scholarly journals 391. Small Towns, Big Cities: Rural and Urban Disparities Among Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S297-S298
Author(s):  
Caroline Hamilton ◽  
Deepak Nag Ayyala ◽  
David Walsh ◽  
Christian-Jevon Bramwell ◽  
Christopher Walker ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Census Data ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Level Of Care ◽  
P Value ◽  
Rural And Urban ◽  
The Impact

Abstract Background More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals; however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Baseline Characteristics of Hospitalized Patients with COVID-19 Day 30 Outcomes and Characteristics Level of Care at Time of Admission Conclusion This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Impact of Targeted Educational Interventions on Clostridium difficile Infection Treatment in Critically Ill Adults

2016 ◽  
Vol 51 (11) ◽  
pp. 901-906 ◽  
Author(s):  
Drayton A. Hammond ◽  
Catherine A. Hughes ◽  
Jacob T. Painter ◽  
Rose E. Pennick ◽  
Kshitij Chatterjee ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Care Providers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Strategy ◽  
Educational Interventions ◽  
Hospital Length Of Stay ◽  
Care Providers ◽  
The Impact ◽  
Post Period

Background Clostridium diffcile infection (CDI) is a growing clinical and economic burden throughout the world. Pharmacists often are members of the primary care team in the intensive care unit (ICU) setting; however, the impact of pharmacists educating other health care providers on appropriateness of CDI treatment has not been previously examined. Objective This study was performed to determine the impact of structured educational interventions on CDI treatment on appropriateness of CDI treatment and clinical outcomes. Methods This was a single-center, retrospective, cohort study of patients with CDI in the medical ICU at an academic medical center between January and June 2014 (pre-period) and 2015 (post-period). All patients were evaluated for appropriate CDI treatment before and after implementing pharmacist-provided educational interventions on CDI treatment. Results Patients in the post-period were prescribed appropriate CDI treatment more frequently than patients in the pre-period (91.7% vs 41.7%; p = .03) and received fewer inappropriate doses of a CDI treatment agent (14 doses vs 30 doses). Patients in the pre-period had a shorter ICU length of stay [1.5 days (range, 1–19) vs 3.5 days (range, 2–36); p = .01] and a similar hospital length of stay [9.5 days (range, 4–24) vs 11.5 days (range, 3–56); p = .30]. Total time spent providing interventions was 4 hours. Conclusion Patients had appropriate CDI treatment initiated more frequently in the post-period. This low-cost intervention strategy should be easy to implement in institutions where pharmacists interact with physicians during clinical rounds and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

scholarly journals Evaluation of a Multidisciplinary Pain, Agitation, and Delirium Guideline in Mechanically Ventilated Critically Ill Adults

2018 ◽  
Vol 54 (2) ◽  
pp. 119-124
Author(s):  
Melissa Heim ◽  
Ryan Draheim ◽  
Anna Krupp ◽  
Paula Breihan ◽  
Ann O’Rourke ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Medical Center ◽  
Guideline Implementation ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Hospital Length Of Stay ◽  
Mechanically Ventilated ◽  
The Impact ◽  
Daily Sedation Interruption

Background: A multidisciplinary team updated an institution-specific pain, agitation, and delirium (PAD) guideline based on the recommendations from the Society of Critical Care Medicine (SCCM) PAD guidelines. This institution-specific guideline emphasized protocolized sedation with increased as needed boluses, and nonbenzodiazepine infusions, daily sedation interruption, and pairing of spontaneous awakening (SAT) and breathing trials (SBT). Objective: The purpose of this study was to evaluate the impact of implementation of a PAD guideline on clinical outcomes and medication utilization in an academic medical center intensive care unit (ICU). It was hypothesized that implementation of an updated guideline would improve clinical outcomes and decrease usage of benzodiazepine infusions. Methods: Pre-post retrospective chart review of 2417 (1147 pre, 1270 post) critically ill, mechanically ventilated adults in a medical/surgical ICU over a 2-year period (1 year pre and post guideline implementation). Results: After guideline implementation, average ventilation days was reduced (3.98 vs 3.43 days, P = .0021), as well as ICU and hospital length of stay (LOS) (4.79 vs 4.34 days, P = .048 and 13.96 vs 12.97 days, P = .045, respectively). Hospital mortality (19 vs 19%, P = .96) and acute physiology and chronic health evaluation (APACHE) IV scores (77.28 vs 78.75, P = .27) were similar. After guideline implementation, the percentage of patients receiving midazolam infusions decreased (422/1147 [37%] vs 363/1270 patients [29%], P = .0001). The percentage of patients receiving continuous infusion propofol (679/1147 [59%] vs 896/1270 [70%], P = .0001) and dexmedetomidine (78/1147 [7%] vs 147/1270 [12%], P = .0001) increased. Conclusions: Implementing a multidisciplinary PAD guideline utilizing protocolized sedation and daily sedation interruption decreased ventilation days and ICU and hospital LOS while decreasing midazolam drip usage.

