Abstract P257: Getting to the Golden Hour: Correlating “Door-To” Times with 60-Minute Administration of tPA in an Academic Medical Center

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Ann M Leonhardt ◽  
Curtis G Benesch ◽  
Kate C Young
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Time Frame ◽  
Arrival Times ◽  
Golden Hour ◽  
Stroke Team ◽  
Time Standards ◽  
Scheduling Protocols

Introduction: The efficacy of intravenous tPA for the treatment of acute stroke diminishes over time. The AHA/ASA and NINDS recommend a goal door to needle time of 60 minutes or less. Objective: Identify potential barriers to tPA administration within 60 minutes of arrival. Methods: Retrospective review of tPA adsinistration using “Get With the Guidelines” (GWTG) and institutional records from January 1, 2009 through December 31, 2010 (n=100). Spearman rank correlation coefficients were calculated for the NINDS recommended time standards, age and NIH Stroke Scale (NIHSS) score. We used a receiver-operator curve (ROC) to identify the door to CT time predictive of tPA administration ≤ 60 minutes. Results: Median door to physician, door to CT, and door to stroke team times were within the recommended goals. Door to CT (ρ=0.53, p<0.0001), and door to stroke team (ρ=0.33, p<0.01) times were positively correlated with door to tPA times. Last known well to arrival (ρ= -0.28, p<0.01) and NIHSS (ρ= -0.32, p<0.01) were negatively correlated with door to tPA times; patients with higher NIHSS and longer last-known-well to arrival times received tPA in a shorter time frame. Age and door to physician time were not correlated with tPA treatment times. After adjusting for the other benchmarks and NIHSS, only door to CT remained significantly correlated with door to IV tPA (partial correlation coefficient=0.40, p<0.001). The ROC curve showed that a goal time of 20 minutes or less for door to CT initiation had the best sensitivity and specificity for predicting tPA administration within 60 minutes. Conclusion: In keeping with the recommended time goals, median times for the intermediate steps were within target. Our median tPA times, however, did not meet the 60 minute goal. Door to CT initiation was the variable that most strongly correlated with door to needle times. Process issues such as order entry and scheduling protocols may be barriers to obtaining CT within the 20 minute time frame identified by our analysis. Other barriers after the CT scan is obtained must be identified to facilitate faster tPA administration. Further evaluation of these factors is warranted to better ensure the timely delivery of tPA to stroke patients, thereby improving patient outcomes.

Fluoroscopy time is not accurate as a surrogate for radiation exposure

Vascular ◽  
2017 ◽  
Vol 25 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Edvard Skripochnik ◽  
Shang A Loh
Keyword(s):  
Radiation Exposure ◽  
Medical Center ◽  
Pearson Correlation ◽  
Academic Medical Center ◽  
Surrogate Marker ◽  
Correlation Coefficients ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
Poor Correlation ◽  
Dose Area Product

Objective The Food and Drug Administration and the Vascular Quality Initiative still utilize fluoroscopy time as a surrogate marker for procedural radiation exposure. This study demonstrates that fluoroscopy time does not accurately represent radiation exposure and that dose area product and air kerma are more appropriate measures. Methods Lower extremity endovascular interventions ( N = 145) between 2013 and 2015 performed at an academic medical center on a Siemens Artis-Zee floor mounted c-arm were identified. Data was collected from the summary sheet after every case. Scatter plots with Pearson correlation coefficients were created. A strong correlation was indicated by an r value approaching 1. Results Overall mean AK and DAP was 380.27 mGy and 4919.2 µGym2. There was a poor correlation between fluoroscopy time and total AK or DAP ( r = 0.27 and 0.32). Total DAP was strongly correlated to cine DAP and fluoroscopy DAP ( r = 0.92 vs. 0.84). The number of DSA runs and average frame rate did not affect AK or DAP levels. Mean magnification level was significantly correlated with total AK ( r = 0.53). Conclusions Fluoroscopy time shows minimal correlation with radiation delivered and therefore is a poor surrogate for radiation exposure during fluoroscopy procedures. DAP and AK are more suitable markers to accurately gauge radiation exposure.

In-Practice Endocrine Surgery Fellowship: A Novel Training Model

2020 ◽  
pp. 019459982096279
Author(s):  
Hien T. Tierney ◽  
Leslie S. Eldeiry ◽  
Jeffrey R. Garber ◽  
Chia A. Haddad ◽  
Mark A. Varvares ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Training Model ◽  
Time Frame ◽  
Fellowship Training ◽  
Endocrine Surgery ◽  
Community Practice ◽  
Senior Surgeon ◽  
Academic Medical

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

scholarly journals Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

2021 ◽  
Author(s):  
Lori Schirle ◽  
Alvin D Jeffery ◽  
Ali Yaqoob ◽  
Sandra Sanchez-Roige ◽  
David C. Samuels
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Correlation Coefficients ◽  
Pilot Project ◽  
Data Driven ◽  
Risk Scores ◽  
Opioid Use ◽  
Academic Medical ◽  
Manual Review

