scholarly journals Frailty and hospital outcomes within a low socioeconomic population

QJM ◽  
2019 ◽  
Vol 112 (12) ◽  
pp. 907-913
Author(s):  
S Clark ◽  
C Shaw ◽  
A Padayachee ◽  
S Howard ◽  
K Hay ◽  
...  
Keyword(s):  
Community Hospital ◽  
Social Economic ◽  
Geometric Mean ◽  
Hospital Setting ◽  
Socioeconomic Disadvantage ◽  
Disadvantaged Area ◽  
Low Socioeconomic ◽  
Admission Rates ◽  
Unit Increase ◽  
The Impact

Summary Background Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. Aims To evaluate the association of the CFS with hospital-related outcomes. Design Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). Methods The CFS was used in the emergency department (ED) for people aged ≥ 75 years. Frailty was defined as a score of ≥4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. Results Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged ≥ 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3–1.7). Frail persons with CFS 4–6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0–1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04–1.21) compared with non-frail persons. Conclusions The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4–6 as a priority for frail persons within a community hospital setting.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals THE IMPACT OF MIDODRINE ON DURATION OF VASOPRESSOR INFUSION IN PATENTS WITH SEPTIC SHOCK IN A COMMUNITY HOSPITAL SETTING

CHEST Journal ◽  
2019 ◽  
Vol 156 (4) ◽  
pp. A1584
Author(s):  
ali nadhim ◽  
Zar Tun ◽  
Lee Chadrick Chua ◽  
ruwaidah majeed ◽  
Jane Ramos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Community Hospital ◽  
Hospital Setting ◽  
The Impact

747 The Impact of Using the Traumatic Brain Injury Guidelines on Outcomes in a Community Hospital Setting

Neurosurgery ◽  
2000 ◽  
Vol 47 (2) ◽  
pp. 513-513
Author(s):  
Sylvain Palmer ◽  
Mary Kay Bader ◽  
Azhar Quereshi ◽  
Jacques J. Palmer ◽  
Thomas Shaver MD ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Hospital ◽  
Hospital Setting ◽  
The Impact

Feasibility of collaborative precision medicine oncology between academic- and community-based hospitals.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18015-e18015
Author(s):  
Lorna Rodriguez-Rodriguez ◽  
Mark Krasna ◽  
Kim M. Hirshfield ◽  
Veronica Rojas ◽  
Gregory Riedlinger ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Community Hospital ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Hospital Setting ◽  
Tumor Board ◽  
Health Staff ◽  
Study Enrollment ◽  
The Impact

e18015 Background: The Rutgers Cancer Institute of New Jersey (CINJ) is conducting an ongoing, prospective, observational clinical trial that is evaluating use of comprehensive genomic profiling (CGP) and molecular tumor board (MTB) review to assist in caring for patients with rare or refractory cancers. As part of this precision medicine approach to cancer care, CINJ has formed a partnership with community hospitals (Meridian Health) to enroll patients in this study, and to actively participate in MTB meetings. The purpose of this cohort analysis is to evaluate the feasibility of using CGP to identify clinically-relevant genomic alterations as an aid to guiding point-of-care management in a community hospital setting. Methods: Meridian Health staff was trained in patient selection, enrollment, and follow-up. CGP was performed by Foundation Medicine, Inc. The patient case’s clinical history, pathology, and CGP results were presented at an MTB meeting. The enrolling physicians (n = 11) were invited to attend the MTB in person or through web-accessible video conferencing. A letter listing MTB consensus recommendations on potential treatment options was sent to the referring physician, and patient follow-up was scheduled at regular intervals. Results: 35 patients were enrolled by Meridian Health. Gyn and GI cancers were the most common types at enrollment (each 26%, 9 out of 35), followed by breast cancer (20%, 7 out of 35). At study enrollment, the mean KPS was 91%, and 23 patients (66%) had stage IV disease. The median duration between study enrollment and MTB presentation was 44 days. 3 patients were excluded because of deteriorated clinical status at the time of the MTB. MTB-based treatment options were implemented in 9 of 32 patients (28%). This result is similar to those reported in published analyses of patients enrolled at CINJ. Conclusions: Collaborations between an academic cancer center and a community hospital is a feasible approach to facilitating access to precision medicine for cancer patients treated in the community. A larger cohort is needed to determine the impact on patient’s outcomes.

scholarly journals Treatment of Morbidly Adherent Placentation Utilizing a Standardized Multidisciplinary Approach in the Community Hospital–Private Practice Setting