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 2101. Impact of “Code Sepsis” on Antimicrobial Utilization at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S710-S710
Author(s):  
Minji Kang ◽  
Francesca J Torriani ◽  
Rebecca Sell ◽  
Shira Abeles
Keyword(s):  
Organ Dysfunction ◽  
Early Recognition ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Antibiotic Administration ◽  
Academic Medical ◽  
Sepsis Bundle ◽  
The Impact ◽  
Infectious Source

Abstract Background Balancing antimicrobial stewardship with sepsis management is a challenge. At our academic medical center, a “Code Sepsis” was implemented as a nursing driven initiative to improve early recognition and management of sepsis. Per protocol, Code Sepsis is activated in patients who meet two or more systemic inflammatory response syndrome (SIRS) criteria due to a suspected infection to allow for early implementation of the sepsis bundle, which includes laboratory testing, fluid resuscitation, and antibiotic administration (Figure 1). We analyzed the impact that Code Sepsis had on antimicrobial use among hospitalized patients over a six month period. Methods We reviewed the electronic medical records of hospitalized patients with Code Sepsis activation between January 1, 2018 and June 30, 2018 to determine whether antibiotics were “escalated” or “not escalated.” Among patients who had antibiotic escalation, escalation was classified as “indicated” or “not indicated” (Figure 2). A logistic regression model was used to identify characteristics, SIRS or organ dysfunction criteria predictive of indicated antimicrobial escalation. Results Code Sepsis was activated in 529 patients with antibiotics escalated in 247 (47%) and not escalated in 282 (53%) (Table 1). Among patients whose antibiotics were escalated, 64% (152) had an indication. In 36% (89), escalation was not indicated as Code Sepsis was due to a suspected noninfectious source, known infectious source already on appropriate antimicrobials, or a suspected infectious source in which diagnostic results had already shown the absence of the infection (Figure 2). Odds of indicated antibiotic escalation increased with the number of SIRS and organ dysfunction criteria (Table 2). Conclusion In our efforts to improve sepsis outcomes, we focused on early recognition (Code Sepsis) and intervention (sepsis bundle). However, our Code Sepsis inadvertently led to antibiotic overutilization. By refocusing Code Sepsis on early recognition of severe sepsis and septic shock, we hope to optimize resource utilization and improve patient outcomes. Disclosures All authors: No reported disclosures.

Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 801-804 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Healthcare Research ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Patient Safety Indicators ◽  
Academic Medical

Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.

scholarly journals PT Achievement in Public Hospitals and Its Effect on Outcomes

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 58
Author(s):  
Jessica S. Morton ◽  
Alex Tang ◽  
Michael J. Moses ◽  
Dustin Hamilton ◽  
Neville Crick ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Length Of Stay ◽  
Medical Center ◽  
Therapy Group ◽  
Academic Medical Center ◽  
Early Mobilization ◽  
The United States ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Discharge Disposition

The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. (p < 0.01) There was no difference in discharge disposition between the two groups.

Relationship between dental loss and health outcomes among hospitalized patients with and without diabetes

2018 ◽  
Vol 67 (3) ◽  
pp. 669-673
Author(s):  
Kenneth Izuora ◽  
Ammar Yousif ◽  
Gayle Allenback ◽  
Civon Gewelber ◽  
Michael Neubauer
Keyword(s):  
Diabetes Mellitus ◽  
Heart Disease ◽  
Health Outcomes ◽  
Medical Center ◽  
Dental Health ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Academic Medical ◽  
Patients With Diabetes ◽  
The Impact

There is mixed evidence regarding the impact of poor dental health on cardiovascular disease and other health outcomes. Our objective was to determine the outcomes associated with poor dental health among hospitalized patients with and without diabetes mellitus (DM) at our institution. We enrolled a consecutive sample of adult patients admitted to an academic medical center. We gathered demographic, health and dental information, reviewed their medical records and then examined their teeth. We analyzed data using SPSS V.24. There was a high prevalence of dental loss among all hospitalized patients. Older age (p<0.001), smoking (p=0.034), having DM (p=0.001) and lower frequency of teeth brushing (p<0.001) were predictors of having a lower number of healthy teeth. Among DM and non-DM patients, fewer remaining healthy teeth was associated with presence of heart disease (p=0.025 and 0.003, respectively). Patients with diabetes mellitus (DM) had a higher prevalence of stroke (p=0.006) while patients without DM had a higher number of discharge medications (p=0.001) associated with having fewer number of healthy teeth. There was no correlation between number of healthy teeth and the length or frequency of hospitalization. Patients with DM are more likely to have fewer number of healthy teeth compared with non-DM patients. Fewer number of healthy teeth was associated with higher prevalence of heart disease in both DM and non-DM patients and with more discharge medications in non-DM patients.

