Does Reducing Inpatient Length of Stay Have Upstream Effects on the Emergency Room: Exploring the Impact of the General Internal Medicine Care Transformation Initiative

Effective discharge planning is important to ensuring a high quality of patient care and operational efficiency. The general internal medicine (GIM) environment is very complex and fluid, with multiple health professions providing care for patients. This makes coordination of discharges difficult, even with structured daily interprofessional rounds.The purpose of this case-control study was to evaluate a discharge notification form that predicts next-day discharges. The main measures of the study, which took place in GIM wards at two academic teaching hospitals, were the completion and accuracy of the discharge forms, length of stay, discharge times, post-discharge admissions, and emergency department visits.Seventy-six of 200 patients studied had information completed on the discharge notification form. The overall effect appeared to move discharges earlier in the day, while having no effect on length of stay.Patients whose information was completed on the discharge notification form were less likely to have an emergency department visit within 30 days post-discharge.The use of a discharge notification form appears to move discharges earlier in the day, without increasing length of stay. Further refinement and evaluation is necessary to increase usage and assess the impact onoutcomes of care.

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Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist

European Journal of Internal Medicine ◽

10.1016/j.ejim.2015.05.012 ◽

2015 ◽

Vol 26 (6) ◽

pp. 399-406 ◽

Cited By ~ 27

Author(s):

Bertrand Guignard ◽

Pascal Bonnabry ◽

Arnaud Perrier ◽

Pierre Dayer ◽

Jules Desmeules ◽

...

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Clinical Pharmacist ◽

Drug Related Problems ◽

General Internal ◽

The Impact

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Disability Impacts Length of Stay in General Internal Medicine Patients

Journal of General Internal Medicine ◽

10.1007/s11606-014-2815-z ◽

2014 ◽

Cited By ~ 1

Author(s):

Chunzhen Tan ◽

Yee Sien Ng ◽

Gerald C. H. Koh ◽

Deidre A. De Silva ◽

Arul Earnest ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

General Internal Medicine ◽

General Internal

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A Comparison of Hours Length of Stay and Compliance with 24-Hour Patient Length of Stay Between Emergency and General Internal Medicine/Internal Medicine Subspecialty Observation Services: Implication for ED Crowding at a Tertiary Care Center

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.925 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S80-S81 ◽

Cited By ~ 1

Author(s):

F. Khan ◽

M. Faulk ◽

A. Hertlein

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

General Internal Medicine ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

General Internal ◽

Ed Crowding

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Infectious Diseases on a General Internal Medicine Clinical Teaching Unit

Canadian Journal of Infectious Diseases ◽

10.1155/1999/571053 ◽

1999 ◽

Vol 10 (1) ◽

pp. 33-38

Author(s):

LE Nicolle ◽

J Uhanova ◽

P Orr ◽

A Kraut ◽

K Van Ameyde ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Infectious Diseases ◽

General Internal Medicine ◽

Clinical Teaching ◽

Cost Of Care ◽

Therapeutic Interventions ◽

General Internal ◽

Teaching Unit ◽

Time Of Admission

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay.RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

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UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

Frontline Gastroenterology ◽

10.1136/flgastro-2021-101965 ◽

2021 ◽

pp. flgastro-2021-101965

Author(s):

Suneil A Raju ◽

Rebecca Harris ◽

Charlotte Cook ◽

Philip Harvey ◽

Elizabeth Ratcliffe

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Training Programme ◽

British Society ◽

Specialty Training ◽

Endoscopy Training ◽

Electronic Survey ◽

General Internal ◽

The Impact ◽

Training Opportunities

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.

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1057. The Impact of Temporary Suspensions of an Antimicrobial Stewardship Audit and Feedback Program on Antimicrobial Utilization of General Internal Medicine Inpatients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.921 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S373-S374

Author(s):

Cynthia Wong ◽

Linda R Taggart ◽

Elizabeth Leung

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Antimicrobial Stewardship ◽

Audit And Feedback ◽

Patient Specific ◽

Antimicrobial Use ◽

Patient Acuity ◽

General Internal ◽

Antimicrobial Utilization ◽

The Impact

Abstract Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures.

