Abstract WMP94: Root Cause Analyses of Preventable Causes of Readmission after Stroke: The University Hospitals- Case Medical Center (UH-CMC) and University Hospitals System Stroke Program (UHSSP) Experience

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Benny S Kim ◽  
Julie Fussner ◽  
Cathy Sila
Keyword(s):  
Medical Center ◽  
Administrative Databases ◽  
Bleeding Complications ◽  
Case Review ◽  
University Hospitals ◽  
Stroke Subtype ◽  
Vascular Events ◽  
Hospital System ◽  
Root Cause ◽  
The University

Root Cause Analyses of Preventable Causes of Readmission after Stroke: The University Hospitals- Case Medical Center (UH-CMC) and University Hospitals System Stroke Program (UHSSP) Experience Objective: Metrics, such as the 30 day readmission rate after stroke, are increasingly used by consumers and payors to reflect hospital quality of care. Benchmarks determined by large administrative databases lack detailed root cause analyses which are crucial in determining preventable causes. Methods: In 2010, the UHSSP Quality Initiative developed a MIDAS™ report alerting the Stroke Coordinator of all inpatient encounters to any UH hospital within 30 days of a stroke discharge from UH-CMC. A focus study guided a detailed case review including demographics, index admission stroke subtype, discharge treatment and disposition, follow up appointments, medical compliance, readmission diagnosis and location, and Root Cause Analysis of preventable causes. Results: Of 1093 stroke discharges from January 2011 - June 2012, 84 (7.7%) were readmitted within 30 days; 5.7% to UH-CMC and 2% to other UH hospitals. During this period, compliance with evidence-based guidelines for stroke exceeded benchmarks. Readmitted patients were 54% female, 30% aged ≥ 80 years and 45% were transferred from facilities. Stroke subtypes reflected total discharges with 78% ischemic stroke, 9.6% TIA, 8% intracranial hemorrhage and 3.6% subarachnoid hemorrhage. Of the various causes of readmission, the most common were recurrent vascular events in 22% (TIA, stroke 14%, myocardial 8%) and infection in 20% (pneumonia 11%, urinary tract 7%). Bleeding complications of anti-thrombotic therapy occurred in 8% (hemorrhagic transformation 6%, GI 2%). Other frequent events included new onset seizure (7%) or cardiac arrhythmia (5%). Scheduled, elective readmissions accounted for 6% and medically unnecessary transfers from facilities an additional 6%. Conclusions: Single center data would have missed 26% of the readmissions that went to hospital system community hospitals. Root Cause Analyses of readmitted patients discovered evidence relevant to the readmitting diagnosis prior to index hospital discharge in 7% but only 6% of all readmissions were preventable by the discharging team.

Healthcare Epidemiology Practicum Rotation for Postgraduate Physician Trainees in Medicine–Infectious Diseases

2013 ◽  
Vol 34 (10) ◽  
pp. 1114-1116
Author(s):  
Pranavi Sreeramoju ◽  
Maria Eva Fernandez-Rojas
Keyword(s):  
Infectious Diseases ◽  
Infection Control ◽  
Medical Center ◽  
Common Trunk ◽  
University Hospitals ◽  
Hospital System ◽  
University Of Texas ◽  
Core Rotation ◽  
The University ◽  
Healthcare Epidemiology

Practicum education in healthcare epidemiology and infection control (HEIC) for postgraduate physician trainees in infectious diseases is necessary to prepare them to be future participants and leaders in patient safety. Voss et al suggested that training in HEIC should be offered as a “common trunk” for physicians being trained in clinical microbiology or infectious diseases. A 1-month rotation has been recommended previously. A survey by Joiner et al indicated that only 50% of infectious diseases fellows found the infection control training adequate. The objective of this article is to report our 2-year experience with a 1-month practicum rotation we designed and implemented at our institution.The setting is the Adult Infectious Diseases fellowship program at the University of Texas Southwestern Medical Center (UTSW), Dallas, Texas. The fellows have clinical rotations at the Parkland Health and Hospital System, UTSW University hospitals, North Texas Veterans Affairs Health Care System, and Children's Medical Center Dallas. The 2-year program recruits 7 fellows every 2 years. The 1-month core rotation was established in July 2011 and is ongoing. Fellows who completed the rotation during the period July 2011 to April 2013 are included in this study.

scholarly journals SYNTHESIS OF THE ORGANIZATION OF TREATMENT, RESEARCH AND TEACHING (CASE STUDY AT THE UNIVERSITY HOSPITAL IN AACHEN)

