Abstract WP155: Increased Physician and Physical Therapist Communication is Associated With Earlier Mobility and Decreased Length of Stay in the Cerebrovascular and Trauma Neuroscience Population

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Danielle Burch ◽  
Silke Bernert ◽  
Justin F Fraser
Keyword(s):  
Length Of Stay ◽  
Physical Therapist ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intervention Period ◽  
Post Intervention ◽  
Multidisciplinary Rounds ◽  
Level I ◽  
Post Intervention Group

Background and Purpose: There is growing interest in methods for early rehabilitation in patients with acute neurologic conditions. The purpose of this study was to identify whether increased coordination between the physical therapist and an attending cerebrovascular neurosurgeon through daily multidisciplinary rounds would correlate with positive changes in overall care. Hypothesis: We evaluated the hypothesis that a physical therapist participating in cerebrovascular neuroscience rounds would decrease the time to initial physical therapy (PT) consult, decrease hospital length of stay (LOS), decrease Intensive Care Unit (ICU) LOS, and decrease ventilator days. Methods: A retrospective review was performed of 235 patients who were admitted to the neuroscience service under a single cerebrovascular neurosurgeon over a 16-month period (April 2014 through July 2015) in a level-I trauma hospital. The study consisted of an eight-month pre-intervention period (n=117) where the physical therapist did not attend physician rounds and an eight-month post-intervention period (n=118). Results: In the post-intervention group the PT assessment occurred on average 1.57 days sooner than before the physical therapist participated in neuroscience physician rounds (p<0.001). Hospital LOS decreased by an average of 3.46 days (p=0.04) and ICU LOS decreased on average by 1.83 days (p=0.05) in the post-intervention group. Ventilator days decreased on average by 0.55 days, which was not statistically significant (p=0.26). Conclusions: In conclusion, daily coordination with multidisciplinary rounds between the physician and the physical therapist was associated with decreased time to initial PT assessment, decreased hospital LOS, and decreased ICU LOS in the neuroscience population.

scholarly journals 770. Multimodal Sepsis Performance Improvement Initiative Improves Early and Appropriate Treatment, Reduces Sepsis-related Readmissions, and Reduces Overall Mortality

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S343
Author(s):  
Seife Yohannes
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Performance Improvement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Sepsis And Septic Shock

Abstract Background CMS has implemented the SEP-1 Core Measure, which mandates that hospitals implement sepsis quality improvement initiatives. At our hospital, a 900-bed tertiary hospital, a sepsis performance improvement initiative was implemented in April 2016. In this study, we analyzed patient outcomes before and after these interventions. Methods We studied coding data in patients with a diagnosis of Sepsis reported to CMS using a third-party performance improvement database between October, 2015 and July, 2017. The interventions included a hospital-wide education campaign about sepsis; a 24–7 electronic warning system (EWS) using SIRS criteria; a rapid response nursing team that monitors the EWS; a 24–7 mid-level provider team; a database to monitor compliance and timely treatment; and education in sepsis documentation and coding. We performed a before and after analysis of patient outcomes. Results A total of 4,102 patients were diagnosed with sepsis during the study period. 861 (21%) were diagnosed during the pre-intervention period and 3,241 (80%) were diagnosed in the post-intervention period. The overall incidence of sepsis, severe sepsis, and septic shock were 59%, 13%, and 28% consecutively. Regression analysis showed age, admission through the ED, and severity of illness as independent risk factors for increased mortality. Adjusted for these risk factors, the incidence of severe sepsis and septic was reduced by 5.3% and 6.9% in the post-intervention period, while the incidence of simple sepsis increased by 12%. In the post-intervention period, compliance with all 6 CMS mandated sepsis bundle interventions improved from 11% to 37% (P = 0.01); hospital length of stay was reduced by 1.8 days (P = 0.05); length of stay above predicted was less by 1.5 days (P = 0.05); re-admission rate was reduced by 1.6% (P = 0.05); and death from any sepsis diagnosis was reduced 4.5% (P = 0.01). Based on an average of 2000 sepsis cases at our hospital, this amounted to 90 lives saved per year. Death from severe sepsis and septic shock both were also reduced by 5% (P = 0.01) and 6.5% (P = 0.01). Conclusion A multi-modal sepsis performance improvement initiative reduced the incidence of severe sepsis and septic shock, reduced hospital length of stay, reduced readmission rates, and reduced all-cause mortality. Disclosures All authors: No reported disclosures.