Background: Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. There is a need to expand this work to characterize the spectrum of problematic opioid use. Methods: Using a large academic medical center database, we developed 2 data-driven methods of OUD detection: (1) a Comorbidity Score developed from a Phenome-Wide Association Study of phenotypes associated with OUD and (2) a Text-based Score using natural language processing to identify OUD-related concepts in clinical notes. We evaluated the performance of both scores against a manual review with correlation coefficients, Wilcoxon rank sum tests, and area-under the receiver operating characteristic curves. Records with the highest Comorbidity and Text-based scores were re-evaluated by manual review to explore discrepancies. Results: Both the Comorbidity and Text-based OUD risk scores were significantly elevated in the patients judged as High Evidence for OUD in the manual review compared to those with No Evidence (p = 1.3E-5 and 1.3E-6, respectively). The risk scores were positively correlated with each other (rho = 0.52, p < 0.001). AUCs for the Comorbidity and Text-based scores were high (0.79 and 0.76, respectively). Follow-up manual review of discrepant findings revealed strengths of data-driven methods over manual review, and opportunities for improvement in risk assessment. Conclusion: Risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use. This pilot project establishes a foundation for more robust work in the future.

Reliability and Construct Validity of the Complexity Compression Questionnaire

2014 ◽  
Vol 22 (2) ◽  
pp. 291-301 ◽  
Author(s):  
Ronda G. Hughes ◽  
Linda Fridlington ◽  
Polly Ryan
Keyword(s):  
United States ◽  
Factor Analysis ◽  
Organizational Change ◽  
Construct Validity ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Factor Solution ◽  
Health Records ◽  
Academic Medical

Background and Purpose: The purpose of the study was to evaluate the reliability and construct validity of the Complexity Compression Questionnaire (CCQ), a 28-item instrument designed to explain nurses’ experiences when assuming multiple responsibilities in a compressed time frame. Methods: Data were obtained from 607 registered nurses in an academic medical center in the midwestern United States who participated in a larger study on system-wide organizational change involving upgrading electronic health records. Results: Cronbach’s alpha for the 26-item CCQ, was .91. Exploratory factor analysis supported a 5-factor solution that explained 53.6% of the variance. Conclusions: The CCQ may be a useful tool for measurement of the effects of organizational change on the complexity of the work of nurses.

scholarly journals Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development

10.2196/16849 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e16849
Author(s):  
Gennaro Di Tosto ◽  
Ann Scheck McAlearney ◽  
Naleef Fareed ◽  
Timothy R Huerta
Keyword(s):  
Medical Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Median Number ◽  
Patient Portal ◽  
Record System ◽  
User Interactions ◽  
Methodological Choices ◽  
Log File

Background Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients’ use of an outpatient portal to examine how patients engage with the tool. Objective This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. Methods Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. Results Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. Conclusions In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.

scholarly journals Fears, feelings and findings about COVID-19 disease in hospitalized cancer patients in a tertiary Hospital in Spain.

2020 ◽  
Author(s):  
Benjamin Domingo Arrue ◽  
Domingo de Guzmán Ordaz Jurado ◽  
Rosa María Pastor Marí ◽  
Ana Tarazona Ortega ◽  
Lucía Fos Saus ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Correlation Coefficient ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rank Correlation ◽  
Tertiary Hospital ◽  
Educational Background ◽  
Moderate Correlation ◽  
Exact Test ◽  
Systemic Treatments

Abstract IntroductionOn March 11th, COVID-19 was categorized as a pandemic. Risk factors for poor outcome in COVID-19 disease include personal history of cancer. The purpose of this research is to explore what do cancer patients know about COVID-19 and their perception of infection risk.MethodsA pilot questionnaire was initiated in hospitalized cancer patients at a large academic medical center to explore fears and other issues related with COVID-19 disease and cancer patients. A stratified analysis by age, sex, marital status, educational background, number of previous systemic treatments received and hospitalization cause was carried out. χ² test, Fisher’s exact test, Spearman's rank correlation coefficient and Kendall rank correlation coefficient were performed when indicated on each category.Results33 patients were included. 66.7% of patients were male and 33.3% female, with a median age of 57 years old. Natural origin hypothesis of novel coronavirus and high educational levels (tau-c = 0.260, p = 0.040) had a positive moderate correlation. Young cancer patients are more afraid of a SARS-CoV-2 infection than elderly people (p=0.034). Thinking there are differences in COVID-19 symptoms due to cancer treatments had a positive moderate correlation with the number of treatments received (tau-b = 0.342, p = 0.005).ConclusionCancer patients need more information about coronavirus and how can affect them. Some of them are not aware of how can cancer increase their risk of infection. However, they agree with measures that hospitals have implemented and don’t feel they affect the quality of care they receive when admitted.

