scholarly journals Does admission order form design really matter? A reduction in urea blood test ordering

2021 ◽  
Vol 10 (3) ◽  
pp. e001330
Author(s):  
Pamela Mathura ◽  
Cole Boettger ◽  
Reidar Hagtvedt ◽  
Yvonne Suranyi ◽  
Narmin Kassam
Keyword(s):  
Hospital Admission ◽  
High Volume ◽  
Teaching Hospitals ◽  
Medical Procedures ◽  
General Internal ◽  
Order Form ◽  
Significant Step ◽  
Form Design ◽  
Health Zone ◽  
Test Ordering

IntroductionLaboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial implications. Studies have suggested that the design of a standard hospital admission order form and laboratory request forms influence physician test ordering behaviour, reducing inappropriate ordering and promoting resource stewardship.Aim/methodTo redesign the standard medicine admission order form-laboratory request section to reduce inappropriate blood urea nitrogen (BUN) testing.ResultsA redesign of the standard admission order form used by general internal medicine physicians and residents in two large teaching hospitals in one health zone in Alberta, Canada led to a significant step reduction in the ordering of the BUN test on hospital admission.ConclusionsRedesigning the standard medicine admission order form-laboratory request section can have a beneficial effect on the reduction in BUN ordering altering physician ordering patterns and behaviour.

Multiple B-D Glucan and Cmv Test Ordering By Multiple Physicians – Analysis To Assess The Frequency Of Duplicate Test Orders

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S152-S152
Author(s):  
S Fathima ◽  
A R Gardner ◽  
A J Sohn ◽  
R Benavides
Keyword(s):  
Viral Load ◽  
Chart Review ◽  
Medical Center ◽  
Direct Care ◽  
Teaching Hospitals ◽  
Multiple Test ◽  
Baylor University ◽  
Time Period ◽  
Time Stamps ◽  
Test Ordering

Abstract Introduction/Objective In teaching hospitals, patients receive direct care from a succession of different physicians, each of whom may order diagnostic tests on the same patient resulting in multiple physicians unknowingly ordering the same test in the same time period, leading to overutilization. We examined the association of test-ordering by multiple physicians with duplication of two tests, Beta D-Glucan (BDG) and CMV Viral Load by PCR non blood, as aid for detection of fungal and cytomegaloviral infections, respectively Methods Retrospective medical records at Baylor University Medical Center, Dallas were examined in between 10/1/2019- 10/30/2019. A total 167 test orders were identified for CMV Viral Load non blood and BDG presence in blood. Each medical record was assessed for frequency of ordering along with the physicians who ordered them Results A total 167 tests were ordered in which, 120 times BDG was ordered and 52 times CMV was ordered. Singleton orders were noted in 85(50%) instances of BDG & 30(17%) for CMV.Multiple test orders were 44 (25%) for BDG and 8 (4%) for CMV respectively. Both CMV and BDG were ordered together 57 times. The time stamps of multiple test orders in individual patients was assessed for instances of orders that were less than 3 days apart and analysis showed out of the 44 multiple test orders, 34% (15) test orders were ordered less than 3 days apart and 66%(29) tests were ordered more than 3 days apart for BDG. Upon chart review, most of these quickly successive orders were by different physicians. The estimated costs of the duplicate orders are 4334.0$ & 1104.16$ for BDG and CMV respectively. Conclusion CMV and BDG are commonly ordered on many patients. Analysis shows that many times, physicians order testing when the same test has been ordered very recently by a separate physician. Note that for both tests, retesting in less than three days is not normally indicated, however this happens often, especially for BDG. This is most likely due to difficulty in determining within the EHR what tests are drawn and “pending’ but not yet finalized and reported. With usage of prompts/ alerts in EMR that warn of existing “pending’ orders by another caregiver, the frequency of duplicate test ordering for the same patient may be reduced, in turn reducing the costs of healthcare.

Laboratory Test Form Design Influences Test Ordering by General Practitioners in the Netherlands

Medical Care ◽  
1992 ◽  
Vol 30 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Joost O.M. Zaat ◽  
Jacques Th.M. van Eijk ◽  
Harry A. Bonte
Keyword(s):  
The Netherlands ◽  
Laboratory Test ◽  
General Practitioners ◽  
Test Form ◽  
Form Design ◽  
Test Ordering

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

scholarly journals Surgical margin status among men with organ-confined (pT2) prostate cancer: a population-based study

2013 ◽  
Vol 5 (3) ◽  
pp. 161
Author(s):  
Nathan Lawrentschuk ◽  
Andrew Evans ◽  
John Srigley ◽  
Joseph L. Chin ◽  
Bish Bora ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Care ◽  
Surgical Margin ◽  
High Volume ◽  
Information Management System ◽  
Population Based ◽  
Cancer De La Prostate ◽  
Teaching Hospitals ◽  
Qualité Des Soins ◽  
Pathology Reports