scholarly journals 110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Patient Survival ◽  
Intervention Group ◽  
Culture Collection ◽  
Drug Resistant ◽  
Intervention Period ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p &lt; 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

Service evaluation of an acute Parkinson's therapy pathway between hospital and home

2020 ◽  
Vol 27 (7) ◽  
pp. 1-6
Author(s):  
Christopher J Lovegrove ◽  
Jonathan Marsden
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Length Of Stay ◽  
Intervention Group ◽  
Service Evaluation ◽  
Hospital Length ◽  
Community Services ◽  
Hospital Length Of Stay ◽  
Hospital Environments ◽  
Home Based

Background People with Parkinson's disease report that inpatient hospital environments do not replicate their home setup. A therapy pathway was developed integrating early home-based assessment, therapy sessions with photographs of key home areas, enhanced communication with community services, and staggered discharge. Methods Outcome measures (length of stay and readmissions within 14 days) in people with Parkinson's disease on the therapy pathway (n=5) were compared to those previously receiving standard care (n=5). Results Mean length of stay was 7.2 days shorter in the intervention group and their discharge Lindop Parkinson's mobility scale score was 39.4% higher. No difference was found in the Modified Barthel Index between the groups. Both groups had the same readmission rates. The pathway was accepted by both people with Parkinson's disease and clinicians. Conclusions The pathway reduced hospital length of stay and increased mobility in patients with Parkinson's disease. It was accepted by patients and clinicians and was feasible to integrate into current practice. The pathway warrants further evaluation.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals Implementation of a Physician Incentivized QI Strategy to Address Time to Parenteral Analgesia in Patients with Voe in the Pediatric Emergency Department

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2989-2989
Author(s):  
Romy Shane ◽  
Sanjay J. Shah ◽  
Blake Bulloch ◽  
Anita Bharath
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Post Intervention ◽  
Opioid Administration ◽  
Ed Visits ◽  
Mean Time ◽  
Timely Administration ◽  
Order Set

Abstract Introduction Vaso-occlusive episodes (VOE) are the most common cause of pediatric Emergency Department (ED) visits and hospitalizations in Sickle Cell Disease (SCD). The National Heart Lung and Blood Institute published an Expert Panel Report regarding the management of SCD and VOE. Their consensus statement recommends initiating analgesic therapy within 30 minutes of triage or within 60 minutes of registration in the Emergency Department. Previous studies have demonstrated that earlier maximum opioid has been associated with shorter length of hospitalization and improved time to ED disposition decision. Despite the overwhelming evidence for timely administration of parenteral analgesic, significant delays still exist in delivery of pain medication in the pediatric SCD population. Barriers to timely administration include rapid triage of SCD patients, provider ordering of pain medication, and peripheral intravenous access. Therefore, a standardized approach to pain management may improve ED management of SCD crises. In order to address timely administration of opiates to SCD patients with VOE episodes in our pediatric ED a SCD pain order set was developed. This order set implemented the use of intranasal (IN) fentanyl as a first line analgesic for SCD patients who presents to the ED with VOE. The purpose of this study was addressing barriers to decrease time to parenteral opioid administration in the pediatric ED. Methods This Quality Improvement (QI) measure was performed at a free-standing, urban pediatric ED. Patients were included if they had a diagnosis of SCD and presented with a pain score &gt;5 and without fever. A PDSA cycle was utilized for designing and evaluating the proposed changes. This cycle consisted of three intervention phases: (1) electronic medical record (EMR) order set development in October 2019, (2) provider incentive for order set use in January 2020, and (3) nursing/patient & family education in April 2020. Baseline data was collected pre-intervention from April-September 2019. The outcomes measures were mean time to 1 st analgesic, mean time from triage to disposition, Hospital Length of Stay, and overall admission rates. Our balancing measure included 48 hour ED re-visits after discharge. Results There were 67 ED visits from April-September 2019 (pre-intervention) and 104 ED visits in the post-intervention data from October-June 2020. There was no significant difference in age or initial pain score in the pre- and post- intervention groups. Improvements were seen in: mean time to first analgesic (58 to 26 minutes), time to disposition (271 to 213 minutes). Hospital length of stay was found to increase with the introduction of IN fentanyl: pre-intervention (120 hours), phase 1 (148 hours), phase 2 (152 hours), phase 3 (218 hours). However, the overall admission rate decreased (55% to 44%). The number of 48-hour ED re-visits remained stable. Conclusion By using QI methods to address key barriers in the pediatric ED, we demonstrated that timely administration of parenteral analgesic can be achieved for SCD patients with VOE. Utilizing the EMR order set allowed for more stream-lined care, both by physicians and nursing staff, resulting in more rapid ordering of medication therefore decreasing time to ED disposition. Additional interventions such as provider incentivization to meet the goal of parenteral opioids within 30 minutes of patient arrival led to further improvement. One of the greatest barriers to our QI intervention was hesitancy both by patients and their caregivers regarding the efficacy of IN fentanyl in decreasing pain compared to IV opioid. Further education was needed both for families and medical staff regarding the efficacy of IN fentanyl as a first line analgesic. It is unclear why overall hospital length of stay was not shown to be decreased with these interventions but this can be offset by an overall decrease in hospital admissions seen with our interventions. This data may be limited by the SARS-CoV-2 pandemic and how psychosocial stressors can impact patients with chronic medical conditions. Length of stay is also confounded by other factors during the hospitalization and acquisition of other diagnoses such as acute chest. Future research is needed to determine if the demonstrated trend of admission rates and hospital length of stay can be replicated in other pediatric EDs and whether earlier opioid administration affects the outcome of VOEs beyond the ED. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals An Evaluation of Pharmacist-Led Interventions for Inpatient HIV-Related Medication Errors

