Abstract 173: Simple Guidance Improves Appropriate Telemetry Utilization

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alekhya Potluri ◽  
Mrudula Kudaravalli ◽  
Anthony Defail ◽  
Dilip Prabhakaran ◽  
Sangita Prabhakaran ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Guideline Implementation ◽  
Heart Association ◽  
Limited Resource ◽  
Cost Effective ◽  
Post Intervention ◽  
Qt Interval Prolongation ◽  
Intervention Cost ◽  
Before And After ◽  
Bed Days

Introduction: Cardiac telemetry is an in-hospital monitoring tool intended for ischemia surveillance, monitor QT-interval prolongation, and detect arrhythmias. It is a costly and limited resource that is frequently misused. Inappropriate telemetry use can lead to prolonged hospital stays, patient discomfort, alarm fatigue, and increased healthcare costs. We designed and implemented a telemetry guideline independent of the electronic health record (EHR) in an attempt to increase appropriate telemetry use in non-intensive care unit (ICU) setting Objectives: To design and implement a telemetry guideline. To increase appropriate use of telemetry. To practice cost-conscious, high-value care Aim: Primary Aim: Implement a telemetry guideline using pocket cards and educational conferences and monitor telemetry assignments Secondary Aim: Assess patient outcomes as reflected by the number of codes before and after the intervention Methods: We adopted telemetry criteria based on the American Heart Association guidelines from 2004 and other published literature. Baseline data was collected in November 2015 for all medicine teaching team admissions at our institution that came through the emergency department. Exclusion criteria were ICU transfers, step-down units, and direct admissions. Guidelines were then implemented via educational conferences and pocket card distribution to ED physicians, admitting hospitalists and medicine residents. Post-intervention data was collected from February through March 2016 Results: Of 180 admissions prior to guideline implementation, 93 patients (52%) went to non-telemetry beds and 87 patients (48%) to telemetry beds. Of the telemetry admissions, 60 patients (69%) were appropriately assigned to telemetry while 27 (31%) were not. After the guideline was implemented, 255 patients were reviewed. Of these, 110 (43%) went to telemetry beds, and 86 patients (78%) were appropriately assigned while 24 patients (22%) were not. There was no significant increase or decrease in the number of codes post intervention. Cost analysis revealed 103 telemetry-bed-days saved per month Conclusion: Our intervention resulted in a large (9.1%) but statistically insignificant increase in appropriate telemetry use. Although statistically insignificant, this improvement was durable across two months. Cost analysis revealed 103 telemetry-bed-days saved per month with an estimated savings of $100,000 in unnecessary charges. The relatively simple and cost-effective intervention of creating and implementing a telemetry assignment guideline was effective in changing telemetry ordering behavior. This was done without telemetry assignment logic in the EHR, which can be a tedious and time-consuming endeavor. Future efforts will include the implementation of a telemetry auditing tool, and ultimately the embedded logic to facilitate ordering practices.

scholarly journals Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome

2007 ◽  
Vol 4 (4) ◽  
pp. 493-502 ◽  
Author(s):  
David Shapiro ◽  
Ian A. Cook ◽  
Dmitry M. Davydov ◽  
Cristina Ottaviani ◽  
Andrew F. Leuchter ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Emotional Regulation ◽  
Partial Remission ◽  
Biological Effects ◽  
Low Frequency ◽  
Cost Effective ◽  
Future Research ◽  
Post Intervention ◽  
Complementary Treatment ◽  
Before And After

Preliminary findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission. The purpose of this article is to present further data on the intervention, focusing on individual differences in psychological, emotional and biological processes affecting treatment outcome. Twenty-seven women and 10 men were enrolled in the study, of whom 17 completed the intervention and pre- and post-intervention assessment data. The intervention consisted of 20 classes led by senior Iyengar yoga teachers, in three courses of 20 yoga classes each. All participants were diagnosed with unipolar major depression in partial remission. Psychological and biological characteristics were assessed pre- and post-intervention, and participants rated their mood states before and after each class. Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability in the 17 completers. Eleven out of these completers achieved remission levels post-intervention. Participants who remitted differed from the non-remitters at intake on several traits and on physiological measures indicative of a greater capacity for emotional regulation. Moods improved from before to after the yoga classes. Yoga appears to be a promising intervention for depression; it is cost-effective and easy to implement. It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study. The physiological methods are especially useful as they provide objective markers of the processes and effectiveness of treatment. These observations may help guide further clinical application of yoga in depression and other mental health disorders, and future research on the processes and mechanisms.

