Assessment of the July Effect on Bronchoscopies in Teaching Hospitals Across the United States

Background: Carotid revascularization procedure, carotid endarterectomy (CEA) and carotid stent placement (CAS), are some of the most common procedures performed in United States and expected to change due to wider adoption of CAS. We performed this study to determine the changes in utilization of CEA and CAS in United States using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2005 to 2014 to assess the changes in utilization of CEA and CAS over last 10 years in patients with symptomatic and asymptomatic carotid artery stenosis. NIS is the largest all payer dataset that includes diagnoses, admissions and discharge, demographics, and outcomes data of patients admitted to short stay non-Federal hospitals in the United States. We analyzed patterns of changes in utilization in various subsets of patients with carotid artery stenosis. Results: A total of 1,186,182 patients underwent carotid revascularization procedures during study period; 1,032,148 (87.1%) and 154,035 (12.9%) were CEA and CAS, respectively. The overall carotid revascularization procedures decreased over last 10 years (11.1% in 2005 to 8.4%in 2014, trend test p <.0001). Carotid revascularization in symptomatic patients increased (7.64% in 2005 to 11.01% in 2014, trend test p <.0001) while it decreased in asymptomatic patients (92.36% in 2006 to 88.99% in 2014, trend test p <.0001). There was an overall decrease in CEA (11.6% in 2005 to 8.3% in 2014, trend test <.0001) while in CAS remained unchanged (8.1% in 2005 to 8.9% in 2014, p=NS). There was an increase in carotid revascularization in teaching hospitals (40.9% in 2005 to 67.1% in 2014, trend test p <.0001) while decrease in non-teaching hospitals (50.9% in 2006 to 27.1% in 2014, trend test p <.0001). There was a decrease in carotid revascularization procedures in patients aged ≥80 years (19.8% in 2005 to 18.7% in 2014, trend test p <.0001) and CEA (19.6% in 2006 to 18.8% in 2014, trend test P<.0001) and CAS (21.2% in 2006 to 18.6% in 2014, trend test p=<.0001). Conclusion: Although CAS is increasing in a disproportionate manner within patient subgroups in United States, overall carotid revascularization procedures have decreased for unclear reasons.

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The recent evolution of patient care rounds in pediatric teaching hospitals in the United States and Canada

Hospital Practice ◽

10.1080/21548331.2021.1977561 ◽

2021 ◽

Author(s):

Jeffrey Van Blarcom ◽

Andrew Chevalier ◽

Benjamin Drum ◽

Sarah Eyberg ◽

Elizabeth Vukin ◽

...

Keyword(s):

United States ◽

Patient Care ◽

The United States ◽

Teaching Hospitals

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Training Opportunities for Overseas Psychiatrists

The British Journal of Psychiatry ◽

10.1192/bjp.127.2.179 ◽

1975 ◽

Vol 127 (2) ◽

pp. 179-184 ◽

Cited By ~ 3

Author(s):

Peter Brook

Keyword(s):

United States ◽

Great Majority ◽

The United States ◽

Teaching Hospitals ◽

Training Opportunities

SummaryThe literature relating to the training opportunities offered to overseas graduates in this country and the United States is reviewed. Although overseas trainees in psychiatry do not see themselves at a great disadvantage, the fact that the great majority are working in non-teaching hospitals means by implication that overall their training is not as good as that of home graduates.

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Effect of Hospital Characteristics on Performance of Pediatric Digit Replantation in the United States

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1719230 ◽

2020 ◽

Author(s):

Neill Y. Li ◽

Justin E. Kleiner ◽

Edward J. Testa ◽

Nicholas J. Lemme ◽

Avi D. Goodman ◽

...