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Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice

BMC Health Services Research ◽

10.1186/s12913-021-06710-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anastasia Pozdnyakova Piersa ◽

Neda Laiteerapong ◽

Sandra A. Ham ◽

Felipe Fernandez del Castillo ◽

Sachin Shah ◽

...

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Close Encounter ◽

General Internal ◽

Clinical Efficiency ◽

Preventative Health ◽

Academic General Internal Medicine ◽

Number Of Visits ◽

Internal Medicine Clinic ◽

The Impact

Abstract Background Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice. Methods Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations. Results Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes. Conclusions Working with a scribe in an academic internal medicine practice was associated with more timely documentation.

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Morning Discharges and Patient Length of Stay in Inpatient General Internal Medicine

Journal of Hospital Medicine ◽

10.12788/jhm.3605 ◽

2021 ◽

Vol 16 (6) ◽

Author(s):

Abirami Kirubarajan ◽

Saeha Shin ◽

Michael Fralick ◽

Janice Kwan ◽

Lauren Lapointe-Shaw ◽

...

Keyword(s):

Internal Medicine ◽

Length Of Stay ◽

Hospital Mortality ◽

General Internal Medicine ◽

Patient Flow ◽

Situational Factors ◽

General Internal ◽

Number Of Patients ◽

Improve Patient ◽

Multivariable Adjustment

BACKGROUND: Many initiatives seek to increase the number of morning hospital discharges to improve patient flow, but little evidence supports this practice. OBJECTIVE: To determine the association between the number of morning discharges and emergency department (ED) length of stay (LOS) and hospital LOS in general internal medicine (GIM). DESIGN, SETTING, AND PARTICIPANTS: Multicenter retrospective cohort study involving all GIM patients discharged between April 1, 2010, and October 31, 2017, at seven hospitals in Ontario, Canada. MAIN MEASURES: The primary outcomes were ED LOS and hospital LOS, and secondary outcomes were 30-day readmission and in-hospital mortality. The number of morning GIM discharges (defined as the number of patients discharged alive between 8:00 am and 12:00 pm ) on the day of each hospital admission was the primary exposure. Multivariable regression models were fit to control for patient characteristics and situational factors, including GIM census. RESULTS: The sample included 189,781 patient admissions. In total, 36,043 (19.0%) discharges occurred between 8:00 am and 12:00 pm . The average daily number of morning discharges and total discharges per hospital was 1.7 (SD, 1.4) and 8.4 (SD, 4.6), respectively. The median ED LOS was 14.5 hours (interquartile range [IQR], 10.0- 23.1), and the median hospital LOS was 4.6 days (IQR, 2.4-9.0). After multivariable adjustment, there was not a significant association between morning discharge and hospital LOS (adjusted rate ratio [aRR], 1.000; 95% CI, 0.996-1.000; P = .997), ED LOS (aRR, 0.999; 95% CI, 0.997-1.000; P = .307), 30-day readmission (aRR, 1.010; 95% CI, 0.991-1.020; P = .471), or in-hospital mortality (aRR, 0.967; 95% CI, 0.920-1.020; P = .183). The lack of association between morning discharge and LOS was generally consistent across all seven hospitals. At one hospital, morning discharge was associated with a 1.9% shorter ED LOS after multivariable adjustment (aRR, 0.981; 95% CI, 0.966-0.996; P = .013). CONCLUSIONS: The number of morning discharges was not significantly associated with shorter ED LOS or hospital LOS in GIM. Our findings suggest that increasing the number of morning discharges alone is unlikely to substantially improve patient throughput in GIM, but further research is needed to determine the effectiveness of specific interventions.

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