937: CATEGORIZATION OF FULL-TIME TELE-CRITICAL CARE PHARMACIST INTERVENTIONS BASED ON SHIFT

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

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Abstract 301: Identifying Critical Care Unit Organizational Factors That Impact Cardiac Arrest Incidence and Outcomes: A Report From the Pediatric Cardiac Critical Care Consortium

Circulation ◽

10.1161/circ.140.suppl_2.301 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Javier J Lasa ◽

Jeffrey A Alten ◽

Mousumi Banerjee ◽

Wenying Zhang ◽

Kurt Schumacher ◽

...

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Critical Care Unit ◽

Organizational Factors ◽

Full Time ◽

Provider Education ◽

Multinomial Regression ◽

Clinical Registry ◽

The Impact ◽

Cardiac Critical Care

Introduction: Patient factors leading to cardiac arrest (CA) in the pediatric cardiac critical care unit (CICU) are well understood, but may be unmodifiable. Our understanding of the impact of CICU organizational factors (OFs) such as staffing models, health care provider education, and CICU bed management is limited. The association between these potentially modifiable CICU OFs on CA prevention and rescue outcomes is unknown. Hypothesis: CICU OFs associate with CA prevention and rescue. Methods: Retrospective analysis of Pediatric Cardiac Critical Care Consortium (PC4) clinical registry including data for all patients admitted to CICUs from August 2014 to March 2019. Prevention was defined as the prevalence of subjects not suffering CA. Rescue was defined as survival after CA. CICU OFs were captured via questionnaire distributed to PC4 participants in 2017 (100% response). Stratified, multivariable regression was used to evaluate associations between OFs and outcome in medical and surgical admission subgroups: competing time-to-events framework (to assess prevention) and multinomial regression (to assess rescue), accounting for clustering of patients within hospitals. Results: We analyzed 54,521 CICU admissions (59% surgical, 41% medical) from 29 hospitals with 1398 CA events (2.5%). We studied 12 OFs that varied across centers after accounting for collinearity. For both surgical and medical admissions, lower average daily occupancy (<80%) was associated with better arrest prevention for all admissions, and better rescue in the surgical cohort. Increased proportion of nurses with >2 years experience, increased proportion of nurses with critical care certification, % of full-time intensivists, % of intensivists with critical care training, dedicated respiratory therapists, quality/safety resources, and annual CICU admission volume were not associated with improved prevention or rescue. Conclusion: Our multi-institutional analysis suggests that lower average CICU occupancy was the only consistent OF evaluated that was associated with CA prevention and rescue. CICUs that have average daily occupancy >80% may need specific strategies to mitigate the risks of CA.

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548: TELE-CRITICAL CARE (TCC) PHARMACY FIRST SHIFT COMPARED TO SECOND SHIFT TCC PHARMACIST INTERVENTIONS

Critical Care Medicine ◽

10.1097/01.ccm.0000808516.60138.11 ◽

2021 ◽

Vol 50 (1) ◽

pp. 265-265

Author(s):

Carrie Griffiths ◽

Desiree Kosmisky ◽

Sonia Everhart

Keyword(s):

Critical Care ◽

Pharmacist Interventions ◽

Second Shift

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Implementation of electronic charting is not associated with significant change in physician productivity in an academic emergency department

JAMIA Open ◽

10.1093/jamiaopen/ooy022 ◽

2018 ◽

Vol 1 (2) ◽

pp. 227-232 ◽

Cited By ~ 1

Author(s):

Dusadee Sarangarm ◽

Gregory Lamb ◽

Steven Weiss ◽

Amy Ernst ◽

Lorraine Hewitt

Keyword(s):

Emergency Department ◽

Critical Care ◽

Productivity Index ◽

Full Time ◽

Full Time Equivalent ◽

Physician Productivity ◽

Relative Value ◽

Before And After ◽

Study Implementation ◽

Total Productivity

Abstract Objectives To compare physician productivity and billing before and after implementation of electronic charting in an academic emergency department (ED). Materials and methods This retrospective, blinded, observational study compared the 6 months pre-implementation (January to June 2012) with the 6 months post-implementation 1 year later (January to June 2013). Thirty-one ED physicians were recruited, with each physician acting as his/her own control in a before-after design. Productivity was measured via total number of encounters and “productivity index” defined as worked relative value units divided by the clinical full-time equivalent. Values for charges, encounters, and productivity index were determined during each study period and separately for procedures, observational stays, and critical care. Results No differences were found for total productivity index per month (758 [623-876] pre-group vs. 756 [673-886] post-group; P = 0.30). There was, however, a 9% decrease in total encounters per month (138 [101-163] pre-group vs. 125 [99-159] post-group; P = 0.01). Significant decreases were seen across all observation stay categories. Conversely, significant increases were seen across all critical care categories. There was no difference in total charges per month. Discussion This is one of few studies to demonstrate minimal disruption in physician productivity after transitioning to electronic documentation. The reasons for these findings are likely multi-factorial. Conclusion In this study, implementation of electronic charting was not associated with decreases in productivity or billing for total ED care, but may be associated with increases for critical care and decreases for observational stays.