Keyword(s):

United States ◽

Pediatric Population ◽

The United States ◽

Teaching Hospitals ◽

Level Of Evidence ◽

Teaching Status ◽

Private And Public ◽

Subsequent Revision ◽

Privately Owned ◽

Hospital Characteristics

Abstract Introduction Utilize a national pediatric database to assess whether hospital characteristics such as location, teaching status, ownership, or size impact the performance of pediatric digit replantation following traumatic digit amputation in the United States. Materials and Methods The Kid’s Inpatient Database (KID) was used to query pediatric traumatic digit amputations between 2000 and 2012. Ownership (private and public), teaching status (teaching and non-teaching), location (urban and rural), hospital type (general and children’s), and size (large and small-medium) characteristics were evaluated. Replantations were then divided into those that required subsequent revision replantation or amputation. Fisher’s exact tests and multivariable logistic regressions were performed with p <0.05 considered statistically significant. Results Overall, 1,015 pediatric patients were included for the digit replantation cohort. Hospitals that were privately owned, general, large, urban, or teaching had a significantly greater number of replantations than small-medium, rural, non-teaching, public, or children’s hospitals. Privately owned (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.06–3.06; p = 0.03) and urban (OR: 2.29; 95% CI: 1.41–3.73; p = 0.005) hospitals were significantly more likely to perform replantation. Urban (OR: 4.02; 95% CI: 1.90–8.47; p = 0.0003) and teaching (OR: 2.11; 95% CI: 1.17–3.83; p = 0.014) hospitals were significantly more likely to perform a revision procedure following primary replantation. Conclusion Private and urban hospitals were significantly more likely to perform replantation, but urban and teaching hospitals carried a greater number of revision procedures following replantation. Despite risk of requiring revision, the treatment of pediatric digit amputations in private, urban, and teaching centers provide the greatest likelihood for an attempt at replantation in the pediatric population. The study shows Level of Evidence III.

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A SURVEY OF RADIOLOGY CLERKSHIPS AT TEACHING HOSPITALS IN THE UNITED STATES

Investigative Radiology ◽

10.1097/00004424-199312000-00127 ◽

1993 ◽

Vol 28 (12) ◽

pp. 1206

Author(s):

D. M. Barlev ◽

E. M. Lautin ◽

E. S. Amis ◽

M. E. Lerner

Keyword(s):

United States ◽

The United States ◽

Teaching Hospitals

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Antibiotic-Stewardship Practices at Top Academic Centers Throughout the United States and at Hospitals Throughout Massachusetts

Infection Control and Hospital Epidemiology ◽

10.1086/503346 ◽

2006 ◽

Vol 27 (7) ◽

pp. 695-703 ◽

Cited By ~ 20

Author(s):

Tamar F. Barlam ◽

Margarita DiVall

Keyword(s):

United States ◽

Antibiotic Stewardship ◽

Bacterial Resistance ◽

Hospital Costs ◽

Geographic Area ◽

The United States ◽

Teaching Hospitals ◽

Antibiotic Prescribing ◽

Community Hospitals ◽

Management Interventions

Objective.Improvements in antibiotic prescribing to reduce bacterial resistance and control hospital costs is a growing priority, but the way to accomplish this is poorly defined. Our goal was to determine whether certain antibiotic stewardship interventions were universally instituted and accepted at top US academic centers and to document what interventions, if any, are used at both teaching and community hospitals within a geographic area.Design.Two surveys were conducted. In survey 1, detailed phone interviews were performed with the directors of antibiotic stewardship programs at 22 academic medical centers that are considered among the best for overall medical care in the United States or as leaders in antibiotic stewardship programs. In survey 2, teaching and community hospitals throughout Massachusetts were surveyed to ascertain what antibiotic oversight program components were present.Results.In survey 1, each of the 22 participating hospitals had instituted interventions to improve antibiotic prescribing, but none of the interventions were universally accepted as essential or effective. In survey 2, of 97 surveys that were mailed to prospective participants, a total of 54 surveys from 19 teaching hospitals and 35 community hospitals were returned. Ninety-five percent of the teaching hospitals had a restricted formulary, compared with 49% of the community hospitals, and 89% of teaching hospitals had an antibiotic approval process, compared with 29% of community hospitals.Conclusion.There was great variability among the approaches to the oversight of antibiotic prescribing at major academic hospitals. Antibiotic management interventions were lacking in more than half of the Massachusetts community hospitals surveyed. More research is needed to define the best antibiotic stewardship interventions for different hospital settings.

