scholarly journals A Computerized Order Set Entry (CPOE) for Vancomycin Dosing Results in Improved Clinical Outcomes in Adult Patients Treated at an Academic Medical Center

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Sandra Susanibar-Adaniya ◽  
Kevin Kuriakose ◽  
Sunita Parajuli ◽  
Krystina Walker ◽  
Jorge Jo-Kamimoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Academic Medical ◽  
Order Set

Clinical Impact of an Antibiotic Time Out Initiative at an Academic Medical Center

2020 ◽  
pp. 001857871990127
Author(s):  
Amy Parks Taylor ◽  
Kelci Coe ◽  
Kurt Stevenson ◽  
Lynn Wardlow ◽  
Zeinab El Boghdadly ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Infection Type ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Antimicrobial Use ◽  
Time Out ◽  
Academic Medical ◽  
The Impact ◽  
Homogenous Population

Background: Various strategies aimed at limiting inappropriate antimicrobial use including antibiotic time out (ATO) have been proposed to combat the development of antimicrobial resistance, yet there are limited studies that have assessed the impact of ATO on clinical outcomes. Methods: This single-center retrospective study reviewed the effect of a passive ATO strategy by comparing 100 adult patients with an ATO matched by infection type to 100 antibiotic-treated adult patients lacking an ATO note. Results: No difference in clinical outcomes was observed, however, ATO did result in improved optimization of antibiotic selection and duration, and reduction of piperacillin/tazobactam and vancomycin use. Conclusion: Further studies are warranted to evaluate the impact of ATO on clinical outcomes of a larger homogenous population with specified infectious diagnoses and clinical characteristics.

scholarly journals Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

2020 ◽  
Vol 41 (6) ◽  
pp. 1120-1125
Author(s):  
C.W.C. Huang ◽  
A. Ali ◽  
Y.-M. Chang ◽  
A.F. Bezuidenhout ◽  
D.B. Hackney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Spine Mri

Factors Related to Complications Among Adult Patients With Intellectual Disabilities Hospitalized at an Academic Medical Center

2015 ◽  
Vol 53 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Sarah H. Ailey ◽  
Tricia J. Johnson ◽  
Louis Fogg ◽  
Tanya R. Friese
Keyword(s):  
Intellectual Disabilities ◽  
Medical Center ◽  
Academic Medical Center ◽  
Autism Spectrum ◽  
Adult Patients ◽  
Respiratory Disorder ◽  
Academic Medical ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Improve Hospital

Abstract People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N  =  70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ2  =  2.893, df  =  1, p  =  .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ2  =  6.836, df  =  1, p  =  .009) if they had multiple chronic health conditions (three of the following: history of cerebral palsy, autism spectrum symptoms, aggressive behavior, respiratory disorder, and admission through the emergency department). Findings suggest preliminary criteria for assessing risk for complications among hospitalized people with ID and the need for attention to their specific needs when hospitalized.

Comparing successful insertions, dwell time, reinsertions and the costs of supplies between integrated and simple short peripheral catheters

2021 ◽  
pp. 112972982110548
Author(s):  
Jonathan D Cura
Keyword(s):  
Patient Safety ◽  
Dwell Time ◽  
Clinical Performance ◽  
Medical Center ◽  
Academic Medical Center ◽  
Insertion Site ◽  
The Philippines ◽  
Adult Patients ◽  
Academic Medical ◽  
Quasi Experimental

Background: Along with the challenges to strengthen patient safety in the use of short peripheral catheters (SPCs), various studies have been conducted in the past to explore differences between two main types of SPCs—integrated SPC (ISPC) and simple SPC (SSPC) in terms of clinical performance. The accumulated evidence from the literature lean toward the benefits of ISPC use in preventing complications leading to longer dwell time and more economical savings than SSPC use. The study aimed to compare ISPC and SSPC in terms of first-attempt successful insertions, number of attempts before successful insertion, perceived ease of insertion, dwell time, reinsertion rate, reasons for removal, and costs of supplies used for the insertions. Furthermore, it aimed to verify whether the previous results of referenced work in the use of ISPC were similar, and its use provided more foreseeable benefit for patient safety and cost-efficiency. Methods: This quasi-experimental study was conducted in a 650-bed tertiary academic medical center in the Philippines. Eligible participants were adult patients who were required SPC for at least 72 h by the physician. Using inferential statistics, comparisons were done among adult patients with integrated ( n = 350) and simple ( n = 350) SPC. Comparisons were also made according to insertion site and gauge of SPC. Results: The successful first-attempt insertions did not vary significantly at around 80% in both groups ( p = 0.428). No significant differences were found in terms of attempts before successful insertion ( p = 0.677), dwell time ( p = 0.144), reinsertions ( p = 0.934), and reasons for removal ( p = 0.424). Meanwhile, comparable differences were noted in terms of perceived ease of insertion ( p < 0.001) and cost of supplies used during the insertions ( p < 0.001). Conclusion: ISPCs can yield the same results with that of SSPCs while being easier to use and less costly.

Using Sonography to Examine Adult Patients at an Academic Medical Center: Have Usage Patterns Changed with the Expansion of Managed Care?