scholarly journals Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

2020 ◽  
Vol 20 (3) ◽  
pp. 1080-1089
Author(s):  
Ifeyinwa Chizoba Akamike ◽  
Ijeoma Nkem Okedo-Alex ◽  
Chigozie Jesse Uneke ◽  
Henry Chukwuemeka Uro-Chukwu ◽  
Onyedikachi Echefu Chukwu ◽  
...  
Keyword(s):  
Health Worker ◽  
Educational Intervention ◽  
Health Workers ◽  
Guideline Implementation ◽  
Good Practice ◽  
University Teaching ◽  
Post Intervention ◽  
Laboratory Equipment ◽  
Keywords Hiv ◽  
Before And After

Background: The aim of this study was to appraise the implementation of the National HIV guidelines and determine the effect of an educational intervention on health worker knowledge and practice of the guidelines. Methods: A before and after study design without control was carried out using a self-administered questionnaire and key informant interviews. Data was also collected from client record cards. An educational intervention was carried out using pamphlets containing summarized information on the guideline. Data analysis was carried out using IBM-SPSS version 20. Result: Results showed that 54.5% of the respondents were males and 76% were medical doctors. Baseline knowledge level of respondents was high with 97% of respondents having good knowledge with a mean score of 3.9. This increased to 4.1 out of 5 post-intervention. All respondents had good practice of the guidelines before and after intervention with a mean score of 4.5 out of 5. Client records also showed good practice. Barriers to guideline implementation include: poor knowl- edge, inadequate training, guideline unavailability, poor functioning of the laboratory equipment, poor funding. Conclusion: HIV guidelines are being implemented in the clinic to a large extent; however, trainings, funding and provision of the guideline in the clinics are recommended. Keywords: HIV; guideline implementation; health worker.

Decreasing Costs and Optimizing Therapy of Erythropoietic Medications in a Hospital-Based Outpatient Cancer Treatment Center

2005 ◽  
Vol 40 (9) ◽  
pp. 788-795 ◽  
Author(s):  
Deidre B. Clark ◽  
Debbie C. Byrd ◽  
Miranda R. Andrus ◽  
Tom Rogers ◽  
Timothy A. Martin
Keyword(s):  
Cost Analysis ◽  
Cancer Treatment ◽  
Initial Dose ◽  
Cost Effective ◽  
Treatment Center ◽  
Protocol Implementation ◽  
Before And After ◽  
Continued Use ◽  
Cost Calculations ◽  
Protocol Review

The objectives of this study were to decrease the costs associated with erythropoietic medications and to optimize the use of these medications for patients with chemotherapy-induced anemia. Methods A cost-analysis was completed by performing cost calculations which determined that darbepoetin is the most cost-effective erythropoietic medication for one Cancer Treatment Center (CTC). Darbepoetin protocol and order forms were then developed for chemotherapy-induced anemia. The total costs of all erythropoietic medications at the CTC before and after protocol implementation were evaluated via purchasing data. Pre- and post-protocol retrospective chart reviews were completed to determine if protocol implementation resulted in therapy optimization. Results Forty-two patients were included in the pre-protocol review, and 21 patients were included in the post-protocol review. After darbepoetin protocol implementation, the average cost per month of erythropoietic medications decreased by approximately $30,500. The percent of patients receiving an appropriate initial dose doubled post-protocol (pre: 38% vs post: 76%). Appropriate monitoring of hemoglobin at baseline, monthly, and before dose adjustments increased to 100% post-protocol implementation; and there was a 50% increase in the percent of patients who had their hemoglobin monitored appropriately until stable. Conclusions A savings of approximately $335,000 was expected for the year of 2004 with the protocol use and darbepoetin as the erythropoietic agent of choice. The optimization of therapy should continue to improve via continued use of the darbepoetin protocol.

scholarly journals Stress, Hope, and Depression Among Older Adults Living in Public Housing

