Improving liaison neurology services

2020 ◽  
Vol 20 (6) ◽  
pp. 494-498
Author(s):  
Geraint N Fuller
Keyword(s):  
Patient Outcomes ◽  
Neurological Disease ◽  
Electronic Systems ◽  
Medical Unit ◽  
Inpatient Ward ◽  
Acute Medical Unit ◽  
Improve Patient ◽  
The Way

Liaison neurology (consulting with inpatient ward referrals) is the main way that most patients admitted with neurological disease will access neurology services. Most liaison neurology services are responsive, seeing referrals on request, but they also can be proactive, with a regular neurology presence in the acute medical unit. Fewer than half of hospitals in England have electronic systems, yet these can facilitate the process—allowing electronic responses to advise on investigations before seeing the patient, and arranging follow-up after—as well as prioritising referrals and documenting the process. In this time of COVID-19, there are additional benefits in providing prompt remote advice. Improving the way liaison neurology is delivered can improve patient outcomes and save money by shortening admissions. This hidden work of the neurologists needs to be recorded and recognised.

scholarly journals Impact of Hospitalist Care Model on Patient Outcomes in Acute Medical Unit

2020 ◽  
Author(s):  
Hyun Jeong Kim ◽  
Jinhyun Kim ◽  
Jung Hun Ohn ◽  
Nak-Hyun Kim
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Waiting Time ◽  
Admission Rate ◽  
Care Hospital ◽  
Care Model ◽  
Medical Unit ◽  
Icu Admission ◽  
Medical Needs ◽  
Acute Medical Unit

Abstract BACKGROUND: The present study aimed to assess a newly introduced, hospitalist-run, acute medical unit (AMU) model in Korea. The AMU in our institution started in October 2015. Four hospitalists managed patients with acute medical needs that were admitted through the emergency department (ED). STUDY DESIGN: We conducted a retrospective cohort study of all medical inpatients admitted through the ED from June 1, 2016 to May 31, 2017, at a tertiary care hospital. We evaluated 6391 patients whether the hospitalist care in the AMU improved patient outcomes compared to standard non-hospitalist care. METHODS: We created multivariate analysis models to compare the clinical outcomes of patients cared for by hospitalists with the outcomes of patients cared for by non-hospitalists. RESULTS: In the adjusted models, compared to the non-hospitalist group, the AMU hospitalist group had a lower in-hospital mortality (OR: 0.46, P <0.001), a lower intensive care unit (ICU) admission rate (OR: 0.39, P <0 .001), a shorter hospital length of stay (coefficient: -1.349, SE: 0.217; P <0.001), and a shorter ED waiting time (coefficient: -3.021, SE: 0.256; P <0.001). There were no significant differences in the 10-day or 30-day re-admission rates (P = 0.493, P = 0.201; respectively). CONCLUSIONS: The AMU hospitalist care model was associated with reductions in in-hospital mortality, ICU admission rate, length of hospital stay, and ED waiting time. These findings suggested that this AMU hospitalist care model might be adaptable to other healthcare systems to improve care for patients with acute medical needs.

scholarly journals Opt-out bloodborne virus screening: a cross-sectional observational study in an acute medical unit

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e022777
Author(s):  
Niamh Allen ◽  
Collette Faherty ◽  
Andre Davies ◽  
Anne Lyons ◽  
Margarent Scarry ◽  
...  
Keyword(s):  
Observational Study ◽  
Routine Practice ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Panel Testing ◽  
Opt Out ◽  
Lost To Follow Up