Implementation of a Volunteer Reiki Program at an Academic Medical Center in the Midwest

2020 ◽  
Vol 38 (4) ◽  
pp. 400-409
Author(s):  
Priscilla Jurkovich ◽  
Sara Watson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Care Plans ◽  
Academic Medical ◽  
Average Change ◽  
Research Findings ◽  
Life Force ◽  
Frame Method ◽  
Minute Session

Background: Reiki is a universal life-force energy that promotes healing and relaxation. Reiki requires no equipment or technology, is noninvasive, does not interfere with conventional treatments, is appropriate for all ages, and has no known medical contraindications. There is an emerging preference for nonopioid therapies for symptom management. Within an integrative person-centered holistic care model, nursing care plans include a patient’s whole narrative with physical, mental, emotional, and spiritual elements. The Evidence-Based Practice PICOT Question: Will hospitalized patients of any age (population) receiving one 20-minute session of Reiki (intervention) compared with usual care (comparison) report a change from prerating symptom score (outcome) at the completion of the 20-minute session (time frame)? Method: A total of 1,278 patients received a 20-minute Reiki session with volunteer, certified Reiki practitioners from September 2017 through October 2019. Results: The average symptom prescore was 5.52 and postscore was 2.25, thus showing an average change of −3.17. Conclusions: The authors presented the results that were consistent with research findings from the literature review suggesting that Reiki can decrease pain, general discomfort, anxiety, insomnia, and nausea.

Drug purchase price volatility in an academic medical center

2021 ◽  
Author(s):  
Armando Cortes ◽  
Megan Park ◽  
Bryan C McCarthy
Keyword(s):  
Drug Price ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Purchase Price ◽  
Price Changes ◽  
Price Increases ◽  
Academic Medical ◽  
Price Trends ◽  
The Impact

Abstract Purpose Inpatient drug purchase price trends at an 811-bed academic medical center are described. Summary Recent highly publicized drug price increases by pharmaceutical manufacturers have generated public interest in regulatory solutions to reduce drug costs. Monitoring drug price changes through internal dashboards has been demonstrated to aid in purchasing decisions to reduce the impact of drug price changes on inpatient pharmacy drug budgets. In this research, University of Chicago Medicine created an internal dashboard to detail specific inpatient drug purchase price trends. Dashboard data input included all medications purchased through the organization’s group purchasing organization over a 25-month time frame. A total of 69,245 drug purchases of 2,432 unique medications and/or dosage strengths were analyzed in the study. Within the 25-month time period, 706 medications (29%) had a net drug purchase price increase, while 898 (37%) had a net drug purchase price decrease. The range of net price percentage changes for medications with price increases was 0.01% to 733.6%; the range for medications with price decreases was 0.01% to 97.5%. Conclusion Relative to previous purchase prices, drug purchase prices decreased or remained the same more often than they increased over a 25-month time frame. However, drug purchase price percentage changes were far greater for medications whose prices increased rather than decreased.

scholarly journals Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development (Preprint)

2019 ◽  
Author(s):  
Gennaro Di Tosto ◽  
Ann Scheck McAlearney ◽  
Naleef Fareed ◽  
Timothy R Huerta
Keyword(s):  
Medical Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Median Number ◽  
Patient Portal ◽  
Record System ◽  
User Interactions ◽  
Methodological Choices ◽  
Log File

BACKGROUND Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients’ use of an outpatient portal to examine how patients engage with the tool. OBJECTIVE This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. METHODS Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. RESULTS Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. CONCLUSIONS In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.

Assessment of a pharmacy technician medication history program

2020 ◽  
Author(s):  
Danielle E Baker ◽  
Meredith K Hollinger ◽  
Katherine D Mieure
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Medication List ◽  
Medication History ◽  
Prescribing Pattern ◽  
Medication Discrepancies ◽  
Time Service ◽  
Pharmacy Technician ◽  
Academic Medical

Abstract Purpose To determine the percentage of unintentional prior-to-admission (PTA) medication list discrepancies captured by second-source verification. Methods A prospective, randomized, controlled intervention was conducted on all patients admitted to a large academic medical center with a PTA medication list completed by a pharmacy technician from December 2018 through January 2019. Excluded patients included those admitted as observation status or discharged prior to the time of second-source verification. The following data was collected: patient’s medical record number, age, admission date and time, service admitted to, date and time of completed PTA medication list, date and time of second-source verification, type of second-source verification, medication name, dose, route, frequency, formulation, and confidence level of pharmacy technician completing the initial PTA medication list. Second-source verification was conducted on all medications from a patient’s PTA medication list after completion by a pharmacy technician. Results There were a total of 992 medications from the 200 randomly assigned patients with a completed PTA medication list by a pharmacy technician during the study time frame. Of these medications, 116 (11.7%) contained a discrepancy identified by second-source verification. The most common type of discrepancy was omission (67%) followed by dosing, frequency, and formulation. The median time to complete second-source verification was 9 minutes (interquartile range, 5-17 minutes). Conclusion Second-source verification at the time of hospital admission helps identify medication discrepancies and may improve medication use safety and prescribing pattern and, accordingly, may contribute to reducing medication errors.

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