scholarly journals 760. Incidence, Predictors and 30-Day Outcomes of Clostridoides difficile Infection in Patients Undergoing Cystectomy: A Nationwide Analysis Using the ACS-NSQIP Database

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S478-S478
Author(s):  
Armaghan-e-Rehman Mansoor ◽  
Yousaf B Hadi ◽  
Mohamad Salkini ◽  
Arif R Sarwari
Keyword(s):  
Hospital Admissions ◽  
Surgical Care ◽  
Improvement Program ◽  
Number Of Patients ◽  
The Us ◽  
Incidence Risk ◽  
Acs Nsqip Database ◽  
Utilization Of Healthcare ◽  
Patients Experience

Abstract Background Clostridoides difficile infection is the second most common healthcare acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the CDC in 2017. CDI continues to remain a major cause of inpatient admission and utilization of healthcare resources. The exact incidence of peri-procedural CDI with cystectomy is unknown, and reported incidence of CDI in literature vary widely Methods We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the ACS National Surgical Quality Improvement Program (NSQIP) to study the incidence, risk factors and 30-day post-surgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk-adjusted, outcomes-based program designed to determine and improve the quality of surgical and post-surgical care. Results The incidence of CDI following cystectomy was 3.6% in our patient cohort. 18.8% of patients developed CDI following hospital discharge. Non-elective surgeries, and complete cystectomy procedures had higher rate of CDI. 48.4% of patients with CDI had a preceding post-operative infection. Post-operative organ space infections (OR 1.95), post-operative renal failure (OR 2.38), post-operative sepsis (OR 2.49) and septic shock (OR 2.33) were independently associated with development of CDI, (all p values < 0.05). Patients who developed post-operative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI (OR 2.29) and had a higher risk of DVT formation (2.48), and were also more likely to have unplanned readmissions (OR 7.8) Conclusion This is the first nationwide study looking at inpatient and 30-day post-operative CDI after cystectomy in the US. A sizable number of patients experience CDIs after cystectomy procedures, and CDI development is associated with an increase in length of stay and unplanned readmissions. This study lends further evidence to the need for continued interventions and initiatives to reduce this burden of post-operative CDI. Disclosures All Authors: No reported disclosures

scholarly journals Improving the paediatric surgery patient experience: an 8-year analysis of narrative quality data

2020 ◽  
Vol 9 (2) ◽  
pp. e000924 ◽  
Author(s):  
Julie M Robillard ◽  
Stephanie C Bourne ◽  
Mallorie T Tam ◽  
Patricia M Page ◽  
Elizabeth A Lamb ◽  
...  
Keyword(s):  
Content Analysis ◽  
Quality Improvement ◽  
Patient Experience ◽  
Surgical Care ◽  
Quality Data ◽  
Paediatric Surgery ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Surgery Patient

BackgroundNarrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Though qualitative data about patient experience are captured as part of the NSQIP database, to date no framework or methodology has been proposed, or reported on, to analyse these data for the purposes of quality improvement. The goal of this study was to demonstrate the feasibility of using content analysis to empirically derive key areas for quality improvement from a sample of 3601 narrative comments about paediatric surgery from patients and families at British Columbia Children’s Hospital.Study designThematic content analysis conducted on a total of 3601 patient and family narratives received between 2011 and 2018.ResultsOverall satisfaction with care was high and experiences with healthcare providers at the hospital were positive. Areas for improvement were identified in the themes of health outcomes, communication and surgery timelines. Results informed follow-up interprofessional quality improvement initiatives.ConclusionsRecording and analysing patient experience data as part of validated quality improvement programmes such as ACS NSQIP can provide valuable and actionable information to improve quality of care.

scholarly journals Identifying homelessness using health information exchange data

2015 ◽  
Vol 22 (3) ◽  
pp. 682-687 ◽  
Author(s):  
John Zech ◽  
Gregg Husk ◽  
Thomas Moore ◽  
Gilad J Kuperman ◽  
Jason S Shapiro
Keyword(s):  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Housing Status ◽  
Number Of Patients ◽  
Address Data ◽  
Patients Experience ◽  
Exchange Data

Abstract Background Homeless patients experience poor health outcomes and consume a disproportionate amount of health care resources compared with domiciled patients. There is increasing interest in the federal government in providing care coordination for homeless patients, which will require a systematic way of identifying these individuals. Objective We analyzed address data from Healthix, a New York City–based health information exchange, to identify patterns that could indicate homelessness. Methods Patients were categorized as likely to be homeless if they registered with the address of a hospital, homeless shelter, place of worship, or an address containing a keyword synonymous with “homelessness.” Results We identified 78 460 out of 7 854 927 Healthix patients (1%) as likely to have been homeless over the study period of September 30, 2008 to July 19, 2013. We found that registration practices for these patients varied widely across sites. Conclusions The use of health information exchange data enabled us to identify a large number of patients likely to be homeless and to observe the wide variation in registration practices for homeless patients within and across sites. Consideration of these results may suggest a way to improve the quality of record matching for homeless patients. Validation of these results is necessary to confirm the homeless status of identified individuals. Ultimately, creating a standardized and structured field to record a patient’s housing status may be a preferable approach.