Impact of Obesity on Warfarin Reversal With Fixed-Dose Factor VIII Inhibitor Bypassing Activity (aPCC)

2020 ◽  
pp. 106002802096804
Author(s):  
Amanda L. McKinney ◽  
Lindsey M. Dailey ◽  
James C. McMillen ◽  
A. Shaun Rowe
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bleeding Complications ◽  
Fixed Dose ◽  
Factor Viii Inhibitor ◽  
End Points ◽  
Warfarin Reversal ◽  
The Impact

Background: Data are limited addressing anticoagulant reversal in obese patients using activated prothrombin complex concentrate (aPCC). Objective: Assess the impact of obesity on INR reversal with fixed aPCC dosing. Methods: Institutional review board–approved, retrospective cohort conducted in a large academic medical center. Patients 18 years or older who received fixed-dose aPCC for warfarin-associated hemorrhage were included. Patients who received aPCC for any other indications or who had no follow-up INR after aPCC administration were excluded. Patients with an INR of 5 or greater received 1000 units aPCC, whereas those with INR less than 5 received 500 units aPCC, per institutional protocol. Patients were stratified into obese and nonobese based on body mass index. Primary end point was INR reversal, defined as repeat INR of 1.4 or less within 4 hours following aPCC treatment, without a repeated dose. Secondary end points included percentage change in INR, proportion of patients requiring an additional dose of aPCC, bleeding complications, thrombotic complications, hospital length of stay, and in-hospital mortality. Results: 259 patients were included, of whom 83 were obese (32%). A significantly higher proportion of nonobese patients achieved an INR of 1.4 or less within 4 hours of treatment (169 [96.02%] vs 69 [83.13%]; P = 0.0004). There were no differences in any secondary end points. Conclusion and Relevance: When fixed-dose aPCC is used for warfarin reversal, obesity is associated with a significantly lower rate of INR reversal, without increased bleeding. This study adds to the limited amount of literature on aPCC dosing in obesity.

scholarly journals Perioperative Sedation in Mechanically Ventilated Cardiac Surgery Patients With Dexmedetomidine-Based Versus Propofol-Based Regimens

2018 ◽  
Vol 53 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Taylor Chuich ◽  
Christopher Lewis Cropsey ◽  
Yaping Shi ◽  
Daniel Johnson ◽  
Matthew S. Shotwell ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Medical Center ◽  
Artery Bypass ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Suitable Alternative ◽  
Replacement Surgery ◽  
Icu Discharge

Background: Sedative agents used during cardiac surgery can influence the patient’s time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. Objective: This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. Methods: This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium. Results: Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P = 0.001). There was no significant association between use of dexmedetomidine and ICU discharge ( P = 0.99), hospital discharge ( P = 0.52), and incidence of delirium ( P = 0.27) after adjusting for other covariates. Conclusion and Relevance: Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.

Abstract 15580: The Impact of Sex and Gender-related Factors on Length-of-stay Following NSTEMI: A Multicountry Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Uri Bender ◽  
Colleen M Norris ◽  
Valeria Raparelli ◽  
Tadiri Christina ◽  
Louise Pilote
Keyword(s):  
Length Of Stay ◽  
Cardiac Risk ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
P Value ◽  
Sex And Gender ◽  
Related Factors ◽  
And Gender ◽  
The Impact

Introduction: Gender refers to psycho-socio-cultural characteristics typically ascribed to men, women and gender-diverse individuals and has been shown to be associated with adverse clinical outcomes in AMI independent of sex. Substantial heterogeneity in hospital length of stay exists among patients admitted with NSTEMI. Whether sex and gender-based differences contribute to length-of-stay (LOS) among patients with NSTEMI remains unknown. Methods: To examine the relationship between sex, gender-related factors and LOS in adults hospitalized for NSTEMI, data from the GENESIS-PRAXY (n=1,210, Canada, U.S. and Switzerland), EVA (n=430, Italy) and VIRGO (n=3,572, U.S., Spain and Australia) studies of adults hospitalized for AMI were combined and analyzed. A best-fit linear regression model was selected through incremental analysis by stepwise addition of gender-related variables thought to be different in either impact or distribution between men and women. Results: Among the overall cohort (n=5,212), 2,218 participants with a diagnosis of NSTEMI were included in the final cohort (66% women, mean age 48.5 years, 67.8% U.S.). Half of the patients had a LOS of longer than 4 days (n=1,124) and were more likely to be white and have a clustering of cardiac risk factors in comparison to those with shorter LOS. No association between sex and LOS was observed in the bivariate analysis (p=0.87). In the multivariable model adjusted for sex, age, country of hospitalization, level of education, marital status, employment status, income, and social support, age (0.062 days/year, p=0.0002), being employed (-0.63 days in workers, p=0.01) and the treatment country relative to Canada (Italy=4.1 days; Spain=1.7 days; and the U.S.=-1.0 days, all p-value<0.001) were significant predictors of LOS. Conclusions: Employed individuals are more likely to experience a shorter LOS following NSTEMI. Variation in LOS exists across different countries and is likely due to institutional policy, resource allocation, and differences in cultural and psychosocial influences.

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