2021 ◽  
pp. 349-358
Author(s):  
Maryna Lienkova ◽  
Irina Bulakh
Keyword(s):  
Medical Center ◽  
Multidisciplinary Treatment ◽  
University Hospital ◽  
Survey Analysis ◽  
University Hospitals ◽  
Medical Institutions ◽  
Hospital Patients ◽  
Student Training ◽  
Treatment Research ◽  
The University

The article considers and analyzes the existing in the world, but new for Ukraine, type of healthcare institutions - a university hospital, which today is an example of one of the largest and best university hospitals in Germany - the Medical Center of the University of Aachen. The planning and functional structure of the university hospital and special design approaches that contributed to its design and development are analyzed. The purpose of the article is to illustrate an innovative approach for our state to the organization of medical institutions and to emphasize the importance of their implementation in the domestic healthcare system. The research methodology is based on the systematization and analysis of data from various information sources, as well as on the method of sociological survey (analysis of reviews). The article considers the features of the structure of the University Hospital Aachen, namely the multidisciplinary treatment, research and student training, which are combined in one institution. According to hospital patients, the only drawback of this structure is the frequent long wait for visitors. This is probably due to the significant daily flow of patients of varying complexity and, consequently, the shortcomings of the managerial approach. However, at the same time, the hospital has many advantages, which were highlighted in the article.  

scholarly journals Tracing diagnosis trajectories over millions of inpatients reveal an unexpected association between schizophrenia and rhabdomyolysis

2018 ◽  
Author(s):  
Hyojung Paik ◽  
Matthew J. Kan ◽  
Nadav Rappoport ◽  
Dexter Hadley ◽  
Marina Sirota ◽  
...  
Keyword(s):  
San Francisco ◽  
Large Scale ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Case Review ◽  
Health Records ◽  
Disease Registries ◽  
Disease Associations ◽  
Muscle Breakdown ◽  
The University

AbstractWhile it has been technically feasible to create longitudinal representations of individual health at a nationwide scale, the use of these techniques to identify novel disease associations for the risk stratification of patients has had limited success. Here, we created a large-scale US longitudinal disease network of traced readmission patterns (i.e., disease trajectories), merging data from over 10.4 million inpatients from 350 California hospitals through the Healthcare Cost and Utilization Project between 1980 and 2010. We were able to create longitudinal representations of disease progression mapping over 300 common diseases, including the well-known complication of heart failure after acute myocardial infarction. Surprisingly, out of these generated disease trajectories, we discovered an unknown association between schizophrenia, a chronic mental disorder, and rhabdomyolysis, a rare disease of muscle breakdown. It was found that 92 of 3674 patients (2.5%) with schizophrenia were readmitted for rhabdomyolysis (relative risk, 2.21 [1.80–2.71, confidence interval = 0.95] P-value 9.54E-15), which has a general population incidence of 1 in 10,000. We validated this association using independent electronic health records from over 830,000 patients treated over seven years at the University of California, San Francisco (UCSF) medical center. A case review of 29 patients at UCSF who were treated for schizophrenia and who went on to develop rhabdomyolysis demonstrated that the majority of cases (62%) are idiopathic, which suggests a biological connection between these two diseases. Together, these findings demonstrate the power of using public disease registries in combination with electronic medical records to discover novel disease associations.One Sentence SummaryBased on the longitudinal health records from millions of California inpatient discharges, we created a temporal network that enabled us to understand statewide patterns of hospital readmissions, which led to the novel finding that hospitalization for schizophrenia is significantly associated with rehospitalization for rhabdomyolysis.

scholarly journals A Model for Syphilis Screening in the Emergency Department

2020 ◽  
pp. 003335492096730
Author(s):  
Justin A. Yax ◽  
Joshua D. Niforatos ◽  
Daniel L. Summers ◽  
Margaret H. Bigach ◽  
Christine Schmotzer ◽  
...  
Keyword(s):  
Emergency Department ◽  
African American Men ◽  
Medical Center ◽  
The United States ◽  
University Hospitals ◽  
Syphilis Screening ◽  
Sex With Men ◽  
Testing Algorithm ◽  
The University

The incidence of syphilis infections is on the rise, particularly among African American men and men who have sex with men, and it is reaching epidemic levels in these communities throughout the United States. Although syphilis is relatively inexpensive to treat and cure and is a predictor for HIV incidence among men and transgender women who have sex with men, rates of co-screening for syphilis are low in the emergency department setting, with a dearth of literature on this topic since the 1990s and early 2000s. In this case study, we describe an operational model for routine syphilis screening implemented in June 2017 at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. We describe the advantages of screening using a reverse testing algorithm rather than the traditional method and the necessity of partnering with the Cleveland Department of Public Health for both diagnostic and follow-up logistics.