scholarly journals SARS-CoV-2 in Pediatric Inpatient Care: Management, Clinical Presentation and Utilization of Healthcare Capacity

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1190
Author(s):  
Christine Busch ◽  
Maximilian Blickle ◽  
Beatrix Schmidt ◽  
Laura Katharina Sievers ◽  
Constanze Pfitzer
Keyword(s):  
Inpatient Care ◽  
Clinical Presentation ◽  
Hospital Admissions ◽  
Clinical Symptoms ◽  
Economic Consequences ◽  
Hospital Treatment ◽  
Clinical Center ◽  
Number Of Patients ◽  
Pediatric Inpatient ◽  
Utilization Of Healthcare

This study scrutinizes management and clinical presentation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in pediatric inpatient care and evaluates the utilization of pediatric healthcare capacity during the pandemic. Within this retrospective cohort study, we systematically reviewed data of all 16,785 pediatric patients (<18 years admitted to our clinical center between January 2018 and June 2021). Data on SARS-CoV-2 test numbers, hospital admissions and clinical characteristics of infected patients were collected. Since January 2020, a total of 2513 SARS-CoV-2 tests were performed. In total, 36 patients had a positive test result. In total, 25 out of 36 SARS-CoV-2 positive children showed at least mild clinical symptoms while 11 were asymptomatic. Most common clinical symptoms were fever (60%), cough (60%) and rhinitis (20%). In parallel with the rising slope of SARS-CoV-2 in spring and fall 2020, we observed a slight decrease in the number of patients admitted to the pediatric department while the median duration of hospital treatment and intensive care occupancy remained unchanged. This study underlines that SARS-CoV-2 infected children most frequently exhibit an asymptomatic or mild clinical course. Noteworthy, the number of hospital admissions went down during the pandemic. The health and economic consequences need to be discussed within health care society and politics.

Continuous Wristband Monitoring Over 2 Years Decreases Identification Errors

2002 ◽  
Vol 126 (7) ◽  
pp. 809-815 ◽  
Author(s):  
Peter J. Howanitz ◽  
Stephen W. Renner ◽  
Molly K. Walsh
Keyword(s):  
Error Rate ◽  
Continuous Monitoring ◽  
The United States ◽  
Error Rates ◽  
Quality Of Services ◽  
Improvement Program ◽  
Monthly Basis ◽  
Number Of Patients ◽  
The Mean

Abstract Context.—Identification of patients is one of the first steps in ensuring the accuracy of laboratory results. In the United States, hospitalized patients wear wristbands to aid in their identification, but wristbands errors are frequently found. Objective.—To investigate if continuous monitoring of wristband errors by participants of the College of American Pathologists (CAP) Q-Tracks program results in lower wristband error rates. Setting.—A total of 217 institutions voluntarily participating in the CAP Q-Tracks interlaboratory quality improvement program in 1999 and 2000. Design.—Participants completed a demographic form, answered a questionnaire, collected wristband data, and at the end of the year, best and most improved performers answered another questionnaire seeking suggestions for improvement. Each institution's phlebotomists inspected wristbands for errors before performing phlebotomy and recorded the number of patients with wristband errors. On a monthly basis, participants submitted data to the CAP for data processing, and at the end of each quarter, participants received summarized comparisons. At the end of each year, participants also received a critique of the results along with suggestions for improvement. Main Outcome Measures.—The percentage of wristband errors by quarter, types of wristband errors, and suggestions for improvement. Results.—During 2 years, 1 757 730 wristbands were examined, and 45 197 wristband errors were found. The participants' mean wristband error rate for the first quarter in 1999 was 7.40%; by the eighth quarter, the mean wristband error rate had fallen to 3.05% (P &lt; .001). Continuous improvement occurred in each quarter for participants in the 1999 and 2000 program and in 7 of 8 quarters for those who participated in both 1999 and 2000. Missing wristbands accounted for 71.6% of wristband errors, and best performers usually had wristband error rates under 1.0%. The suggestion for improvement provided by the largest number of best and most improved performers was that phlebotomists should refuse to perform phlebotomy on a patient when a wristband error is detected. Conclusions.—The wristband error rate decreased markedly when this rate was monitored continuously using the CAP Q-Tracks program. The Q-Tracks program provides a useful tool for improving the quality of services in anatomic pathology and laboratory medicine.

scholarly journals Comparisons of Quality of Surgical Care between the US Department of Veterans Affairs and the Private Sector

2010 ◽  
Vol 211 (6) ◽  
pp. 823-832 ◽  
Author(s):  
Sierra R. Matula ◽  
Amal N. Trivedi ◽  
Isomi Miake-Lye ◽  
Peter A. Glassman ◽  
Paul Shekelle ◽  
...  
Keyword(s):  
Private Sector ◽  
Surgical Care ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
The Us

scholarly journals MEASUREMENT OF GERIATRIC SURGERY OUTCOMES IN A NATIONAL REGISTRY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Emily Finlayson
Keyword(s):  
Older Adult ◽  
Surgical Care ◽  
National Registry ◽  
Geriatric Surgery ◽  
Improvement Program ◽  
Medical Centers ◽  
National Quality ◽  
American College Of Surgeons ◽  
Surgery Outcomes