Background: Following prostate cancer surgery, positive surgicalmargin (PSM) status varies among institutions and there is evidencethat high-volume surgeons and centres obtain better oncologicalresults. However, larger studies recording PSM for radicalprostatectomy (RP) are from large “centres of excellence” and notpopulation-based. Cancer Care Ontario undertook an audit ofpathology reports to determine the province-wide PSM rate forpathological stage T2 (pT2) disease prostate cancer and to assessthe overall and regional-based PSM rates based on surgical volumeto understand gaps in quality of care prior to undertaking qualityimprovement initiatives.Methods: Data were extracted as part of the Pathology ProjectAudit data output (2005, 2006). Pathology reports were submittedto Cancer Care Ontario by Ontario hospitals electronically viathe Pathology Information Management System. An experiencedcancer pathology coder extracted the PSM data from eligible RPcancer specimen pathology reports. Only reports that provideda pathological stage were included in the analysis. Biopsy andtransurethral resection of the prostate reports were excluded. Aconvenience sample of 1346 reports from 2006 and 728 from2005 were analyzed. Regression analysis was performed to assessvolume-margin associations.Results: The median province-wide surgical PSM rate for pT2disease was 33%, ranging 0-100% among 43 hospitals whereRP volumes ranged 12-625. There was no significant correlation(p > 0.05) between volume and PSM by logistic regression withvariable odds ratios (95% confidence interval [CI]) for PSM by quartile(1st = 1.66 [0.93-2.96]; 2nd = 0.97 [0.58-1.62]; 3rd = 1.44[0.91-2.29]) compared to the highest volume last quartile. Mean PSMrates between community and teaching hospitals were not significantlydifferent.Conclusions: The province-wide PSM rate for pT2 disease prostatecancer undergoing RP is higher than those published from “centresof excellence.” Results from larger volume centres were not statisticallysignificantly better, which contradicts previously publisheddata. Factors, such as individual surgeon, patient selection, pathologicalprocessing and interpretation, may explain the differences.Contexte : Après une chirurgie pour traiter un cancer de la prostate,la présence de marges chirurgicales positives (MCP) varie d’unétablissement à l’autre. Des données montrent que les chirurgiens etles centres qui traitent des nombres élevés de patients obtiennent demeilleurs résultats oncologiques. Cela dit, les études de plus grandeenvergure ayant noté la présence de MCP après une prostatectomieradicale (PR) ont été menées dans de grands « centres d’excellence »et ne sont donc pas fondées sur la population. Action Cancer Ontarioa entrepris une vérification de rapports de pathologie afin de déterminerle taux provincial de MCP pour le cancer de la prostate et lestaux de MCP en fonction du nombre de chirurgies dans le but decomprendre les lacunes dans la qualité des soins avant de lancer desinitiatives d’amélioration de la qualité.Méthodologie : Les données ont été obtenues par le PathologyProject Audit (2005, 2006). Des rapports de pathologie ont été soumispar voie électronique à Action Cancer Ontario par des hôpitauxde la province par le biais du Système de gestion d’informationpathologique. Un programmeur expérimenté en pathologie cancéreusea extrait l’information concernant les MCP des rapports depathologie portant sur des échantillons provenant de cas admissiblesde cancer de la prostate traités par PR. Seuls les rapportsfournissant un stade pathologique ont été inclus dans l’analyse. Lesrapports concernant les biopsies et résections transurétrales de laprostate ont été exclus. Un échantillon convenable de 1346 rapportsde 2006 et 728 rapports de 2005 a été analysé. Une analysepar régression a permis d’évaluer les associations entre le nombrede cas traités et les marges chirurgicales.Résultats : Le taux médian de MCP pour la province pour les casde stade pT2 était de 33 %, et se situait entre 0 et 100 % dans43 hôpitaux où le nombre de PR se chiffrait entre 12 et 625. Onn’a noté aucune corrélation significative (p > 0.05) entre le nombred’interventions et les MCP lors d’une analyse de régression logistiquetenant compte des rapports de cotes (intervalle de confiance[CI] à 95 %) pour les marges chirurgicales positives par quartile(1er = 1,6 [0,93-2,96]; 2e = 0,97 [0,58-1,62]; 3e = 1,44 [0,91-2,29])en comparaison avec le dernier quartile pour le nombre le plusélevé. Les taux de MCP n’étaient pas significativement différentsdans les hôpitaux communautaires et les hôpitaux universitaires.Conclusions : Le taux provincial de MCP pour les cas de cancerde la prostate de stade pT2 subissant une PR est plus élevé que les taux provenant des « centres d’excellence ». Les résultats des centres traitant des nombres plus élevés n’étaient pas significativement meilleurs sur le plan statistique, ce qui contredit les données publiées antérieurement. Des facteurs comme le chirurgien concerné, la sélection des patients, et l’analyse et l’interprétation pathologiques peuvent expliquer les différences.