scholarly journals Tracing diagnosis trajectories over millions of patients reveal an unexpected risk in schizophrenia

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Hyojung Paik ◽  
Matthew J. Kan ◽  
Nadav Rappoport ◽  
Dexter Hadley ◽  
Marina Sirota ◽  
...  
Keyword(s):  
San Francisco ◽  
Medical Records ◽  
Large Scale ◽  
Medical Center ◽  
Disease Incidence ◽  
Muscle Disease ◽  
Case Review ◽  
Large Scale Analysis ◽  
Disease Associations ◽  
The University

Abstract The identification of novel disease associations using big-data for patient care has had limited success. In this study, we created a longitudinal disease network of traced readmissions (disease trajectories), merging data from over 10.4 million inpatients through the Healthcare Cost and Utilization Project, which allowed the representation of disease progression mapping over 300 diseases. From these disease trajectories, we discovered an interesting association between schizophrenia and rhabdomyolysis, a rare muscle disease (incidence < 1E-04) (relative risk, 2.21 [1.80–2.71, confidence interval = 0.95], P-value 9.54E-15). We validated this association by using independent electronic medical records from over 830,000 patients at the University of California, San Francisco (UCSF) medical center. A case review of 29 rhabdomyolysis incidents in schizophrenia patients at UCSF demonstrated that 62% are idiopathic, without the use of any drug known to lead to this adverse event, suggesting a warning to physicians to watch for this unexpected risk of schizophrenia. Large-scale analysis of disease trajectories can help physicians understand potential sequential events in their patients.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

Pulmonary Hypertension Roundtable: COPD, IPF, and Pulmonary Hypertension: A Clinician's Dilemma

2013 ◽  
Vol 12 (3) ◽  
pp. 145-151
Keyword(s):  
Pulmonary Hypertension ◽  
Rhode Island ◽  
Medical Center ◽  
Puget Sound ◽  
Health Science ◽  
Pulmonary Vascular Disease ◽  
University Hospitals ◽  
Science Center ◽  
University Of Texas ◽  
Transplant Program

On October 9, 2013, a group of experts met by telephone to discuss PH in the setting of COPD and IPF. The group consisting of guest editor of this issue Jeffrey Edelman, MD, Head, Lung Transplant Program VA Puget Sound Health System, University of Washington; Deborah J. Levine, MD, Director, Pulmonary Hypertension Center, University of Texas Health Science Center at San Antonio; James Klinger, MD, Director, Rhode Island Hospital Pulmonary Hypertension Center; and Robert Schilz, DO, PhD, Director of Pulmonary Vascular Disease and Lung Transplantation, University Hospitals, Case Medical Center; provided perspective and insight into how clinicians can approach these patients most effectively.

scholarly journals Liquid materials for biomedical research: a highly IT-integrated and automated biobanking solution

2019 ◽  
Vol 43 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Daniela Popp ◽  
Romanus Diekmann ◽  
Lutz Binder ◽  
Abdul R. Asif ◽  
Sara Y. Nussbeck
Keyword(s):  
Life Cycle ◽  
Medical Center ◽  
Research Results ◽  
Long Term Storage ◽  
Medical Centers ◽  
It Systems ◽  
Complete Life Cycle ◽  
The University ◽  
Term Storage

Abstract Various information technology (IT) infrastructures for biobanking, networks of biobanks and biomaterial management are described in the literature. As pre-analytical variables play a major role in the downstream interpretation of clinical as well as research results, their documentation is essential. A description for mainly automated documentation of the complete life-cycle of each biospecimen is lacking so far. Here, the example taken is from the University Medical Center Göttingen (UMG), where the workflow of liquid biomaterials is standardized between the central laboratory and the central biobank. The workflow of liquid biomaterials from sample withdrawal to long-term storage in a biobank was analyzed. Essential data such as time and temperature for processing and freezing can be automatically collected. The proposed solution involves only one major interface between the main IT systems of the laboratory and the biobank. It is key to talk to all the involved stakeholders to ensure a functional and accepted solution. Although IT components differ widely between clinics, the proposed way of documenting the complete life-cycle of each biospecimen can be transferred to other university medical centers. The complete documentation of the life-cycle of each biospecimen ensures a good interpretability of downstream routine as well as research results.

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