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 338-338
Author(s):  
Mignon Montpetit ◽  
LaKeesha James-Smith ◽  
Amy Gourley
Keyword(s):  
Public Housing ◽  
Life Stress ◽  
Cost Effective ◽  
Well Being ◽  
Short Term ◽  
Post Intervention ◽  
Initial Questionnaire ◽  
Before And After ◽  
The Impact ◽  
The Relationship

Abstract Individuals living in public housing often experience myriad stressors related to poverty and mental illness. The current study explores how hope impacts the relationship between stress and depression in a sample of adults (aged 51-90 years; Mage= 63.3 years; SDage= 8.6 years) living in public housing. Questionnaire data were collected before and after running an intervention geared toward improving residents’ well-being. Results of the initial questionnaire study suggest that hope moderates the stress -> depression relationship (p = .001), with effects in the expected directions: individuals exhibiting higher-than-average levels of stress and below-average hope reported the highest levels of depression. Data further suggest modest increases in hope post-intervention (p = .06). Overall, results suggest that hope may be important in helping mitigate the impact of life stress on vulnerable individuals, and that it can be augmented in the context of a short-term, cost-effective intervention.

scholarly journals Improving Residents' Knowledge of Peripheral Smears

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4950-4950
Author(s):  
Sara Ashraf ◽  
Mina Shenouda
Keyword(s):  
Internal Medicine ◽  
Conflicts Of Interest ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Target Cells ◽  
Multiple Choice Questions ◽  
Post Intervention ◽  
Peripheral Smear ◽  
Giant Platelets ◽  
Before And After

Abstract Background: A peripheral smear is an important diagnostic tool, inexpensive, reliable and quick. It reflects the functional status of the bone marrow and can identify many blood disorders, some of which are life threatening and very time sensitive. Peripheral smears are useful to assess cytopenic states (eg, anemia, leukopenia, thrombocytopenia) or identify hematologic emergencies such as thrombocytopenic purpura/hemolytic uremic syndrome, acute myeloid leukemia, and disseminated intravascular coagulation etc. Sometimes it is sufficient to make a diagnosis solely based on them which can be life saving when time is of the essence. Based on our literature search, there are no studies to assess internal medicine residents' knowledge and understanding of peripheral smears. Methods: We created a multiple-choice questions survey of 13 questions for residents to fill out, involving common findings on peripheral smears and those found in hematologic emergencies that every resident should be aware of. Response rate in all three program years (PGY) was 100%. 16/16 PGY-1, 10/10 PGY-2 and 9/9 PGY-3 completed the survey. Results: Average pre-intervention score for PGY-1 was 42%, PGY-2 was 34% and PGY-3 was 30%. Questions most commonly wrong were regarding target cells, metamyelocytes, giant platelets and schistocytes. Most were correct about microcytosis and Auer rods. We then conducted the same survey weeks after our intervention, which was interactive, small group didactics sessions on peripheral smears. We compared results of the survey before and after didactics to check for improvement. Post-intervention score for PGY-1 was 98%, PGY-2 and PGY-3 were 96%. Conclusions: Most medical residents are not aware of common interpretations of peripheral smears and this does not seem to improve with each progressive year. Improving residents' knowledge of peripheral smears is a cost effective and quick measure that can improve patient care, in addition to potentially improving internal medicine board results. In the future, we aim to make a curriculum for peripheral smear review for residents. We can compare results of the survey with hematology oncology fellows. Disclosures No relevant conflicts of interest to declare.

scholarly journals Evaluation of a Neonatal Resuscitation Curriculum in Liberia

Children ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. 56 ◽  
Author(s):  
Mary Chang ◽  
Camila Walters ◽  
Carmelle Tsai ◽  
Deborah Aksamit ◽  
Francis Kateh ◽  
...  
Keyword(s):  
Health Care ◽  
Neonatal Mortality ◽  
Health Care Providers ◽  
Test Scores ◽  
Neonatal Resuscitation ◽  
Heart Association ◽  
Limited Resource ◽  
Comfort Level ◽  
Care Providers ◽  
Post Intervention