ObjectiveRecent treatment developments for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV) have greatly improved prognoses. Current screening practices are mainly risk based and are suboptimal. Improved efforts are critically needed to identify persons with these viruses. The aims of this study were to assess the feasibility of an opt-out bloodborne virus (BBV) screening programme in an acute medical unit (AMU) and to describe the prevalence of HIV, HBV and HCV in this population.Design and settingThis was a cross-sectional observational study in the AMU of a tertiary referral hospital in Galway, a city in the west of Ireland.Participants1936 patients entered the study; 54% were male, mean age was 53.1 years (SD 19.6). During the study period, all patients attending the AMU aged ≧16 years who were having bloods drawn and who had the ability to verbally consent for an additional blood sample met the inclusion criteria for the study.ResultsOver 44 weeks, 1936/4793 (40.4%) patients consented to BBV panel testing. Diagnosed prevalence rates for HIV, HBV and HCV were 0.5/1000, 2/1000 and 1.5/1000, respectively. There was one HIV-positive result; the patient was already engaged in care. Four patients tested positive for HBV surface antigen; one new diagnosis, one previously lost to follow-up and two already engaged in care. Three patients had active HCV infection; two had been lost to follow-up and are now linked back into services.ConclusionBBV testing uptake of 40.4% is higher than previous studies in AMU settings that used opt-in strategies, but lower than expected, possibly due to not incorporating testing into routine practice. The diagnosed prevalence of HBV is notable as little data currently exist about its prevalence in Ireland. These data are valuable in order to inform further prevention strategies for these infections in low-prevalence settings.

Pathway to Dry Skin Prevention and Treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Lyn Guenther ◽  
Chuck W. Lynde ◽  
Anneke Andriessen ◽  
Benjamin Barankin ◽  
Eric Goldstein ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Therapeutic Area ◽  
Dry Skin ◽  
Treatment Practice ◽  
Modified Delphi ◽  
Prevention And Treatment ◽  
Improve Patient

Background: This article presents an evidence-supported clinical pathway for dry skin prevention and treatment. Objective: The development of the pathway involved the following: a literature review was conducted and demonstrated that literature on dry skin is scarce. To compensate for the gap in the available literature, a modified Delphi method was used to collect information on prevention and treatment practice through a panel, which included 10 selected dermatologists who currently provide medical care for dermatology patients in Ontario. An advisor experienced in this therapeutic area guided the process, including a central meeting. Panel members completed a questionnaire regarding their individual practice in caring for these patients and responded to questions on assessment of dry skin etiology, frequency of skin care visits for consultation and follow-up, assessment, and referral to other specialties. The panel members reviewed a summary of all responses and reached a consensus. The result was presented as a clinical pathway. Conclusion: The panel concluded that our current awareness of dry skin and therefore prevention and effective treatment is limited; that identifying dry skin and its clinical issues requires tools such as clinical pathways, which may improve patient outcomes; and that additional research on dry skin etiology, prevention, and treatment is necessary.

scholarly journals Urinary Markers of Tubular Injury in HIV-Infected Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Temesgen Fiseha ◽  
Angesom Gebreweld
Keyword(s):  
Renal Disease ◽  
Patient Outcomes ◽  
Renal Involvement ◽  
Tubular Injury ◽  
Accurate Identification ◽  
Urinary Markers ◽  
Increased Risk ◽  
Patients At Risk ◽  
Improve Patient

Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients.

scholarly journals Building a rapid autopsy program – a step-by-step logistics guide

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Eliza R. Bacon ◽  
Kena Ihle ◽  
Peter P. Lee ◽  
James R. Waisman
Keyword(s):  
Patient Outcomes ◽  
Program Implementation ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Successful Program ◽  
Rapid Autopsy ◽  
Comprehensive Framework ◽  
The City ◽  
Improve Patient

Abstract Background Rapid Autopsy Programs offer an opportunity to collect tissue from patients immediately after death, providing critical biological material necessary to develop more effective therapies and improve patient outcomes. Here, we present a step-by-step guide to build a cancer-focused Rapid Autopsy Program, based on our own experiences building “The Legacy Project” at the City of Hope Comprehensive Cancer Center. Methods The linear timeline of events is separated into four phases: 1) Building the Infrastructure, 2) Recruiting and Consenting, 3) Preparing for Death, and 4) Tissue Collection and Follow up. Important considerations and methods for adaptation are discussed throughout the protocol. Discussion Using these methods, we successfully collected a total of 533 specimens from 9 subjects. The average time from death to last specimen acquisition was 6.1 h (range: 4.03–7.66 h; median: 5.71 h). A diverse team with various areas of expertise is critical for successful program implementation. Our goal herein this protocol is to provide a comprehensive framework and foundation for other institutions to use as a model.

scholarly journals Building a Rapid Autopsy Program – A Step-by-Step Logistics Guide

