Staphylococcal resistance to aminoglycosides before and after introduction of amikacin in two teaching hospitals.

BackgroundElectronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).ObjectiveTo assess changes in MAE rates and types associated with EMS implementation.MethodsThis was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.Results7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.ConclusionsImplementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.

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A Successful Strategy to Reduce Hospital-Onset Clostridium difficile

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1017 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S406-S406

Author(s):

Lou Ann Bruno-Murtha ◽

Rebecca Osgood ◽

Casey Alexandre ◽

Rumel Mahmood

Keyword(s):

Best Practice ◽

Teaching Hospitals ◽

Incentive Payment ◽

Contact Precautions ◽

Testing Protocol ◽

Antigen Assay ◽

Before And After ◽

Practice Advisory ◽

Community Onset ◽

Community Teaching

Abstract Background Our goal was to reduce the rate of hospital-onset (HO) C. difficile (CD) by prompt testing in patients with diarrhea on hospital day (HD) 1–3 using a nurse-driven testing protocol (NTP) with PCR and improve identification of disease after HD 3 using a combined toxin/antigen assay (TAA). Methods An automated best practice advisory/NTP was developed in Epic, triggered by documentation of diarrhea during HD 1–3, to facilitate prompt stool collection, testing and initiation of contact precautions. Education was provided. The NTP was fully implemented at 2 community-teaching hospitals mid-February 2016. The TAA was adopted 7/27/16 for testing after HD 3. Results In 2016, the standardized infection ratio (SIR) at Cambridge and Everett was 0.43 (P = 0.009) and 0.5 (P = 0.017), respectively, reflecting a 48–61% decrease from 2015. There was a 14–28% improvement in identifying cases as community-onset. The TAA led to a further decline in HO-CD by 10–61%. Refer to the graph for quarterly SIRs before and after implementation. Despite a 26% increase in testing volume, costs are less with the current strategy. Conclusion Prompt identification of CD improves care and prevents inflation of HO-CD. This strategy has enhanced our efforts to reduce our SIR (observed/expected cases) and resulted in a substantial incentive payment for CHA. Disclosures All authors: No reported disclosures.

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Old Nurses and New: Nursing in the London Teaching Hospitals Before and After the Mid-Nineteenth-Century Reforms

Nursing History Review ◽

10.1891/1062-8061.1.1.43 ◽

1993 ◽

Vol 1 (1) ◽

pp. 43-70 ◽

Cited By ~ 2

Author(s):

CAROL HELMSTADTER

Keyword(s):

Nineteenth Century ◽

Teaching Hospitals ◽

Before And After

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Clinical and Hematological Evaluation of Patients with Sickle Cell Anemia Before and After Four Years of Using Hydroxyurea

International Archives of Medicine ◽

10.3823/2469 ◽

2017 ◽

Vol 10 ◽

Author(s):

Ieda Maria Gonçalves Pacce Bispo ◽

Maria Lúcia Ivo ◽

Valter Aragão do Nascimento ◽

Alexandra Maria Almeida Carvalho de Pinto ◽

Olinda Maria Rodrigues de Araújo ◽

...

Keyword(s):

Sickle Cell ◽

Sickle Cell Anemia ◽

Hematological Parameters ◽

Fetal Hemoglobin ◽

Hemoglobin Concentration ◽

Teaching Hospitals ◽

Acute Chest Syndrome ◽

Mean Values ◽

Significant Difference ◽

Before And After

Objective: Evaluating clinical and hematological-clinical parameters of patients with sickle cell anemia (SCA) before and after four years of using hydroxyurea (HU). Method: A retrospective cohort study implementing a quantitative, descriptive and analytical approach developed in two public teaching hospitals located in the Central-West region of Brazil, from November 2010 to October 2011. Data collection was performed through medical records of 32 patients with SCA to assess clinical and hematological parameters before and after HU treatment. The study was approved by the UFMS Ethics Committee under protocol number 1890/2010. Results: All of the 32 patients were homozygous with a mean age in the prescription of hydroxyurea of 19.72±7.58 years, an initial dose of 15.59±4.27 mg/kg/day, and 22.48±5.35 mg/kg/day in the fourth year of treatment. Regarding the use of HU, average values of some hematological parameters presented a significant difference in the fourth year compared to the mean values prior to HU use, such as fetal hemoglobin (14.49±7.52%), red blood cells (2.54±0.38x1012/L), hematocrit (25.30±4.03%) and hemoglobin (9.22±3.34g/dL). Conclusion: Treatment with hydroxyurea showed a significant increase in fetal hemoglobin levels, increased hemoglobin, hematocrit and average corpuscular hemoglobin concentration, with reduced episodes of pain, infection and acute chest syndrome in such a way as to reaffirm its efficiency in treating these patients. Keywords: Hemoglobin; Sickle Cell Anemia; Hydroxyurea.