Neonatal mortality in Africa is among the highest in the world. In Liberia, providers face significant challenges due to lack of resources, and providers in referral centers need to be prepared to appropriately provide neonatal resuscitation. A team of American Heart Association health care providers taught a two-day neonatal resuscitation curriculum designed for low-resource settings at a regional hospital in Liberia. The goal of this study was to evaluate if the curriculum improved knowledge and comfort in participation. The curriculum included simulations and was based on the Neonatal Resuscitation Protocol (NRP). Students learned newborn airway management, quality chest compression skills, and resuscitation interventions through lectures and manikin-based simulation sessions. Seventy-five participants were trained. There was a 63% increase in knowledge scores post training (p < 0.00001). Prior cardiopulmonary resuscitation (CPR) training, age, occupation, and pre-intervention test score did not have a significant effect on post-intervention knowledge test scores. The median provider comfort score improved from a 4 to 5 (p < 0.00001). Factors such as age, sex, prior NRP education, occupation, and post-intervention test scores did not have a significant effect on the post-intervention comfort level score. A modified NRP and manikin simulation-based curriculum may be an effective way of teaching health care providers in resource-limited settings. Training of providers in limited-resource settings could potentially help decrease neonatal mortality in Liberia. Modification of protocols is sometimes necessary and an important part of providing context-specific training. The results of this study have no direct relation to decreasing neonatal mortality until proven. A general resuscitation curriculum with modified NRP training may be effective, and further work should focus on the effect of such interventions on neonatal mortality rates in the region.

scholarly journals The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty

2021 ◽  
Vol 10 (5) ◽  
pp. 971
Author(s):  
Kristoff Hammerich ◽  
Jens Pollack ◽  
Alexander F. Hasse ◽  
André El Saman ◽  
René Huber ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Success ◽  
Cost Effective ◽  
Revision Total Knee Arthroplasty ◽  
Rotational Stability ◽  
X Rays ◽  
Free Interval ◽  
Major Disadvantage ◽  
Cost Effective Approach ◽  
Before And After

Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.

scholarly journals 400 - Effects of Computerized Cognitive Training with an Elderly Community Sample

2020 ◽  
Vol 32 (S1) ◽  
pp. 116-116
Author(s):  
M Pires ◽  
A Antunes ◽  
C Gameiro ◽  
C Pombo
Keyword(s):  
Older Adults ◽  
Cognitive Training ◽  
New Technologies ◽  
Community Sample ◽  
Cost Effective ◽  
Well Being ◽  
Control Group ◽  
Depression Symptoms ◽  
Intensive Training ◽  
Before And After

Community-focused programs that promote active and healthy aging can help preserve cognitive capacities, prevent or reverse cognitive deficits. Computer-based cognitive training (CCT) is a promising non-pharmacological, cost -effective and accessible intervention to face the effects of age-related cognitive decline. Previous studies proved CCT to have equal or better efficacy compared to traditional interventions. This comparative multifactorial study aims to test the efficacy of a CCT in a non-randomized community sample of 74 older adults: G1-CCT Experimental group (n=43) (Mean age M=72.21, SD=12.65) and G2- Paper-Pencil Control group (n=31; M=77.94, SD=10.51). Pensioners (97.3%), mostly women (83.8 %) with basic education (51.4%) and without dementia diagnosis, completed a cognitive training program of 17 or 34 group sessions (twice a week). G2 undertook a classic cognitive paper-pencil stimuli tasks. G1, performed, additionally, individual CCT with COGWEB® in a multimodal format (intensive training of attention, calculation, memory, gnosis, praxis, executive functions). Both groups completed Portuguese versions of Mini -Mental State Examination (MMSE),Montreal Cognitive Assessment (MOCA); Geriatric Depressive Scale (GDS); Mini Dependence Assessment (MDA); WHOOQL 5 and Social Support Satisfaction Scale (ESSS) before and after participating in the program. Both groups reported better post-test scores on basic cognitive functions (MMSE, MOCA), Depression symptoms (GDS-30), subjective well-being and quality of life (WHOOQL-5). G1 presented higher MOCA and lower GDS scores before and after CCT, although, group differences become less expressive when interaction effects are considered. Results are in line with findings from past studies, CCT supported by the new technologies, is as a relevant cost-effective therapeutic tool for health professionals working with older adults. Particularly for preventive purposes of neuro-cognitive disorders.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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