital admission (IQR: 1,3) with 6 patients having a test ordered longer than 72 hours into their admission. The median length of stay was 5 days (IQR: 3,7). Testing was negative for 82 % of patients. For patients with positive tests, the most common pathogen identified was E coli (EPEC). Five out of 50 patients (10%) had antimicrobial therapy modified after GI PCR results. Internal medicine providers ordered the majority of tests in these patients (n = 26 (52 %)). Conclusion Our findings suggest the majority of GI PCRs were ordered within 72 hours of admission. However, changes in antimicrobial therapy were minimal. A limitation of our study includes patients who were on antimicrobials for other indications. Disclosures All Authors: No reported disclosures

A prospective quality improvement study in the emergency department targeting paediatric sepsis

2016 ◽  
Vol 101 (10) ◽  
pp. 945-950 ◽  
Author(s):  
Elliot Long ◽  
Franz E Babl ◽  
Eleanor Angley ◽  
Trevor Duke
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Quality Improvement ◽  
Length Of Stay ◽  
Venous Blood ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antibiotic Administration ◽  
Post Intervention ◽  
Intravenous Cannula

ObjectiveQuality improvement sepsis initiatives in the paediatric emergency department have been associated with improved processes, but an unclear effect on patient outcome. We aimed to evaluate and improve emergency department sepsis processes and track subsequent changes in patient outcome.Study designA prospective observational cohort study in the emergency department of The Royal Children's Hospital, Melbourne. Participants were children aged 0–18 years of age meeting predefined criteria for the diagnosis of sepsis. The following shortcomings in management were identified and targeted in a sepsis intervention: administration of antibiotics and blood sampling for a venous gas at the time of intravenous cannulation, and rapid administration of all fluid resuscitation therapy. The primary outcome measure was hospital length of stay.Results102 patients were enrolled pre-intervention, 113 post-intervention. Median time from intravenous cannula insertion to antibiotic administration decreased from 55 min (IQR 27–90 min) pre-intervention to 19 min (IQR 10–32 min) post-intervention (p≤0.01). Venous blood gas at time of first intravenous cannula insertion was performed in 60% of patients pre-intervention vs 79% post-intervention (p≤0.01). Fluids were administered using manual push-pull or pressure-bag methods in 31% of patients pre-intervention and 84% of patients post-intervention (p≤0.01). Median hospital length of stay decreased from 96 h (IQR 64–198 h) pre-intervention to 80 h (IQR 53–167 h) post-intervention (p=0.02). This effect persisted when corrected for unequally distributed confounders between pre-intervention and post-intervention groups (uncorrected HR: 1.36, 95% CI 1.04 to 1.80, p=0.02; corrected HR: 1.34, 95% CI 1.01 to 1.80, p=0.04).ConclusionsUse of quality improvement methodologies to improve the management of paediatric sepsis in the emergency department was associated with a reduction in hospital length of stay.

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