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Infectious Disease Physician Assessment of Hospital Preparedness for Ebola Virus Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv087 ◽

2015 ◽

Vol 2 (3) ◽

Cited By ~ 10

Author(s):

Philip M. Polgreen ◽

Scott Santibanez ◽

Lisa M. Koonin ◽

Mark E. Rupp ◽

Susan E. Beekmann ◽

...

Keyword(s):

Infectious Disease ◽

United States ◽

Ebola Virus ◽

Virus Disease ◽

The United States ◽

Ebola Virus Disease ◽

Teaching Hospitals ◽

Emerging Infections ◽

First Case ◽

Hospital Preparedness

Abstract Background. The first case of Ebola diagnosed in the United States and subsequent cases among 2 healthcare workers caring for that patient highlighted the importance of hospital preparedness in caring for Ebola patients. Methods. From October 21, 2014 to November 11, 2014, infectious disease physicians who are part of the Emerging Infections Network (EIN) were surveyed about current Ebola preparedness at their institutions. Results. Of 1566 EIN physician members, 869 (55.5%) responded to this survey. Almost all institutions represented in this survey showed a substantial degree of preparation for the management of patients with suspected and confirmed Ebola virus disease. Despite concerns regarding shortages of personal protective equipment, approximately two thirds of all respondents reported that their facilities had sufficient and ready availability of hoods, full body coveralls, and fluid-resistant or impermeable aprons. The majority of respondents indicated preference for transfer of Ebola patients to specialized treatment centers rather than caring for them locally. In general, we found that larger hospitals and teaching hospitals reported higher levels of preparedness. Conclusions. Prior to the Centers for Disease Control and Prevention's plan for a tiered approach that identified specific roles for frontline, assessment, and designated treatment facilities, our query of infectious disease physicians suggested that healthcare facilities across the United States were making preparations for screening, diagnosis, and treatment of Ebola patients. Nevertheless, respondents from some hospitals indicated that they were relatively unprepared.

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Continuous Quality Improvement in a Hospital System: Implications for Hospital Epidemiology

Infection Control and Hospital Epidemiology ◽

10.1086/646528 ◽

1992 ◽

Vol 13 (5) ◽

pp. 288-292 ◽

Cited By ~ 2

Author(s):

Michael D. Decker ◽

William E. Scheckler

Keyword(s):

United States ◽

Quality Improvement ◽

Infection Control ◽

Continuous Quality Improvement ◽

The United States ◽

Teaching Hospitals ◽

Hospital Epidemiology ◽

Hospital System ◽

Continuous Quality ◽

Key Steps

The purpose of this report is to describe the “Continuous Quality Improvement” (CQI) paradigm as adopted by one of the 30 largest hospital systems in the United States and to explore the implications for hospital epidemiology and infection control. Hospital epidemiology has its roots in the application of epidemiologic tools and principles to the problems of nosocomial infections. Key steps in the development of hospital epidemiology came from physicians in Great Britain and the United States who were part of the public health systems of those countries. In the United States, physicians trained in infectious diseases as a subspecialty occupy the position of hospital epidemiologist in most university, Veterans Affairs, and larger community teaching hospitals. Some of these individuals argue that hospital epidemiologists should continue to focus principally on infection control. Others are just as convinced that the premises and knowledge of epidemiology honed by experiences in infection control are very well suited to many other problems facing hospitals in the 1990s.

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Teaching Medicine

10.1093/med/9780190671495.003.0001 ◽

2017 ◽

Author(s):

Molly Harrod ◽

Sanjay Saint ◽

Robert W. Stock

Keyword(s):

United States ◽

Medical Education ◽

Medical Schools ◽

The United States ◽

Time Constraints ◽

Teaching Hospitals ◽

Complex Patients

Medical schools in the United States now graduate some 18,000 students a year, and most of them will continue their medical education at one of the more than 1,000 teaching hospitals. Time constraints, complex patients, and the involvement of multiple disciplines in the care of patients have necessitated changes in medical education on the units. Unlike prior research, this project focused on the context in which learning happens and designated the team as the focus of research. The authors spent time with 12 outstanding attendings and their teams in order to provide detailed descriptions of the specific strategies, methods, and even language that the attendings use to teach their learners not only about medicine but also about how to care for patients.

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