2002 ◽  
Vol 179 (6) ◽  
pp. 1395-1399 ◽  
Author(s):  
Marc E. Liebeskind ◽  
Peter H. Arger ◽  
Amy Liebeskind ◽  
Keith Maston ◽  
Curtis Langlotz
Keyword(s):  
Managed Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Academic Medical ◽  
Usage Patterns

scholarly journals Use of a Beta-Lactam Graded Challenge Process at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s502-s502
Author(s):  
Andrew Watkins ◽  
Lee Amaya ◽  
Macey Wolfe ◽  
John Schoen ◽  
Erica Stohs ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Guidance Document ◽  
Beta Lactam ◽  
Full Dose ◽  
Stewardship Program ◽  
Academic Medical ◽  
Ige Mediated ◽  
Graded Challenge ◽  
Order Set

Background: A penicillin allergy guidance document containing an algorithm for challenging penicillin allergic patients with β-lactams was developed by the antimicrobial stewardship program (ASP). As part of this algorithm, a “graded challenge” order set was created containing antimicrobial orders and safety medications along with monitoring instructions. The process is designed to challenge patients at low risk of reaction with infusions of 1% of the target dose, then 10%, and finally the full dose, each 30 minutes apart. We evaluated outcomes from the order set. Methods: Orders of the graded challenge over 17 months (March 2018 through July 2019) were reviewed retrospectively. Data were collected on ordering and outcomes of the challenges and allergy documentation. Use was evaluated based on ASP-recommended indications: history of IgE-mediated or unknown reaction plus (1) no previous β-lactam tolerance and the reaction occurred >10 years ago, or (2) previous β-lactam tolerance, now requiring a different β-lactam for treatment. Only administered challenges were included and descriptive statistics were utilized. Results: Of 67 orders, 57 graded challenges were administered to 56 patients. The most common allergies were penicillins (87.7%) and cephalosporins (38.6%), with the most common reactions being unknown (41.7%) or hives (22%). The most common antibiotics challenged were ceftriaxone (43.9%), cefepime (21.1%), and cefazolin (5.3%). Antibiotics given prior to challenge included vancomycin (48.2%), fluoroquinolones (35.7%), carbapenems (21.4%), aztreonam (19.6%), and clindamycin (12.5%). The median duration of challenged antibiotic was 6 days. The infectious diseases service was consulted on 59.6% of challenges and 75.4% of challenges were administered in non-ICU settings. There was 1 reaction (1.8%) involving a rash with the second infusion, which was treated with oral diphenhydramine and had no lasting effects. Based on indications, 80.7% of challenges were aligned with ASP guidance criteria. The most common use outside of these criteria was in patients without IgE-mediated reactions (10.5%). Most of these had minor rashes and could have received a full dose of a cephalosporin. Allergy information was updated in the electronic health record after 91.2% of challenges. Conclusions: We demonstrated the utility of a graded challenge process at our academic medical center. It was well tolerated, ordered frequently by noninfectious diseases clinicians, administered primarily in non-ICU settings, and regularly resulted in updated allergy information in the medical record. With many patients initially receiving broad-spectrum antibiotics with high costs or increased rates of adverse effects, graded challenges can potentially prevent the use of suboptimal therapies with minimal time and resource investment.Funding: NoneDisclosures: Scott Bergman reports a research grant from Merck.

scholarly journals Comparison of Resident, Advanced Practice Clinician, and Hospitalist Teams in an Academic Medical Center: Association with Clinical Outcomes and Resource Utilization

2020 ◽  
Vol 15 (12) ◽  
pp. 709-715
Author(s):  
Stacy A JOhnson ◽  
Claire E Ciarkowski ◽  
Katie L Lappe ◽  
David R Kendrick ◽  
Adrienne Smith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Resource Utilization ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Total Direct Cost ◽  
Advanced Practice ◽  
Interhospital Transfer ◽  
Academic Medical ◽  
Inpatient Medicine

BACKGROUND: Academic medical centers have expanded their inpatient medicine services with advanced practice clinicians (APCs) or nonteaching hospitalists in response to patient volumes, residency work hour restrictions, and recently, COVID-19. Reports of clinical outcomes, cost, and resource utilization differ among inpatient team structures. OBJECTIVE: Directly compare outcomes among resident, APC, and solo hospitalist inpatient general medicine teams. DESIGN: Retrospective cohort study using multivariable analysis adjusted for time of admission, interhospital transfer, and comorbidities that compares clinical outcomes, cost, and resource utilization. SUBJECTS: Patients 18 years or older discharged from an inpatient medicine service between July 2015 and July 2018 (N = 12,716). MAIN MEASURES: Length of stay (LOS), 30-day readmission, inpatient mortality, normalized total direct cost, discharge time, and consultation utilization. KEY RESULTS: Resident teams admitted fewer patients at night (32.0%; P < .001) than did APC (49.5%) and hospitalist (48.6%) teams. APCs received nearly 4% more outside transfer patients (P = .015). Hospitalists discharged patients 26 minutes earlier than did residents (mean hours after midnight [95% CI], 14.58 [14.44-14.72] vs 15.02 [14.97-15.08]). Adjusted consult utilization was 15% higher for APCs (adjusted mean consults per admission [95% CI], 1.00 [0.96-1.03]) and 8% higher for residents (0.93 [0.90-0.95]) than it was for hospitalists (0.85 [0.80-0.90]). No differences in LOS, readmission, mortality, or cost were observed between the teams. CONCLUSION: We observed similar costs, LOS, 30-day readmission, and mortality among hospitalist, APC, and resident teams. Our results suggest clinical outcomes are not significantly affected by team structure. The addition of APC or hospitalist teams represent safe and effective alternatives to traditional inpatient resident teams.

SU-E-I-78: CT Usage in Adult Patients at An Academic Medical Center: A Snapshot

2011 ◽  
Vol 38 (6Part5) ◽  
pp. 3413-3413
Author(s):  
M Naveed ◽  
W Huda ◽  
S Tipnis ◽  
E Mah ◽  
G Frey
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Academic Medical
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