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Increasing the Registered Dietitian Full-Time Equivalents to the Neonatal Critical Care Unit Improved Incidence of Growth Outcomes in Preterm Infants

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2021.08.060 ◽

2021 ◽

Vol 121 (10) ◽

pp. A139

Author(s):

D. Drenckpohl ◽

M. Javed ◽

G. Ewalt ◽

L. Monagle ◽

A. Simper ◽

...

Keyword(s):

Critical Care ◽

Preterm Infants ◽

Critical Care Unit ◽

Full Time ◽

Registered Dietitian ◽

Growth Outcomes

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PROTECTED-UK - Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level

International Journal of Pharmacy Practice ◽

10.1111/ijpp.12304 ◽

2016 ◽

Vol 25 (4) ◽

pp. 311-319 ◽

Cited By ~ 6

Author(s):

Nicola Rudall ◽

Catherine McKenzie ◽

June Landa ◽

Richard S. Bourne ◽

Ian Bates ◽

...

Keyword(s):

Critical Care ◽

Clinical Pharmacist ◽

Critical Care Unit ◽

Experience Level ◽

Service Characteristics ◽

Pharmacist Interventions ◽

Intervention Service ◽

The Uk

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A Profile of Female Academic Surgeons: Training, Credentials, and Academic Success

The American Surgeon ◽

10.1177/000313480607201201 ◽

2006 ◽

Vol 72 (12) ◽

pp. 1153-1159 ◽

Cited By ~ 6

Author(s):

Amy D. Wyrzykowski ◽

E. Han ◽

B.J. Pettitt ◽

T.M. Styblo ◽

G.S. Rozycki

Keyword(s):

Critical Care ◽

Academic Success ◽

General Surgery ◽

Breast Disease ◽

Full Time ◽

General Surgery Residency ◽

Academic Surgery ◽

Surgical Critical Care ◽

Age Range ◽

Academic Surgeons

The objective of this study was to determine the profile (credentials, training, and type of practice) of female academic general surgeons and factors that influenced their career choice. A survey was sent to female academic surgeons identified through general surgery residency programs and American medical schools. The women had to be Board eligible/certified by the American Board of Surgery or equivalent Board and have an academic appointment in a Department of Surgery. Data were analyzed using the SPSS program. Two hundred seventy women (age range, 32–70 years) completed the survey (98.9% response rate). Fellowships were completed by 82.3 per cent (223/270), most commonly in surgical critical care. There were 134 (50.2%, 134/367) who had two or more Board certificates, most frequently (46%, 61/134) in surgical critical care. Full-time academic appointments were held by 86.7 per cent of women, most as assistant professors, clinical track; only 12.4 per cent were tenured professors. The majority of women described their practice as “general surgery” or “general surgery with emphasis on breast.” The most frequent administrative title was “Director.” Only three women stated that they were “chair” of the department. The top reason for choosing surgery was “gut feeling,” whereas “intellectual challenge” was the reason they pursued academic surgery. When asked “Would you do it again?”, 77 per cent responded in the affirmative. We conclude that female academic surgeons are well trained, with slightly more than half having two or more Board certificates; that most female academic surgeons are clinically active assistant or associate professors whose practice is “general surgery,” often with an emphasis on breast disease; that true leadership positions remain elusive for women in academic general surgery; and that 77 per cent would choose the same career again.

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Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220915763 ◽

2020 ◽

Vol 26 (5) ◽

pp. 1172-1179

Author(s):

Jonathan de Grégori ◽

Pauline Pistre ◽

Meredith Boutet ◽

Laura Porcher ◽

Madeline Devaux ◽

...

Keyword(s):

Chemotherapy Regimen ◽

Cost Savings ◽

Clinical Impact ◽

Financial Impact ◽

Drug Event ◽

Full Time ◽

Cost Avoidance ◽

Clinical Pharmacists ◽

Pharmacist Interventions ◽

The Cost

Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/patient. The clinical impact of pharmacist interventions was classified as negative, null, minor, moderate, major and lethal in 0, 84 (4%), 1353 (68%), 385 (20%), 148 (8%) and 0 cases, respectively. The overall cost savings were €175,563. One hundred and nine (6%) of all pharmacist interventions concerned immuno- or chemotherapy regimen for cost savings of €148,032 (84% of the total amount of cost savings). The cost avoidance was €390,480. Cost avoidance results were robust to sensitivity analyses with cost of preventable adverse drug event as main driver of the model. When the cost of employing a pharmacist was subtracted from the average yearly cost savings plus cost avoidance per pharmacist, this yielded a net benefit of €223,021. The cost–benefit ratio of the clinical pharmacist was €3.7 for every €1 invested. Principal conclusions: To have two full-time clinical pharmacists in a 55-bed ambulatory adult hematology–oncology department is both clinically and financially beneficial.

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