Interdisciplinary Rounds on a Hospitalist Service

2019 ◽  
Vol 34 (4) ◽  
pp. E7-E8
2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Stephen R Morris ◽  
Yoichiro Natori ◽  
Douglas Salguero ◽  
Alejandro Mantero ◽  
Ruixuan Ma ◽  
...  

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) is responsible for coronavirus disease 2019 (COVID-19), a disease that had not been previously described and for which clinicians need to rapidly adapt their daily practice. The novelty of SARS-CoV-2 produced significant gaps in harmonization of definitions, data collection, and outcome reporting to identify patients who would benefit from potential interventions. Methods We describe a multicenter collaboration to develop a comprehensive data collection tool for the evaluation and management of COVID-19 in hospitalized patients. The proposed tool was developed by a multidisciplinary working group of infectious disease physicians, intensivists, and infectious diseases/antimicrobial stewardship pharmacists. The working group regularly reviewed literature to select important patient characteristics, diagnostics, and outcomes for inclusion. The data collection tool consisted of spreadsheets developed to collect data from the electronic medical record and track the clinical course after treatments. Results Data collection focused on demographics and exposure epidemiology, prior medical history and medications, signs and symptoms, diagnostic test results, interventions, clinical outcomes, and complications. During the pilot validation phase, there was <10% missing data for most domains and components. Team members noted improved efficiency and decision making by using the tool during interdisciplinary rounds. Conclusions We present the development of a COVID-19 data collection tool and propose its use to effectively assemble harmonized data of hospitalized individuals with COVID-19. This tool can be used by clinicians, researchers, and quality improvement healthcare teams. It has the potential to facilitate interdisciplinary rounds, provide comparisons across different hospitalized populations, and adapt to emerging challenges posed by the pandemic.


2019 ◽  
Vol 34 (4) ◽  
pp. 295-300 ◽  
Author(s):  
Catherine V. Smith ◽  
Ralitsa S. Maduro ◽  
Merri K. Morgan ◽  
Patricia Ver Schneider ◽  
Carolyn M. Rutledge ◽  
...  

2019 ◽  
Vol 40 (12) ◽  
pp. 1344-1347
Author(s):  
Bradley J. Langford ◽  
Kevin A. Brown ◽  
April J. Chan ◽  
Mark Downing

AbstractBackground:Antimicrobial stewardship program (ASP) interventions, such as prospective audit and feedback (PAF), have been shown to reduce antimicrobial use and improve patient outcomes. However, the optimal approach to PAF is unknown.Objective:We examined the impact of a high–intensity interdisciplinary rounds–based PAF compared to low–intensity PAF on antimicrobial use on internal medicine wards in a 400–bed community hospital.Methods:Prior to the intervention, ASP pharmacists performed low–intensity PAF with a focus on targeted antibiotics. Recommendations were made directly to the internist for each patient. High–intensity, rounds–based PAF was then introduced sequentially to 5 internal medicine wards. This PAF format included twice–weekly interdisciplinary rounds, with a review of all internal medicine patients receiving any antimicrobial agent. Antibiotic use and clinical outcomes were measured before and after the transition to high–intensity PAF. An interrupted time–series analysis was performed adjusting for seasonal and secular trends.Results:With the transition from low–intensity to high–intensity PAF, a reduction in overall usage was seen from 483 defined daily doses (DDD)/1,000 patient days (PD) during the low–intensity phase to 442 DDD/1,000 PD in the high–intensity phase (difference, −42; 95% confidence interval [CI], −74 to −9). The reduction in usage was more pronounced in the adjusted analysis, in the latter half of the high intensity period, and for targeted agents. There were no differences seen in clinical outcomes in the adjusted analysis.Conclusions:High–intensity PAF was associated with a reduction in antibiotic use compared to a low–intensity approach without any adverse impact on patient outcomes. A decision to implement high–intensity PAF approach should be weighed against the increased workload required.


2003 ◽  
Vol 17 (3) ◽  
pp. 133-142 ◽  
Author(s):  
MARGO A. HALM ◽  
STEVEN GAGNER ◽  
MARY GOERING ◽  
JULIE SABO ◽  
MAUREEN SMITH ◽  
...  

2016 ◽  
Vol 11 (7) ◽  
pp. 513-523 ◽  
Author(s):  
V. Surekha Bhamidipati ◽  
Daniel J. Elliott ◽  
Ellen M. Justice ◽  
Ene Belleh ◽  
Seema S. Sonnad ◽  
...  

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