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Intensive Care Unit Services Preparedness for the Pandemic: An Efficiency Analysis

Health Services Insights ◽

10.1177/11786329211037527 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110375

Author(s):

Songul Cinaroglu

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Health Resources ◽

Public Hospitals ◽

Teaching Hospitals ◽

Efficient Management ◽

Study Results ◽

Before And After ◽

The Difference

Intensive care unit (ICU) services efficiency and the shortage of critical care professionals has been a challenge during pandemic. Thus, preparing ICUs is a prominent part of any pandemic response. The objective of this study is to examine the efficiencies of ICU services in Turkey right before the pandemic. Data were gathered from the Public Hospital Statistical Year Book for the year 2017. Analysis are presented at hospital level by comparing teaching and non-teaching hospitals. Bootstrapped data envelopment analysis procedure was used to gather more precise efficiency scores. Three analysis levels are incorporated into the study such as, all public hospitals (N = 100), teaching (N = 53), non-teaching hospitals (N = 47), and provinces that are providing high density of ICU services through the country (N = 54). Study results reveal that average efficiency scores of ICU services obtained from teaching hospitals (eff = 0.65) is higher than non-teaching (eff = 0.54) hospitals. After applying the bootstrapping techniques, efficiency scores are significantly improved and the difference between before and after bootstrapping results are statistically significant ( P < .05). Province based analysis indicates that, ICU services efficiencies are high for provinces located in southeast part of the country and highly populated places, such as İstanbul. Evidence-based operational design that considers the spatial distribution of health resources and effective planning of critical care professionals are critical for efficient management of intensive care. Study results will be helpful for health policy makers to deeply understand dynamics of critical care.

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Abstract W P298: Simulation Based Acute Stroke Training for Neurology Residents

Stroke ◽

10.1161/str.46.suppl_1.wp298 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Deependra Khanal ◽

Sara Hocker

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Teaching Hospitals ◽

Self Confidence ◽

Emergency Department Nurse ◽

Simulation Based ◽

Before And After ◽

Tomography Scan ◽

Normal Head

Background: The majority of patients presenting with acute stroke in teaching hospitals are assessed by neurology residents. Simulation based training has been shown to be an effective teaching tool in medical education. We sought to determine whether simulation based training improves learner confidence in the evaluation and management of acute ischemic stroke. Methods: We devised a simulated acute stroke scenario utilizing a standardized patient instructed to act out a right hemispheric syndrome and an emergency department nurse. Scenarios were performed in May/June of 2013 and April/May of 2014. Laboratory values, vitals, electrocardiogram and a normal head computerized tomography scan were shown to the residents. Residents were expected to efficiently take a focused history, perform an NIHSS exam, evaluate exclusion and inclusion criteria, obtain informed consent for thrombolysis administration and give the correct dose of t-PA. Following t-PA administration, the patient develops an acute severe headache and the learner is evaluated on whether they immediately discontinue the infusion and initiate appropriate management steps for t-PA associated hemorrhage. Following the scenario the learner met one on one with staff for a debriefing session. Learner confidence in the management of acute stroke was assessed before and after the simulation experience using a 5 point Likert scale with 1=novice, 3=competent and 5=expert. Following the simulation, learners were asked to evaluate the experience (poor, needs improvement, good or outstanding). Results: 21 Neurology residents completed the scenario (11 in 2013 and 10 in 2014). Learner confidence improved from mean 2.81(SD-0.88) to 3.36(SD-0.73), p=0.03. Evaluations were favorable with all residents reporting a ‘good’ or ‘outstanding’ experience. Conclusion: We have demonstrated that simulation training in the evaluation of acute ischemic stroke among neurology residents is feasible and improves learner self-confidence.

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Do non-targeted gastric biopsies affect the management of patients, and can a simple protocol and education reduce the rate?