scholarly journals Functional independence of long-living elderly at hospital admission

2014 ◽  
Vol 23 (3) ◽  
pp. 673-679
Author(s):  
Tânia Maria Lourenço ◽  
Maria Helena Lenardt ◽  
Denise Faucz Kletemberg ◽  
Márcia Daniele Seima ◽  
Nathalia Hammerschmidt Kolb Carneiro
Keyword(s):  
Hospital Admission ◽  
Social Cognitive ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Cross Sectional Study ◽  
Teaching Hospitals ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Social ◽  
Functional Independence Measurement

The aim of this quantitative cross-sectional study was to assess the functional independence of long-living elderly at the time of hospitalization. The study was conducted in two teaching hospitals, in the period between January and June of 2011, with 116 long-living elderly. The Functional Independence Measure Scale was applied for data collection and data analyses were performed using descriptive statistics. The score of the total Functional Independence Measure varied from 48 to 126, with a mean of 105.9% (±17.9), which represents functional independence. The motor Functional Independence Measurement of 30 to 91 (77.3%; ±14.5) and the social/cognitive Functional Independence Measurement of 18 to 35 (28.6%; ±4.9). At the hospital admission, the long-living elderly appeared to be independent in all of the Functional Independence Measurement domains. Knowing the functional capacity is essential to plan care throughout the entire hospitalization process.

Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010

2014 ◽  
Vol 20 (2) ◽  
pp. 125-141 ◽  
Author(s):  
Mayur Sharma ◽  
Ashish Sonig ◽  
Sudheer Ambekar ◽  
Anil Nanda
Keyword(s):  
Household Income ◽  
Nationwide Inpatient Sample ◽  
Young Patients ◽  
High Volume ◽  
Teaching Hospitals ◽  
Median Household Income ◽  
Inpatient Mortality ◽  
Discharge Disposition ◽  
Comorbidity Index ◽  
The Mean

Object The aim of this study was to analyze the incidence of adverse outcomes and inpatient mortality following resection of intramedullary spinal cord tumors by using the US Nationwide Inpatient Sample (NIS) database. The overall complication rate, length of the hospital stay, and the total cost of hospitalization were also analyzed from the database. Methods This is a retrospective cohort study conducted using the NIS data from 2003 to 2010. Various patient-related (demographic categories, complications, comorbidities, and median household income) and hospital-related variables (number of beds, high/low case volume, rural/urban location, region, ownership, and teaching status) were analyzed from the database. The adverse discharge disposition, in-hospital mortality, and the higher cost of hospitalization were taken as the dependent variables. Results A total of 15,545 admissions were identified from the NIS database. The mean patient age was 44.84 ± 19.49 years (mean ± SD), and 7938 (52%) of the patients were male. Regarding discharge disposition, 64.1% (n = 9917) of the patients were discharged to home or self-care, and the overall in-hospital mortality rate was 0.46% (n = 71). The mean total charges for hospitalization increased from $45,452.24 in 2003 to $76,698.96 in 2010. Elderly patients, female sex, black race, and lower income based on ZIP code were the independent predictors of other than routine (OTR) disposition (p < 0.001). Private insurance showed a protective effect against OTR disposition. Patients with a higher comorbidity index (OR 1.908, 95% CI 1.733–2.101; p < 0.001) and with complications (OR 2.214, 95% CI 1.768–2.772; p < 0.001) were more likely to have an adverse discharge disposition. Hospitals with a larger number of beds and those in the Northeast region were independent predictors of the OTR discharge disposition (p < 0.001). Admissions on weekends and nonelective admission had significant influence on the disposition (p < 0.001). Weekend and nonelective admissions were found to be independent predictors of inpatient mortality and the higher cost incurred to the hospitals (p < 0.001). High-volume and large hospitals, West region, and teaching hospitals were also the predictors of higher cost incurred to the hospitals (p < 0.001). The following variables (young patients, higher median household income, nonprivate insurance, presence of complications, and a higher comorbidity index) were significantly correlated with higher hospital charges (p < 0.001), whereas the variables young patients, nonprivate insurance, higher median household income, and higher comorbidity index independently predicted for inpatient mortality (p < 0.001). Conclusions The independent predictors of adverse discharge disposition were as follows: elderly patients, female sex, black race, lower median household income, nonprivate insurance, higher comorbidity index, presence of complications, larger hospital size, Northeast region, and weekend and nonelective admissions. The predictors of higher cost incurred to the hospitals were as follows: young patients, higher median household income, nonprivate insurance, presence of complications, higher comorbidity index, hospitals with high volume and a large number of beds, West region, teaching hospitals, and weekend and nonelective admissions.

