Abstract W P351: A Stroke Above the Rest: A Reengineering of the Interdisciplinary Plan of Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Noella J West
Keyword(s):  
Length Of Stay ◽  
Patient Participation ◽  
Stroke Survivor ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Steady Increase ◽  
Quality Enhancement ◽  
Phone Calls ◽  
Stroke Team

Background and Purpose: Patients who are newly diagnosed with a stroke are often overwhelmed due to the devastating nature of their condition. The post-acute phase frequently involves a significant amount of education regarding new medications, treatments, recovery and follow up. Ineffective education may be associated with poor outcomes; therefore information from healthcare professionals should be easily understood by patients and their families. The purpose of this evidence based nursing practice and quality enhancement initiative was to improve the patient outcomes and provide tools to assist patients for reentry into the community. Methods: The reengineered plan of care was implemented by the interdisciplinary Stroke Team. Individual education packets were developed based on diagnosis and specific comorbidities, and took into consideration the concept of health literacy. Communication with the primary care provider as well as providing patients with a thirty-day filled prescription prior to discharge assisted with continuity of care. Follow up phone calls reinforced education. Creation of a listserv provided notification of monthly stroke support group meetings and our yearly stroke retreat. Both programs are tailored to the stroke survivor and caregiver, and have been beneficial to the community. Results: This interdisciplinary initiative contributed to a steady increase in patient’s ratings of communication with doctors, and with a decrease in hospital length of stay for patients who were treated by the Interdisciplinary Stroke Team. In addition, patient participation in the annual Stroke Retreat and patient participation in community stroke programs have increased.Conclusions : Reengineering of the interdisciplinary plan of care improved not only the patient experience, but also better prepared patients and their caregivers for discharge. This quality enhancement initiative was vital in decreasing length of stay and quality of care in the stroke population.

scholarly journals Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

2016 ◽  
Author(s):  
Antonio Tarasconi ◽  
Fausto Catena ◽  
Hariscine K. Abongwa ◽  
Belinda De Simone ◽  
Federico Coccolini ◽  
...  
Keyword(s):  
Survival Rate ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Procedures ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asa Score ◽  
Abdominal Emergency ◽  
Emergency Abdominal Surgery

Unlike other surgical fields, such as cardiac surgery, where many trials have been made about safety, feasibility and outcome of surgical procedures in the elderly, there is lack of literature about emergency abdominal surgery in very old patients, especially in people over 90 years of age. The available data reported survival of about 50% one year after the operation. The aim of the study is to determine the survival rate two years after emergency abdominal surgery in a nonagenarian population and to identify any demographic and surgical parameters that could predict a poor outcome in this type of patient. The study was a retrospective multicenter trial. Patient inclusion criteria were: age 90 years old or older, urgent abdominal surgery. The medical charts reviewed and data collected were: gender, age, the American Society of Anesthesiologists (ASA) score and comorbidities, diagnosis, time elapsed between arrival to the Emergency Room and admission to the Operatory Room, surgical procedures, open versus laparoscopic procedure, type of anesthesia and outcomes with hospital length of stay. Phone call follow-up was performed for patient discharged alive and Kaplan-Meier analysis was used to evaluate survival. We identified 72 (20 males and 52 females) nonagenarian patients who underwent abdominal emergency surgery at 6 Italian hospitals (Parma, Bergamo, Bologna, Brescia, Chiari, Adria). Mean age was 92.5 years [range 90-100, standard deviation (SD) 2.6], median ASA score was 3 (range 2-5, mean 3.32) and only 7 patients were without comorbidities. Mean hospital length of stay was 13 days (range 1-60, SD 11.52); 56 patients (77.7%) were discharged alive; 2 years survival rate was 23% [mean follow-up=10 months (range 1-27)]. Among all the parameters analyzed, only ASA score was significantly correlated with survival. Neither the presence of malignancy nor the absence of comorbidities seems to correlate with survival. Nonagenarian patients undergoing emergent abdominal surgical procedures have a high overall in-hospital mortality rate (23%) and a low 2 years survival rate (51.4%). Except for ASA score, there are no other factors predicting poor outcome. Based on the present study emergency abdominal surgery in frail patients over 90 years of age has to be carefully evaluated: only 1 out 5 patients will be alive after 2 years.

scholarly journals Duodenum-preserving pancreatic head resections for surgical treatment of paraduodenal pancreatitis

2020 ◽  
Vol 49 (4) ◽  
pp. 51-54
Author(s):  
O. Yu. Usenko ◽  
V. M. Kopchak ◽  
I. V. Khomiak ◽  
A. I. Khomiak ◽  
A. V. Malik
Keyword(s):  
Surgical Treatment ◽  
Length Of Stay ◽  
Pain Score ◽  
Pain Control ◽  
Pancreatic Head ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Group ◽  
Paraduodenal Pancreatitis

Introduction. Up to date, no consensus exists on the surgical treatment of paraduodenal pancreatitis (PDP). Most authors prefer to perform pancreaticoduodenectomy when surgical treatment is indicated. However, such an aggressive approach may not always be justified for the treatment of benign disease. The aim of our study was to investigate the results of duodenum-preserving pancreatic head resections (DPPHR) for the treatment of PDP. Materials and methods. We performed a retrospective analysis of a database consisting of 112 patients with PDP treated in Shalimov National Institute of Surgery and Transplantology from 2014 to 2019. A total of 45 patients after DPPHR were included to the study. Such modifications of DPPHR as Frey’s, Beger’s and Berne’s procedures were used. The primary study endpoint was pain control assessed according to the Izbicki pain score before surgery and at follow-up visits. Secondary endpoints were defined as complication rate (Clavien — Dindo >2), hospital length of stay and 90-day mortality. All patients were followed-up for the assessment of pain cessation with a median of 33 months (range 8–54 months). Results. There were 42 males (93.3%) and 3 females (6.7%) in the study group. Preoperative Izbicki pain score result was 52.6 points. Follow-up pain score results were significantly lower at 11.7 points. Postoperative complication rate (Clavien — Dindo >2) was measured at 8.9%. Median hospital length of stay was 17.4 days. No mortality was recorded in the study group. All results were statistically significant (p<0.05). Conclusion. Application of DPPHR for the surgical treatment of PDP allows to achieve excellent results in terms of pain control (52.6 and 11.7 points on the Izbicki pain score before surgical intervention and at follow-up), while maintaining low complication (8.9%) and mortality (0%) rates.

Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasi-experimental study*

2010 ◽  
Vol 38 (4) ◽  
pp. 1036-1043 ◽  
Author(s):  
Álvaro Castellanos-Ortega ◽  
Borja Suberviola ◽  
Luis A. García-Astudillo ◽  
María S. Holanda ◽  
Fernando Ortiz ◽  
...  
Keyword(s):  
Experimental Study ◽  
Septic Shock ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surviving Sepsis Campaign ◽  
Quasi Experimental

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

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