Frontline Gastroenterology ◽

10.1136/flgastro-2017-100813 ◽

2017 ◽

Vol 9 (1) ◽

pp. 67-72 ◽

Cited By ~ 2

Author(s):

Victoria Gibson ◽

Stephanie Needham ◽

Manu Nayer ◽

Nick P Thompson

Keyword(s):

Local Population ◽

Cost Savings ◽

Teaching Hospitals ◽

Population Demographics ◽

Simple Protocol ◽

Before And After ◽

Risk Patients ◽

Gastric Biopsies ◽

Upper Gastrointestinal ◽

Targeted Biopsies

ObjectiveTo determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions.DesignRetrospective analysis of patient records over a 3-month period in 2013, repeated in 2015 following intervention.SettingTwo UK teaching hospitalsPatientsPatient record data on indication for endoscopy, endoscopy findings, histopathology results and patient outcome.InterventionsGuidance on upper gastrointestinal biopsy in the form of a new trust-wide protocol, as well as lecture-based education.Main outcome measuresRates of non-targeted and targeted biopsies before and after intervention, and differences between grade of endoscopist.ResultsBetween 2013 and 2015, there was a 36% reduction in non-targeted biopsies (10.4% vs 6.7%, p=0.001), predominantly within registrar and nurse endoscopist groups, with reduction in non-targeted biopsies of 9.5% and 64%, respectively. Percentage of targeted biopsies remained relatively static, 7.9% and 8.2%. In 2013, 92% of non-targeted biopsies had no management change based on histology; in 2015 this was 90%. Of patients with alteration to management, only 0.4% and 0.7% were due to malignancy, in known high-risk patients. Reduction in non-targeted biopsies resulted in estimated annual savings in this trust of £36,000.ConclusionDevelopment of local protocol reduces the numbers of non-targeted biopsies taken, without risk of harm from non-detection of malignant conditions, enabling a significant reduction in workload within busy histopathology services, with significant cost savings. Localised protocols are adaptable to local population demographics.

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Comparing the Effects of Menthol-cold Water and Psyllium on Thirst and Xerostomia among Patients in Intensive Care Unit

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i1.5478 ◽

2021 ◽

Author(s):

Leila Sayadi ◽

Ebrahim Khadem ◽

Elnaz Nasiri

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cold Water ◽

Statistical Tests ◽

Controlled Trial ◽

Herbal Remedies ◽

Teaching Hospitals ◽

Control Group ◽

Before And After ◽

Mouth Wash

Background: Thirst is a prevalent problem among patients in intensive care unit. This study aimed to compare the effects of menthol-cold water and psyllium on thirst and xerostomia among patients in intensive care unit. Methods: This randomized controlled trial was conducted in 2018–2019. Participants were 132 patients consecutively recruited from the intensive care units of two teaching hospitals, Tehran, Iran. They were randomly allocated to either a menthol-cold water, a psyllium, or a control group (44 patients in each group). Participants in the menthol-cold water and the psyllium groups received mouth wash with respectively menthol-cold water and psyllium in two fifteen-minute rounds with a thirty-minute interval. A visual analogue scale was used to assess thirst severity, distress, and xerostomia before and after each round of mouth wash. Data were analyzed through non-parametric statistical tests. Results: There were no significant differences among the groups respecting baseline characteristics, thirst severity and distress, and xerostomia. However, among-group differences respecting thirst severity, distress, and xerostomia were statistically significant after the intervention (P < 0.001). Mouth wash with psyllium was associated with significantly greater reduction in thirst severity, distress, and xerostomia compared with mouth wash with menthol-cold water (P< 0.001). Conclusion: Both menthol-cold water and psyllium are effective in reducing thirst and xerostomia among patients in intensive care unit, though the effectiveness of psyllium is significantly greater than menthol-cold water. Educating nurses about thirst and xerostomia assessment and herbal remedies for their management may help them effectively manage their patients’ thirst and xerostomia.

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Abstract WP409: Utilization of Open Cranial Surgery Following Surgical Trial in Lobar Intracerebral Haemorrhage I & II

Stroke ◽

10.1161/str.51.suppl_1.wp409 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Roxanna M Garcia ◽

William Metcalf-Doetsch ◽

Hannah Weiss ◽

Pedram Golnari ◽

Andrew Naidech ◽

...