2020 ◽  
Author(s):  
Eliza R Bacon ◽  
Kena Ihle ◽  
Peter P Lee ◽  
James R Waisman
Keyword(s):  
Patient Outcomes ◽  
Program Implementation ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Successful Program ◽  
Rapid Autopsy ◽  
Comprehensive Framework ◽  
The City ◽  
Improve Patient

Abstract Background: Rapid Autopsy Programs offer an opportunity to collect tissue from patients immediately after death, providing critical biological material necessary to develop more effective therapies and improve patient outcomes. Here, we present a step-by-step guide to build a cancer-focused Rapid Autopsy Program, based on our own experiences building “The Legacy Project” at the City of Hope Comprehensive Cancer Center. Methods: The linear timeline of events is separated into four phases: 1) Building the Infrastructure, 2) Recruiting and Consenting, 3) Preparing for Death, and 4) Tissue Collection and Follow up. Important considerations and methods for adaptation are discussed throughout the protocol. Discussion: Using these methods, we successfully collected a total of 533 specimens from 9 subjects. The average time from death to last specimen acquisition was 6.1 hours (range: 4.03 – 7.66 hours; median: 5.71 hours). A diverse team with various areas of expertise is critical for successful program implementation. Our goal herein this protocol is to provide a comprehensive framework and foundation for other institutions to use as a model.

scholarly journals Impact of Heart Failure Focused Follow-Up Care at the “Heart Success Clinic” on 30-Day Readmission Rates in Patients with Congestive Heart Failure

2020 ◽  
pp. 1-3
Author(s):  
Deepti Bhandare ◽  
Keyword(s):  
Heart Failure ◽  
Patient Outcomes ◽  
Readmission Rate ◽  
The United States ◽  
Hospital Data ◽  
Readmission Rates ◽  
Medication Reviews ◽  
Improve Patient

Nearly 6.2 million people in the United states are affected by heart failure, it is predicted that this number will rise to 8.5 million by 2030 Significant effort has been made to prevent heart failure and its exacerbations. The Hospital Readmission Reduction Program (HRRP), a Medicaare based program, was established to link payment to quality of care. Payment is reduced to hospitals when patients are readmitted within 30 days for heart failure The “Heart Success Clinic” is an outpatient clinic started to improve patient outcomes and reduce readmission rates. Patients are provided with heart failure focused visits which includes detailed medication reviews, diet modification, weight loss, disease education, etc. During the six months prior to the opening of the clinic, the readmission rate was 15.27% at AdventHealth Sebring hospital which is a community-based hospital. Data was collected on the patients who attended the “Heart Success Clinic” for six months. Zero patients from the clinic were readmitted, bringing the readmission rate down from 15.27% to 0%. This pilot study gives promising initial results. Further studies can be conducted over a longer period time as to gather more patients. Overall, the study demonstrates that there is value in providing heart failure focused follow up visits in improving patient outcomes and readmission rates.

scholarly journals Building a Rapid Autopsy Program – A Step-by-Step Logistics Guide

2020 ◽  
Author(s):  
Eliza R Bacon ◽  
Kena Ihle ◽  
Peter P Lee ◽  
James R Waisman
Keyword(s):  
Patient Outcomes ◽  
Program Implementation ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Successful Program ◽  
Rapid Autopsy ◽  
Comprehensive Framework ◽  
The City ◽  
Improve Patient

Abstract Background: Rapid Autopsy Programs offer an opportunity to collect tissue from patients immediately after death, providing critical biological material necessary to develop more effective therapies and improve patient outcomes. Here, we present a step-by-step guide to build a cancer-focused Rapid Autopsy Program, based on our own experiences building “The Legacy Project” at the City of Hope Comprehensive Cancer Center. Methods: The linear timeline of events is separated into four phases: 1) Building the Infrastructure, 2) Recruiting and Consenting, 3) Preparing for Death, and 4) Tissue Collection and Follow up. Important considerations and methods for adaptation are discussed throughout the protocol. Discussion: Using these methods, we successfully collected a total of 533 specimens from 9 subjects. The average time from death to last specimen acquisition was 6.1 hours (range: 4.03 – 7.66 hours; median: 5.71 hours). A diverse team with various areas of expertise is critical for successful program implementation. Our goal herein this protocol is to provide a comprehensive framework and foundation for other institutions to use as a model.

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