2017 ◽  
Vol 07 (04) ◽  
pp. e211-e214 ◽  
Author(s):  
Mahsa Mansouri ◽  
Kim DeStefano ◽  
Brian Monks ◽  
Jasbir Singh ◽  
Mollie McDonnold ◽  
...  
Keyword(s):  
Private Practice ◽  
Maternal Morbidity ◽  
Multidisciplinary Approach ◽  
Community Hospital ◽  
Hospital Setting ◽  
Teaching Hospitals ◽  
Published Data ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
The Impact

Objective Morbidly adherent placentation is associated with increased maternal morbidity and mortality. Recently, there has been mounting evidence supporting the benefits of a standardized multidisciplinary approach at tertiary teaching hospitals. Our objective was to estimate the impact of the implementation of a similar program at a high-volume private community hospital. Study Design In this retrospective cohort study, we evaluated maternal outcomes in all cases of histopathologically confirmed morbidly adherent placentation since the initiation of our multidisciplinary program (2012–2016). Our data were compared with the previously published outcomes of two large cohorts from tertiary teaching hospitals in Utah and Texas. Results In the 28 cases included for evaluation, our group's median estimated blood loss, median packed red blood cells transfused, median anesthesia time, median length of stay, or rates of maternal morbidity did not statistically differ from the published data in Utah or Texas. Conclusion Our data demonstrate the feasibility and utility of a multidisciplinary morbidly adherent placentation program in the private practice/community hospital setting with outcomes similar to those at tertiary teaching hospitals. Implementation of such program may prove beneficial in remote centers, where various factors may prohibit patient travel to a larger center.

scholarly journals 1044. Impact of Interdisciplinary Rounds on Antimicrobial Use at a Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S368-S368
Author(s):  
Emma Castillo ◽  
Luke Heuts ◽  
Elizabeth Dodds Ashley ◽  
Rebekah W Moehring ◽  
Michael E Yarrington ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Hospital Setting ◽  
Antimicrobial Use ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Interdisciplinary Rounds ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship (AS) implementation is challenging in resource-limited settings such as smaller community hospitals that may lack dedicated personnel resources or have limited access to infectious diseases experts with dedicated time for AS. Few studies have evaluated the impact of interdisciplinary rounds as a strategy to optimize antimicrobial use (AU) in the community hospital setting. Methods We evaluated the impact of interdisciplinary rounds in a 280-bed acute care nonteaching, community hospital with an established ASP. The primary outcome was facility-wide antibiotic utilization pre- and post-implementation. Rounds included key healthcare personnel (hospitalists, clinical pharmacists, case managers, nurses) reviewing all patients on inpatient wards Monday through Friday, with a discussion of diagnosis, antibiotic selection, dosing, duration, and anticipated discharge plans. AU was compared for a 7-month post-intervention period (June 1, 2018–December 31, 2018) vs. similar months in 2017 based on days of therapy (DOT)/1,000 patient-days and length of therapy (LOT) per antimicrobial use admission. In addition, trends in AU for the post-intervention period were compared with the previous 17 months (January 1, 2017–May 31, 2018) using segmented binomial regression. Results Interdisciplinary rounds incorporating AS principles was associated with a decrease in overall AU in this facility, with a significant decrease of 16.33% (P < 0.0001) in DOT/1,000 pd in the first month and was stable (decrease of 1.1% per month, P = 0.15) thereafter (Figure 1). There was no significant change in LOT/admission after the first month of the intervention, but the trend demonstrated a 2% per month decrease (P < 0.03) thereafter (Figure 2). Comparing 2018 intervention months with similar months of 2017, the use of antibacterial agents decreased on average by 191.3 (95% CI −128.2 to −254.4) DOT/1,000 patient-days (Figure 3) and 0.546 (95% CI: −0.28 to −0.81) days per admission (Figure 4). Conclusion In this community hospital with an existing antimicrobial stewardship program, implementation of interdisciplinary rounds was associated with a substantial decrease in antimicrobial use. This was sustained for at least a 7-month period. Disclosures All authors: No reported disclosures.

scholarly journals 39. Impact of Antimicrobial Stewardship Interventions in a Community Hospital setting: An Interrupted Times Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Jason Li ◽  
Ken Chan ◽  
Hina Parvez ◽  
Margaret Gorlin ◽  
Miriam A Smith
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Hospital Setting ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Intervention Period ◽  
Prospective Audit ◽  
Post Intervention ◽  
The Impact

