Impact of systematic cavity shave margins in breast‐conserving surgery at a large community hospital with a low baseline re‐excision rate

Abstract Background Candidemia is the fourth leading hospital-acquired bloodstream infection with an estimated mortality rate of 35%. Fungal blood cultures result in at least five days and fail to identify 40% of Candida infections. The T2 Candida Panel is a diagnostic test which utilizes whole blood to provide rapid detection of five Candida varieties. It has a 91% sensitivity and 99% specificity rate and enables physicians to initiate or de-escalate therapy rapidly, possibly decreasing mortality. However, practical utilization clinically has not been studied. Our aim is to evaluate the appropriate utilization of the T2 Candida Panel in a large community hospital. Methods A retrospective chart review of hospitalized with a T2 Candida Panel result from December 2015 to June 2018 was performed. The panel was restricted and could only be ordered by two specialties, Infectious Disease and Oncology. Baseline demographics and patient characteristics were collected. Endpoints assessed included patient outcomes, antifungal medication use, T2 Candida panel results, corresponding blood culture results, time to appropriate therapy and duration of therapy. Results A total of 628 T2 Candida panels resulted during the study period with 56.6% involving the intensive care setting. The average age was 59.5 years with 52.5% of the population being male. Of the total, 8.1% (n = 60) were positive. Only three patients had a positive fungal blood culture result with a negative T2 panel collected at the same time (sensitivity 94.3%, 95% CI 80.8–99.3; specificity 94.2%, 95% CI 91.4–96.3). 264 (42%) were ordered with concomitant antifungal therapy and 48.1% underwent de-escalation of therapy based on T2 result. The average time to de-escalation was 137 hours. Of the positive results, 40 (66.7%) had an antifungal ordered when the T2 panel was ordered and 30 (50%) were switched to appropriate therapy after T2 resulted in an average time of 11 hours. Conclusion Our data shows that while the T2 Candida Panel demonstrated faster and more sensitive results, there was still a considerable delay in achieving appropriate therapy. The variation in utilization of the T2 Candida Panel indicates that further intervention regarding appropriate use of the panel is required. Disclosures All authors: No reported disclosures.

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TIMING AND MODE OF 2.0 AMPERE HOUR CARDIAC RESYNCHRONIZATION IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OUT OF SERVICE IN A LARGE COMMUNITY HOSPITAL HEART FAILURE COHORT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)30940-2 ◽

2020 ◽

Vol 75 (11) ◽

pp. 313

Author(s):

Jeffrey L. Williams ◽

Bertha Harley ◽

Gabriella Williams

Keyword(s):

Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Community Hospital ◽

Cardiac Resynchronization ◽

Cardioverter Defibrillator ◽

Large Community

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Retrospective Study of Performance, Complications, Outcomes of Hypothermia Protocol in a Large Community Hospital in Last Three Years

CHEST Journal ◽

10.1378/chest.1389002 ◽

2012 ◽

Vol 142 (4) ◽

pp. 386A

Author(s):

Leena Gupta ◽

Narinder Gill ◽

Ben Siu-James

Keyword(s):

Retrospective Study ◽

Community Hospital ◽

Large Community

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Abstract P2-12-03: Impact of the SSO-ASTRO consensus guidelines on invasive margins on the re-excision rate among patients undergoing breast conserving surgery (BCS)

10.1158/1538-7445.sabcs17-p2-12-03 ◽

2018 ◽

Author(s):

M Chavez-MacGregor ◽

X Lei ◽

M Morrow ◽

SH Giordano

Keyword(s):

Breast Conserving Surgery ◽

Consensus Guidelines ◽

Excision Rate

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Multidisciplinary Approach to Improve Utilization and Cost Savings of Multiplex Polymerase chain reaction (PCR) Respiratory Pathogen Testing in a Large Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.853 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S353-S354

Author(s):

Ali Hassoun ◽

Jonathan Edwards

Keyword(s):

Nasal Swab ◽

Community Hospital ◽

Clinical Information System ◽

Retrospective Chart Review ◽

Respiratory Pathogen ◽

Intervention Period ◽

Post Intervention ◽

Large Community ◽

Intervention Cost ◽

Order Sets

Abstract Background PCR technology can be used for precise detection of infectious agents and improves antibiotic stewardship through: Accelerated de-escalation of therapy Rapid identification of pathogens Detection of resistance genes. In our center, basic respiratory Panel detect 11 targets and cost $100 while Complete panel detect 31 targets and cost $230.The purpose of the study is to improve utilization of these panel testing in a large community hospital. Methods Retrospective chart review of all patients with an order for a complete or basic panel and excluding Patients discharged or deceased prior to result reporting or insufficient specimen quantity to perform. Each patient was evaluated for appropriate respiratory panel collection site and antibiotic regimen changes within 48 hours of results. The preintervention period conducted from 10/2015- 12/2015, evaluated how respiratory panels were being utilized in antibiotic decision-making. Three primary interventions were enacted: Eliminated nasal swabs as a source option for respiratory panels in the clinical information system, restricted complete panel ordering to ID physicians and Eliminated PCR ordering options from all order sets. The postintervention period conducted from 5/2016 – 8/2016, re-evaluated the utilization and costs of respiratory panels. Results 270 tests ordered preintervention (13% basic and 87% complete) and 196 postintervention (84% basic and 16% complete), nasal swab was done in 78% in preintervention vs. 8% in postintervention, action was taken in 51 vs. 44 in pre-vs. post intervention. cost in preintervention period was 57,420 in preintervention vs. 23,660 in post intervension. No difference between ID vs. non-ID specialist in utilization of PCR. Conclusion Nasal swab collections for PCR decreased post-intervention from 78% to 8%. Appropriate sources for PCR specimen, such as sputum, were utilized during the post-intervention period. Post-intervention utilization of the panel results was comparable to pre-intervention period. Elimination of PCR respiratory panels from order sets and restrictions of complete respiratory panel ordering to ID physicians resulted in $33,760 saved. Disclosures All authors: No reported disclosures.

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