Abstract 17076: Empowering Telemetry Technicians to Call Code Blue

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Cody McCoy ◽  
Neil Keshvani ◽  
Maryam Warsi ◽  
Eugene Chu ◽  
Anita Hegde
Keyword(s):  
Clinical Status ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Post Intervention ◽  
Neurologic Outcomes ◽  
Code Blue ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Life Threatening ◽  
The Impact

Background: Delays in treatment of in-hospital cardiac arrest (IHCA) events are associated with lower survival and poor neurologic outcomes. With centralized telemetry, telemetry technicians need to notify nursing staff of life-threatening arrhythmias immediately for nursing to verify a patient's clinical status and determine whether code blue activation is necessary. Delays in this verification lead to delays in code activation, which can in turn lead to increased morbidity and mortality. Objective: We sought to assess the impact of empowering telemetry technicians to activate code blues on IHCA code survival, survival to discharge, time to cardiopulmonary resuscitation (CPR), and inappropriate code activation. Methods: We implemented a quality improvement protocol September 1, 2016 at Parkland Memorial Hospital, a 900-bed, urban, safety-net hospital, in Dallas, Texas to empower telemetry technicians to call code blue directly for the following life-threatening arrhythmias: ventricular fibrillation, sustained ventricular tachycardia of greater than 30 seconds, asystole, or bradycardia less than 30 beats/minute. We performed a retrospective chart review of all IHCA in patients on centralized telemetry at Parkland for one year prior to the intervention and three years post intervention to look at code survival and survival to discharge. Secondary outcomes were time to CPR and inappropriate code activation. Results: The pre intervention code survival was 12/20 (60.0%) and the post intervention code survival was 46/55 (83.6%) (p=0.03). The pre intervention survival to discharge was 3/20 (15.0%) and the post intervention survival to discharge was 21/55 (38.2%), (p=0.0585). The time to CPR, in seconds, was 180 versus 120 (p=0.58) for pre and post intervention non-PEA codes. There were 0 inappropriate code activations post intervention. Conclusions: Empowering telemetry technicians to activate code blue for general ward patients on centralized telemetry showed a significant improvement in code survival and a trend in survival to discharge. Importantly, there were no inappropriate code activations by telemetry technicians, highlighting the safety of this intervention.

Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 262-262
Author(s):  
Ronak Patel ◽  
Victor Chiu ◽  
Darcy V. Spicer
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Post Intervention ◽  
Safety Net Hospital ◽  
The Mean ◽  
Chemotherapy Initiation ◽  
Mean Time

262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.

scholarly journals COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

2021 ◽  
Vol 264 ◽  
pp. 117-123
Author(s):  
Katherine F Vallès ◽  
Miriam Y Neufeld ◽  
Elisa Caron ◽  
Sabrina E Sanchez ◽  
Tejal S Brahmbhatt
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Ravi J. Chokshi ◽  
Jin K. Kim ◽  
Jimmy Patel ◽  
Joseph B. Oliver ◽  
Omar Mahmoud
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Abdominal Wall ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Safety Net ◽  
Insurance Status ◽  
Gynecologic Malignancies ◽  
Safety Net Hospital ◽  
The Impact

AbstractObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.

scholarly journals The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System

2019 ◽  
Vol 32 (3) ◽  
pp. 362-374 ◽  
Author(s):  
Thomas F. Northrup ◽  
Kelley Carroll ◽  
Robert Suchting ◽  
Yolanda R. Villarreal ◽  
Mohammad Zare ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Safety Net ◽  
Opioid Prescribing ◽  
Urban Safety ◽  
The Impact ◽  
Care System

scholarly journals Homelessness and discharge delays from an urban safety net hospital

Public Health ◽  
2014 ◽  
Vol 128 (11) ◽  
pp. 1033-1035 ◽  
Author(s):  
J. Feigal ◽  
B. Park ◽  
C. Bramante ◽  
C. Nordgaard ◽  
J. Menk ◽  
...  
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals 338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital

2019 ◽  
Vol 114 (1) ◽  
pp. S200-S200
Author(s):  
Suaka Kagbo-Kue ◽  
Iloabueke Chineke ◽  
Taiwo Ajose ◽  
Keerthi Padooru ◽  
Florence Iloh ◽  
...  
Keyword(s):  
African Americans ◽  
Safety Net ◽  
Factors Associated ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A345-A346
Author(s):  
Erin E Finn ◽  
Lindsay Schlichting ◽  
Rocio Ines Pereira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Monitoring Program ◽  
Glucose Monitoring ◽  
Safety Net ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital. Methods: The program was implemented at a county urban safety net hospital. Patients were eligible to be started on Dexcom G6 CGM if they had hyperglycemia requiring multiple insulin injections daily, were in contact isolation, and were located in 1 of 3 units of the hospital (medical intensive care unit [MICU], surgical intensive care unit, COVID 19 floor unit). Initial program was started in the MICU and subsequently expanded. Nurses and staff underwent training using videos, in-person demonstrations, and written guides. Informational Technology modified the electronic medical system to allow for ordering and documentation of CGM values by nurses. Supplies were stored both on unit and in central supply allowing for primary team to initiate monitoring independent of diabetes team. Records of patients participating in program were maintained by the diabetes team. Amount of PPE saved was estimated to be 10 instances/day while on insulin drip and 3/day when using subcutaneous insulin. Results: A total of 69 patients used a CGM during their hospital course. Average age was 56 years old, 69 % were male, average BMI 31, and 84% had known diabetes prior to admission. The majority of patients were critically ill with 68% intubated, 48% on vasopressors, 6% requiring dialysis, 38% on insulin drip, 46% were on tube feeds, and 74% received steroids. The racial demographics of the patients were 72% White, 3% Black, 4% Native American, 4% Asian, and 14% other. For ethnicity, 73% identified as Hispanic and half spoke Spanish as their primary language. An estimated 2600 instances of PPE were saved. Challenges that were faced in implementing the program included consistent training of large numbers of staff, maintaining supplies in stock, troubleshooting discordant values, and restricting use of CGM to patients who met qualifications. Conclusion: Overall, the implementation of CGM was successful and received a positive response. Staff in the primary units quickly became comfortable with the application of the technology. Potential challenges in the future include ongoing training, improving troubleshooting of technology, validating the accuracy of the devices, and developing funding for CGM equipment and interpretation.

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