Abstract Background Community hospitals have fewer resources for antimicrobial stewardship programs (ASP) compared to larger tertiary hospitals. At our 312-bed community hospital, Long Island Jewish Forest Hills/Northwell, a combination of modified preauthorization, prospective audit feedback, and ASP education was implemented starting in August 2019 (Monday through Friday 9 am to 5 pm). Methods This retrospective study evaluated the impact of ASP interventions on the rate of targeted antimicrobial use over a 7 month pre- vs 7 month post- intervention period (Aug 2018 to Feb 2019 vs Aug 2019 to Feb 2020). Targeted antimicrobials included piperacillin-tazobactam, vancomycin, daptomycin, and carbapenems. The primary outcome was the monthly mean for overall targeted antimicrobial use measured by the rate of antimicrobial days per 1000 days present. Secondary outcomes were the individual rates of antimicrobial days per 1000 days present for each of the targeted antimicrobials, and the hospital’s overall standardized antimicrobial administration ratio (SAAR). Data were analyzed as a segmented regression of interrupted time series. Results Pre-intervention, there was an increasing trend (positive slope, p&lt; 0.05) in the monthly mean, hospital SAAR, vancomycin and piperacillin-tazobactam use. Post-intervention, there was a significant change in slope for these same metrics, indicating a decrease in the mean use. Immediate impact of ASP interventions, measured by the difference in antibiotic use between the end of each intervention period, was visually evident in all cases except carbapenems (Fig. 1 through 4). The immediate impact on the overall monthly mean represented a significant reduction in the rate of antimicrobial days per 1000 days present, -12.72 (CI -21.02 to -4.42, P &lt; 0.0066). The pre- vs post- ASP gap for all measures was negative and consistent with fewer days of antibiotic use immediately following intervention. Conclusion A targeted, multifaceted ASP intervention utilizing modified preauthorization, prospective audit feedback, and education significantly reduced antibiotic use in a community hospital. Disclosures All Authors: No reported disclosures

Pharmacists' Perceived Knowledge and Expertise in Selected Pediatric Topics

2011 ◽  
Vol 16 (1) ◽  
pp. 47-54
Author(s):  
Paul J. Munzenberger ◽  
Ron L. Thomas ◽  
Stephanie B. Edwin ◽  
Victoria Tutag-Lehr
Keyword(s):  
Home Care ◽  
Pediatric Patients ◽  
Community Hospital ◽  
Hospital Setting ◽  
Perceived Knowledge ◽  
Community Based ◽  
Additional Training ◽  
Inpatient Hospital ◽  
Community Or ◽  
The Impact

ABSTRACT OBJECTIVES The purpose of this study is to determine pharmacists' perceived knowledge and expertise required to make recommendations regarding selected pediatric topics. METHODS A questionnaire was distributed to 400 pharmacists practicing in community, hospital, and home care settings. This instrument explored their perceived knowledge, expertise, and comfort in providing recommendations related to 38 pediatric topics. The impact of responder demographics on differences in perceived knowledge and expertise for each topic were evaluated. RESULTS Ninety-five of 400 (24%) questionnaires were returned completed or partially completed. Forty-seven and 36 of responders practiced in the community or inpatient hospital setting, respectively. Seventy percent of responders reported that ≤ 40% of their patients were children. In general, responders believed they had the knowledge and expertise to make recommendations for the frequently occurring conditions or topics but not for the less familiar. Formal pediatric training was the most influential responder characteristic with a larger proportion having training that they believed enables them to have knowledge and expertise to make recommendations. Although less impressive, experience of more than 5 years and a community-based practice were also important factors. CONCLUSION Additional training is beneficial in increasing the perceived knowledge and comfort of pharmacists making recommendations regarding pediatric patients.

The Impact on Outcomes in a Community Hospital Setting of Using the AANS Traumatic Brain Injury Guidelines

2001 ◽  
Vol 50 (4) ◽  
pp. 657-664 ◽  
Author(s):  
Sylvain Palmer ◽  
Mary Kay Bader ◽  
Azhar Qureshi ◽  
Jacques Palmer ◽  
Thomas Shaver ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Hospital ◽  
Hospital Setting ◽  
The Impact

scholarly journals 312. Clinical Attributes and Risk Factors for In- Hospital Mortality among Covid-19 Patients in a Community Hospital Setting: A Propensity Matched Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
Karthik Seetharam ◽  
Premila Bhat ◽  
Kelash Kumar ◽  
Thinzar Wai ◽  
Vamsi Yenugadhati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Community Hospital ◽  
Laboratory Data ◽  
Hospital Setting ◽  
Case Series ◽  
Laboratory Parameters ◽  
Presenting Symptoms ◽  
Discharged Patients ◽  
The Impact

Abstract Background New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P &lt; 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (&lt; .0001), SGOT or AST (IU/L) ≥ 54 (p &lt; 0.001), SGPT or ALT (IU/L) ≥ 41 (p &lt; 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P &lt; 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) &gt; 465 (OR = 2.18, P = 0.001), systolic blood pressure &lt; 90 mm Hg (OR = 4.28, p = .02), respiratory rate &gt; 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation. Disclosures All Authors: No reported disclosures

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