Keyword(s):

Intracerebral Haemorrhage ◽

The United States ◽

Teaching Hospitals ◽

Discharge Disposition ◽

Cranial Surgery ◽

Surgical Trial ◽

Before And After ◽

National Trends ◽

Procedure Codes ◽

The Impact

Introduction: The impact of randomized controlled trials (RCTs) on clinical practice remains an important topic in medical research. Several landmark RCTs have tested the role of neurosurgical management following spontaneous intracerebral hemorrhage (ICH). Studies have found discordant trends in utilization of open cranial surgery following the publication of Surgical Trial in Lobar Intracerebral Haemorrhage (STICH) I & II but national trends have not been assessed. Hypothesis: We hypothesize that recent RCTs have had limited impact on cranial utilization patterns for ICH. Methods: Hospitalizations from 2000 to 2014 were identified from the National Inpatient Sample. A time trend analysis evaluated open cranial surgery utilization by three ICD9CM procedure codes (01.2 “Craniotomy/Craniectomy”, 01.24 “Other Craniotomy”, and 01.25 “Other Craniectomy”), stratified by teaching status, before and after 2005, following publication of STICH I. The impact on patient outcomes was also assessed. Results: Based on a total of 241,160 hospitalizations with 6,984 (2.9%) open cranial surgeries, approximately 33,616 (95% confidence interval (CI): 31,582-35,650) have been performed in the United States since 2000. There was a temporal increase in cranial surgeries (OR 1.04, 95% CI: 1.03-1.05, p<0.0001) between 2000 and 2014 but when stratified by study period (before or after 2005), the increase was only significant after 2005 (OR 1.05, 95% CI: 1.03-1.06, p<0.0001). The effect was greater at teaching hospitals (OR 1.15, 95% CI: 1.10-1.20, p<0.0001) than at non-teaching hospitals (OR 1.10, 95% CI: 0.99-1.21, p=0.07). There was no differences in patient mortality and discharge disposition (p-values >0.15). Conclusion: Utilization of open cranial procedures has increased after STICH I, an effect that was strongest at teaching hospitals. These findings suggest that recent RCTs did not influence utilization of open cranial surgery for management of ICH.

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Associations Between In-Hospital Mortality, Health Care Utilization, and Inpatient Costs With the 2011 Resident Duty Hour Revision

Journal of Graduate Medical Education ◽

10.4300/jgme-d-18-00415.1 ◽

2019 ◽

Vol 11 (2) ◽

pp. 146-155 ◽

Cited By ~ 1

Author(s):

Shaker M. Eid ◽

Lucia Ponor ◽

Darcy A. Reed ◽

May A. Beydoun ◽

Hind A. Beydoun ◽

...

Keyword(s):

Improve Patient Safety ◽

National Level ◽

Interrupted Time Series ◽

Teaching Hospitals ◽

Care Utilization ◽

Control Group ◽

Data Set ◽

Before And After ◽

Nationally Representative ◽

The Impact

ABSTRACT Background The Accreditation Council for Graduate Medical Education (ACGME) has mandated revisions to residents' work hours to improve patient safety and enhance resident education and wellness. The impact on clinical outcomes on a national level is poorly understood. Objective We examined data from before and after the ACGME 2011 duty hour revision and looked for differences between teaching and nonteaching US hospitals. Methods A retrospective observational study of patients admitted to hospitals in the 2-year periods before and after the 2011 duty hour revision was conducted, utilizing a nationally representative data set. We compared patient and hospital characteristics using standardized differences. With nonteaching hospitals serving as the control group, we used multiple group interrupted time series segmented regression analysis to test for postrevision level and trend changes in mortality, length of stay (LOS), and costs. Results We examined more than 117 million hospitalizations. At teaching and nonteaching hospitals, trends in mortality and LOS in prerevision and postrevision periods were not significantly different (all P > .05). A significant monthly reduction in cost per hospitalization was noted postrevision at teaching hospitals (P = .019) but not at nonteaching hospitals (P = .62). In the 2 years following the 2011 revision, there was a monthly reduction in cost per hospitalization (–$52.28; 95% confidence interval –$116.90 to –$12.32; P = .026) at teaching relative to nonteaching hospitals. Conclusions There were no differences in mortality or LOS between teaching and nonteaching hospitals. However, there was a small decrease in cost per hospitalization at teaching hospitals following the 2011 revision.

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