2019 ◽  
Vol 35 (6) ◽  
pp. 235-242
Author(s):  
Mary Joyce B. Wingler ◽  
Kayla R. Stover ◽  
Katie E. Barber ◽  
Jamie L. Wagner
Keyword(s):  
Medication Errors ◽  
Primary Outcome ◽  
Intervention Group ◽  
Audit And Feedback ◽  
Intervention Period ◽  
Prospective Audit ◽  
Post Intervention ◽  
Prospective Audit And Feedback ◽  
Post Intervention Group

Background: Inpatient HIV-related medication errors occur in up to 86% of patients. Objective: To evaluate the number of antiretroviral therapy (ART)- and opportunistic infection (OI)-related medication errors following the implementation of pharmacist-directed interventions. Methods: This quasi-experiment assessed adult patients with HIV who received ART, OI prophylaxis, or both from December 1, 2014, to February 28, 2017 (pre-intervention) or December 1, 2017, to February 28, 2018 (post-intervention). Pre-intervention patients were assessed retrospectively; verbal and written education were provided (intervention); prospective audit and feedback was conducted for post-intervention patients. The primary outcome was rate of ART errors between groups. Secondary outcomes included rate of OI errors, time to resolution of ART and OI errors, types of errors, and rate of recommendation acceptance. Results: Sixty-seven patients were included in each group. ART errors occurred in 44.8% and 32.8% ( P = .156), respectively. OI prophylaxis errors occurred in 11.9% versus 9% ( P = .572), respectively. Medication omission decreased significantly in the post-intervention group (31.3% vs 11.9%; P = .006). Pharmacist-based interventions increased in the post-intervention group (6.3% vs 52.9%; P = .001). No statistical difference was found in time to error resolution (72 vs 48 hours; P = .123), but errors resolved during admission significantly increased (50% vs 86.8%; P < .001). No difference was found in rate of intervention acceptance (100% vs 97%). Conclusion and Relevance: ART and OI prophylaxis errors resolved a day faster in the pharmacist-led, post-intervention period, and there was a trend toward error reduction. Future interventions should target prescribing errors on admission using follow-up education and evaluation of medication reconciliation practices in HIV-infected patients.

scholarly journals 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S201-S202
Author(s):  
John M Boulos ◽  
Kathryn DeSear ◽  
Bethany Shoulders ◽  
Veena Venugopalan ◽  
Stacy A Voils ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Intervention Group ◽  
Hospital Length Of Stay ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Secondary Outcomes ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage. Methods Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI). Figure 1. Flowchart of patient inclusion into the study Results 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p&lt; 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p&lt; 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p&lt; 0.01). Conclusion This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI. Disclosures All Authors: No reported disclosures

The Dangers of Equivocal FAST in Trauma Resuscitation

2017 ◽  
Vol 83 (10) ◽  
pp. 1127-1131 ◽  
Author(s):  
John Kleinman ◽  
Aaron Strumwasser ◽  
David Rosen ◽  
Jeremy Hardin ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
False Negative ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Abdominal Sonography ◽  
Trauma Outcomes ◽  
Level I ◽  
The Right

