Factors Associated With Delayed Discharge on General Medicine Service at an Academic Medical Center

2018 ◽  
Vol 40 (6) ◽  
pp. 329-335 ◽  
Author(s):  
Nidhi Rohatgi ◽  
Marlena Kane ◽  
Marcy Winget ◽  
Farnoosh Haji-Sheikhi ◽  
Neera Ahuja
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Factors Associated ◽  
Delayed Discharge ◽  
Medicine Service ◽  
Academic Medical

Care Coordination

2018 ◽  
pp. 163-167
Keyword(s):  
Emergency Department ◽  
Care Coordination ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Ethnically Diverse ◽  
Medicine Service ◽  
Academic Medical ◽  
Diverse Patient Population ◽  
Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

scholarly journals Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

2019 ◽  
Vol 10 ◽  
pp. 215013271984051 ◽  
Author(s):  
Gregory M. Garrison ◽  
Rachel L. Keuseman ◽  
Christopher L. Boswell ◽  
Jennifer L. Horn ◽  
Nathaniel T. Nielsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Service ◽  
Academic Medical ◽  
The Family ◽  
Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

scholarly journals Disparities in Pediatric Patient Portal Activation and Feature Use

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Jennifer H LeLaurin ◽  
Oliver T Nguyen ◽  
Lindsay A Thompson ◽  
Jaclyn Hall ◽  
Jiang Bian ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
White Female ◽  
Patient Portal ◽  
Patient Portals ◽  
Electronic Health Record Data ◽  
Factors Associated ◽  
Academic Medical ◽  
Vulnerable Individual ◽  
Records Access

Abstract Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

scholarly journals The Hospital Experience Through the Patients’ Eyes

2019 ◽  
Vol 7 (3) ◽  
pp. 408-417 ◽  
Author(s):  
Haverly J Snyder ◽  
Kathlyn E Fletcher
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Hospital Environment ◽  
Quality Reporting ◽  
Hospital Experience ◽  
Academic Medical ◽  
Patient Tolerance ◽  
Qualitative Interview Study ◽  
Patients Experience

Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult. Design: Qualitative interview study using grounded theory methodology. Setting: Single-site academic medical center. Patients: Hospitalized general medicine patients. Measurements: Interviews using a semistructured interview guide. Results: We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction. Conclusions: This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.

Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

2021 ◽  
pp. 106002802098873
Author(s):  
Nicholas F. Hunt ◽  
Kevin C. McLaughlin ◽  
Mary P. Kovacevic ◽  
Kenneth E. Lupi ◽  
Kevin M. Dube
Keyword(s):  
Cardiac Arrhythmias ◽  
Adverse Drug Events ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Setting ◽  
Academic Medical ◽  
Acute Agitation ◽  
Emergency Department Patients ◽  
Events Data

Background Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients. Objective To evaluate the safety of IVP olanzapine administration in the inpatient setting. Methods This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected. Results A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%). Conclusion and Relevance Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.

scholarly journals Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center—A Web-Based Survey

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0140768 ◽  
Author(s):  
Erica Rose Denhoff ◽  
Carly E. Milliren ◽  
Sarah D. de Ferranti ◽  
Sarah K. Steltz ◽  
Stavroula K. Osganian
Keyword(s):  
Clinical Research ◽  
Medical Center ◽  
Academic Medical Center ◽  
Web Based ◽  
Research Recruitment ◽  
Factors Associated ◽  
Academic Medical

Factors Associated With Physician Empowerment and Well-being at an Academic Medical Center

2020 ◽  
Vol 62 (7) ◽  
pp. 478-483
Author(s):  
Elizabeth Ann Yakes ◽  
Stephanie Dean ◽  
Robert F. Labadie ◽  
Daniel Byrne ◽  
Cristina Estrada ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Well Being ◽  
Factors Associated ◽  
Academic Medical

Evaluation of the head and neck cancer patient population and the incidence of hospitalization at an academic medical center

2017 ◽  
Vol 25 (2) ◽  
pp. 333-338 ◽  
Author(s):  
Lindsay A Hazelden ◽  
Matthew J Newman ◽  
Stephanie Shuey ◽  
Julie M Waldfogel ◽  
Victoria T Brown
Keyword(s):  
Logistic Regression ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Factors Associated ◽  
Chemotherapy Agent ◽  
Academic Medical ◽  
The Impact

Purpose Patients with head and neck cancer are at risk for disease- and treatment-related toxicities that may be severe enough to require hospitalization. The risk factors associated with hospitalization in these patients are not well defined. Methods We conducted a single-center, retrospective observational study of patients with head and neck cancer receiving chemotherapy at an academic medical center infusion clinic in a one-year period. The primary objective was to characterize the head and neck cancer population at an academic medical center. Secondary objectives included describing the clinical and social factors associated with hospitalization. Results There were 109 patients with head and neck cancer included in the analysis. Of these patients, 38 (35%) were hospitalized. The factors that were significantly associated with hospitalization on univariable logistic regression were former alcohol abuse, being on a nonstandard of care chemotherapy regimen, and having a chemotherapy agent discontinued. On multivariable logistic regression, the factor that was significantly associated with hospitalization was having a chemotherapy agent discontinued. The most common reasons for hospitalization included shortness of breath/respiratory failure, fever/neutropenic fever, and infection. The most common new supportive care medications prescribed at discharge were stool softeners or laxatives and opioids. Conclusion This study identified several factors which may be useful to identify patients as high risk for hospitalization and the next steps will be to determine and study the role of the pharmacist in preventing hospitalization of these patients. Further studies are needed to assess the impact of adding a pharmacist to the head and neck cancer multidisciplinary team.

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