Abstract The American College of Surgeons National Quality Improvement Program started a “Geriatric Pilot” in January 2014. This project has already collected 19 additional older adult specialty variables in more than 60,000 patients undergoing operations. Twenty-six medical centers participate from across North America. The variables collect information in the domains of cognition, function, mobility and decision-making. Variables are collected in both the pre- and post-operative settings. It is clear that the quality of surgical care cannot be limited to the immediate hospitalization. The pilot has recently expanded its use of longer-term outcomes and has begun collecting 30-day outcomes of functional status and living location.

scholarly journals Analysis of the pattern of ADR’s reported to an ADR monitoring center in South India: a prospective study

2017 ◽  
Vol 6 (10) ◽  
pp. 2477
Author(s):  
Anant Khot ◽  
Thresiamma K. Thomas ◽  
Savithri P. ◽  
Rajalakshmi A. N.
Keyword(s):  
Prospective Observational Study ◽  
South India ◽  
Hospital Admissions ◽  
Tertiary Hospital ◽  
Scientific Data ◽  
Number Of Patients ◽  
Causes Of Mortality ◽  
A Prospective Study ◽  
Patients Experience ◽  
Common Manifestation

Background: All medicines with an ability to produce a desired therapeutic effect will also have the potential to cause unwanted adverse effects. It has been established that ~ 2.9%-5.6% of all hospital admissions are caused by Adverse drug reactions (ADRs) & as many as 35% of the hospitalized patients experience an ADR during their hospital stay. An incidence of fatal ADRs is 0.23%-0.41%. In some countries, ADRs rank among the top 10 leading causes of mortality. In order to increase awareness, observe the pattern of ADRs and communicate scientific data to prevent ADRs, this study was undertaken.Methods: It was a prospective observational study conducted at a tertiary hospital in Kochi. All the spontaneously reported ADRs were assessed and analyzed for type, severity and causality.Results: A total of 120 ADRs were reported during the study period. Most of the ADRs were seen in females in the age group of 61-70 years. Skin and appendage disorders were the most common manifestation of different type of ADRs (49.2%). Antineoplastic and immunomodulating agents (30.8%), followed by anti-infectives for systemic use (29.2%) were mostly implicated in the causation of ADRs. Majority of the ADRs were of mild to moderate in severity (89.2%).Conclusions: Although small, but significant number of patients had severe ADRs. Hence, we require a robust system for monitoring the medication use process. So that we can prevent and reduce the morbidity and mortality due to therapeutic agents.

scholarly journals STATUS, PROBLEMS AND PROSPECTS OF DEVELOPMENT OF SPECIALIZED SURGICAL CARE FOR PATIENTS WITH MAXILLOFACIAL PATHOLOGY IN KAZAN AND WAYS OF THEIRSOLUTION

2019 ◽  
Vol 15 (3) ◽  
pp. 90-95 ◽  
Author(s):  
Саид Ксембаев ◽  
Said Ksembaev ◽  
Олег Иванов ◽  
Oleg Ivanov ◽  
Ольга Торгашова ◽  
...  
Keyword(s):  
Maxillofacial Surgery ◽  
Surgical Care ◽  
Medical Work ◽  
Maxillofacial Region ◽  
Clinical Hospital ◽  
Dental Clinics ◽  
Number Of Patients ◽  
Low Efficiency ◽  
Hospital Morbidity

Subject of the study: current state of the organization and provision of specialized care to patients with pathology of the maxillofacial region in Kazan, the problems of improving the quality of this type of medical care and their solutions. The purpose — is to study organization and provision of specialized surgical care to patients with pathology of the maxillofacial region based on the results of work the Department of maxillofacial surgery of the city clinical hospital No. 7 of Kazan. The volume and nature of the care provided in the conditions of the round-the-clock dental hospital are defined. To determine the factors that reduce the quality of specialized surgical care for patients by analyzing data from the medical records of hospitalized and outpatient patients over the past 3 years. Material and methods. Uses analytical and quantitative-qualitative methods of retrospective study of the main indicators of medical work of the Department of maxillofacial surgery of the Kazan city clinical hospital No. 7 and patient records for 2016-2018. Results. Based on the analysis of the results of specialized Department of maxillofacial surgery determined the evolution of the number of patients according to nosological groups for 3 years, assess the volume of aid, to change its structure in favor of increasing the volume of outpatient surgical care while maintaining the number and structure of hospital morbidity. The evaluation of low efficiency of interaction between dental clinics and hospital, organizational and methodological approaches to the provision of this type of care. Conclusion. Analysis of the data obtained in the course of the study revealed a number of problems in routing patients for urgent and planned indications, in providing assistance at the prehospital stage in dental clinics, in posthospital rehabilitation of patients.

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