Equivocal focused abdominal sonography for trauma (FAST) examinations confound decision-making for trauma surgeons. We sought to determine whether the equivocal FAST (defined as any nonconcordant result) has a deleterious effect on trauma outcomes. A 2-year review (2014–2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST results were compared. Outcomes included resuscitation time (h), ventilation days (d), hospital length of stay (HLOS-d), ICU length-of-stay, and survival (%). In addition, skill level of the sonographer was stratified by novice (postgraduate year (PGY) years 1–3) or expert skill levels (PGY-4/fellow or attending). A total of 1,027 patients were included. Compared with concordant FAST examinations, equivocal FASTs were associated with increased HLOS (14.1 vs 10.6, P = 0.05), higher mortality (9.8 vs 3.7%, P = 0.02), decreased positive predictive value in the right upper quadrant (RUQ) (55 vs 79%, P = 0.02) and left upper quadrant (LUQ) (50 vs 83%, P < 0.01) and significantly decreased specificity in the thoracic (83 vs 98%), RUQ (80 vs 98%), LUQ (86 vs 99%), and pelvic (88 vs 98%) windows (P < 0.01 for all). A trend of greater positive predictive value in the thoracic window (100 vs 81%, P = 0.09) among PGY-4/fellow and attending providers compared with PGY levels 1–3 was observed. Equivocal FASTs portend worse outcomes than concordant FASTs because of high false-negative rates, specifically in the thoracic region and the upper quadrants. Lower thresholds for intervention are recommended.

Early FAST Examinations during Resuscitation May Compromise Trauma Outcomes

2018 ◽  
Vol 84 (10) ◽  
pp. 1705-1709
Author(s):  
John Kleinman ◽  
Kenji Inaba ◽  
Emily Pott ◽  
Kazuhide Matsushima ◽  
Demetrios Demetriades ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Central Line ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Outcomes ◽  
Primary Survey ◽  
Icu Length Of Stay ◽  
Level I ◽  
Review 2014

Focused assessment with Sonography for trauma (FAST) examination is essential to trauma triage. We sought to determine whether FASTs completed early in sequencing portend worse outcomes. A two-year review (2014–2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST times were compared. Outcomes included resuscitation time (RESUS-h), ventilation days (d), hospital length of stay (HLOS-d), ICU length of stay (LOS-d), survival (%), nosocomial infection rate (%), and venous thromboembolism complication rate (%). ED interventions included transfusions, crystalloid, antibiotics, central line placement, intubation, thoracostomy, thoracotomy, pelvic X-ray, and binder. One thousand, three hundred and twelve patients were included for analysis (mean age = 38 ± 19 years, mean Injury Severity Score = 12 ± 11, 21% penetrating). Compared with FASTs completed after the primary survey, early FASTs led to significantly more ventilation days ( P < 0.01), longer ICU length of stay ( P < 0.01), and a greater incidence of nosocomial infections ( P = 0.03). In the ED, early FASTs led to significantly more intubations ( P < 0.01) and transfusions ( P < 0.01) compared with late FASTs. FASTs completed before primary survey portend worse outcomes, with more ED interventions and equivocal results. FAST as a true adjunct to primary survey is recommended.

Implementing an emergency department EMR trigger tool for palliative medicine consultation and its effect on length of stay and health care costs: A retrospective study.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 167-167
Author(s):  
Dmitry Kozhevnikov ◽  
Felix Rivera ◽  
Wendy Edwards
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Palliative Medicine ◽  
Metastatic Cancer ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Control Group ◽  
Trigger Tool

167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. Methods: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR. Patients who met criteria for a palliative consultation as determined by ED physicians at the time of inpatient admission were tracked by the palliative medicine department as part of a pilot phase. Those that were triggered and received usual care made up the control group. The intervention group was made up of patients who were triggered and seen in consultation. Results: Patients who were seen within 3 days of trigger were found to have a mean length of stay of 7.57 days, while those seen after 3 days had a mean length of stay 10.61 days. Patients who were triggered for metastatic cancer were found to have differences in final disposition between the two groups. Discharge to subacute rehabilitation facilities (SAR) in these patients decreased from 24% in the control group to 12% in the intervention group, while use of home hospice more than doubled to 11%. The percentage of these patients dying in the hospital decreased from 18% to 12%. Conclusions: Our study showed that earlier consultation was associated with shorter hospital length of stays if patients were seen within 3 days of being flagged as having palliative care needs in the ED. We also found that our EHR trigger doubled home hospice utilization in patients with metastatic cancer, decreased the proportion of discharges to SAR, and decreased in-hospital death in these patients.

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