Impact of facility volume on complications from immunotherapy for renal cell carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 672-672
Author(s):  
Eugene Blanchard Cone ◽  
Ye Wang ◽  
Stephen Reese ◽  
Steven Lee Chang
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
High Volume ◽  
Teaching Hospitals ◽  
Hospital Treatment ◽  
Complication Rates ◽  
Advanced Cancer Patients ◽  
Low Volume

672 Background: Better outcomes have been generally associated with higher volume providers/hospitals. Recent work found an association between higher volume facilities and survival for advanced cancer patients. Volume and treatment complications for medical cancer therapy is unexplored. We studied a retrospective cohort of patients with metastatic renal cell carcinoma receiving immunotherapy at high and low volume hospitals. Methods: We used Premier Healthcare Data, which includes administrative data from all payors at over 700 community and academic hospitals, and captures 20% of all hospital discharges in the US, including infusions performed in hospital clinics. Using ICD9 codes we identified patients with metastatic renal cell carcinoma treated with nivolumab from 2015-17. Clinicodemographic data were obtained for patients and hospitals. The primary exposure was dichotomized hospital treatment volume (top quartile = high volume). Outcomes were immunotherapy-related complications for which the patient re-presented to the Emergency Department or was readmitted, and readmission for other cause. We performed mixed effects logistic regression adjusting for complex survey design to achieve national representation. Results: We included 15,724 weighted hospital encounters (5,835 at low-volume hospitals and 9,889 at high-volume hospitals). Urban, teaching hospitals were more likely to be high volume, but all patient factors were balanced. We observed 1,457 complications at high volume hospitals and 1,734 at low volume hospitals. There were no significant differences by volume of hospital in overall rates of complications (OR 0.92, 95% CI 0.82-1.09) or in rates of individual complications, with the exception of ocular complications (n=11, all low volume hospitals). We observed that high volume hospitals significantly reduced odds for readmission (OR 0.09, 0.03-0.24) unrelated to immunotherapy complications. Conclusions: We found no difference in immunotherapy-related complication rates by facility volume. This is reassuring for community administration of immunotherapy. Further study is needed to elucidate why we saw significantly more therapy-unrelated readmissions at lower volume hospitals.

scholarly journals Cost Drivers Associated With Anterior Shoulder Stabilization Surgery

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092646
Author(s):  
Lambert T. Li ◽  
Steven L. Bokshan ◽  
James G. Levins ◽  
Brett D. Owens
Keyword(s):  
Hospital Admission ◽  
Regional Anesthesia ◽  
High Volume ◽  
Cost Driver ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Cost Drivers ◽  
Arthroscopic Bankart Repair ◽  
Low Volume ◽  
Total Charges

Background: Arthroscopic Bankart repair, open Bankart repair, and the Latarjet procedure are common treatments for anterior shoulder instability; however, little is known of costs by patient- and surgeon-specific factors. This study aimed to identify areas where cost reduction may be achieved. Hypothesis: Increased total charges will be associated with low-volume surgeons and surgical facilities, hospital-owned facilities, open surgical techniques, and patients with at least 1 comorbidity. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The 2014 State Ambulatory Surgery and Services Databases from 6 states were utilized. There were 3 Current Procedural Terminology codes (23455, 23462, 29806) used to identify open Bankart repair, the Latarjet procedure, and arthroscopic Bankart repair, respectively. Patient demographic and surgical variables were evaluated on a univariate basis, and all significant factors were then included in the multiple linear regression to determine which factors had the largest effect on cost. Total charges billed for the encounter were used as a proxy for cost of surgery. Results: For open Bankart repair, arthroscopic Bankart repair, and the Latarjet procedure, longer operative times increased costs, and high-volume surgical facilities had decreased charges. For the arthroscopic Bankart group, additional factors that increased charges included postoperative hospital admission (US$11,516; P < .001), patient residence in a ZIP code with a below-median income (US$2909; P < .001), presence of a comorbidity (US$1982; P < .001), male sex (US$1545; P = .003), Hispanic race (US$2493; P = .005), and use of regional anesthesia (US$1898; P = .025). Additional cost drivers for the Latarjet procedure included postoperative hospital admission (US$7028; P = .022) and older age (US$187/y; P = .039). Conclusion: Postoperative admission to the hospital was the largest cost driver for arthroscopic Bankart repair and the Latarjet procedure. Low-volume facilities were the largest cost driver for open Bankart repair. High-volume surgery centers had lower costs when compared with low-volume surgery centers. Regional anesthesia increased costs in the arthroscopic Bankart group. These findings may help to show where cost savings can be achieved, particularly considering increasing trends toward bundled health care payments.

Sign in / Sign up

Export Citation Format

Share Document