Abstract P310: Impact of COVID-19 Pandemic on Stroke Care at the University of Rochester Medical Center

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Benjamin P George ◽  
Christine Boerman ◽  
Peter J Papadakos ◽  
Curtis Benesch ◽  
Robert G Holloway ◽  
...  
Keyword(s):  
Medical Center ◽  
Control Period ◽  
Stroke Care ◽  
Admission Rates ◽  
Period 2 ◽  
Rochester Medical ◽  
Pandemic Response ◽  
Incident Rate ◽  
The University ◽  
The Impact

Introduction: The impact of the COVID-19 pandemic response on medical care for stroke is unknown. Methods: We used local “Get With The Guidelines” stroke data for patients with ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage/subarachnoid hemorrhage (ICH/SAH) from March 20–April 14, 2020 (study period) and January 1–March 19, 2020 (control period #1) and March 20–April 14, 2019 (control period #2). We examined daily admission rates, transfers, tPA administration, thrombectomy, and time from last well to hospital arrival. Results: There were 349 patients (n=40 study period, n=225 control period #1, n=84 control period #2); 263 with IS, 37 with TIA, and 49 with ICH/SAH. Overall, 46% were female, 82% white, with median age 70 years (IQR 58-82 years). Daily admission rates were 1.4 IS/day for the study period compared to 2.1 IS/day (Incident rate ratio [IRR] 1.49 95% CI 1.05-2.13, p=0.027) and 2.2 IS/day (IRR 1.57 1.04-2.37, p=0.033) for control periods #1 and #2 ( Table ), respectively. There was only one admission for TIA in the study period compared to approximately one every 4 days in control period #1 (IRR 7.2 95% CI 1.0-53.7, p=0.053) and one every 2 days in control period #2 (IRR 14.0 95% CI 1.8-106.5, p=0.011). ICH/SAH admissions were fewer in the study period. Transfers were less common with approximately one transfer every four days in the study period compared to one each day of the control periods. Rates of tPA, thrombectomy, and time from last well to first hospital contact did not differ across the epochs. Conclusions: Our data suggest the COVID-19 pandemic response has led to reduced admission volumes for all stroke types in the University of Rochester Medical Center catchment area, partly due to decreases in hospital transfers. These data raise the question whether fewer patients sought care for stroke symptoms at the height of the COVID-19 pandemic.

Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

2019 ◽  
Vol 40 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Charlotte Brewer ◽  
Micah Beachy ◽  
Elizabeth Lyden ◽  
Tammy Winterboer ◽  
...  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Poisson Model ◽  
Panel Testing ◽  
Period 2 ◽  
Gastrointestinal Pathogen ◽  
Pathogen Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design:We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.Setting:Midwest academic medical center.Participants:Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention:A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.Results:During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.Conclusions:A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

Program development of a preceptor bootcamp for operational pharmacy preceptors

2020 ◽  
Vol 77 (Supplement_1) ◽  
pp. S2-S7
Author(s):  
Devlin V Smith ◽  
Stefani Gautreaux ◽  
Alison M Gulbis ◽  
Jeffrey J Bruno ◽  
Kevin Garey ◽  
...  
Keyword(s):  
Survey Methodology ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
University Of Texas ◽  
Qualitative Feedback ◽  
Md Anderson ◽  
The University ◽  
Functional Areas ◽  
The Impact

Abstract Purpose To describe the development, design, and implementation of a pilot preceptor development bootcamp and feedback related to its feasibility and impact on operational pharmacy preceptors. Summary The University of Texas MD Anderson Cancer Center designed and implemented a pilot preceptor development bootcamp for operational staff pharmacists serving as residency preceptors for longitudinal weekend staffing experiences. A systematic, multipronged approach was taken to identify preceptor development gaps and design a full-day bootcamp curriculum. The resultant curriculum was comprised of content in major functional areas including using the 4 preceptor roles, documenting performance, giving and receiving feedback, and dealing with difficult situations or learners. The impact of the pilot preceptor development bootcamp was assessed using survey methodology and qualitative feedback from debrief discussions. Conclusion Implementation of a pilot preceptor bootcamp program addressing major areas of precepting skill was well received, resulted in positive feedback from operational pharmacy preceptors, and was feasible to implement at a large academic medical center.

Simulation to Standardize Patient Care and Maintain Procedural Competency

2015 ◽  
Vol 34 (1) ◽  
pp. 18-30 ◽  
Author(s):  
Meggan Butler-O’Hara ◽  
Margaret Marasco ◽  
Rita Dadiz
Keyword(s):  
Patient Care ◽  
Medical Center ◽  
Standardize Patient ◽  
Advanced Practice ◽  
Invasive Procedures ◽  
Simulated Environment ◽  
Simulation Based ◽  
Rochester Medical ◽  
Heath Care ◽  
The University

ABSTRACTSimulation-based training is a means to teach procedural skills and to help advanced practice providers maintain procedural competency and credentialing. There is growing recognition of the importance of requiring providers to demonstrate competency of invasive procedures in a simulated environment prior to performing these high-risk procedures on patients. This article describes the development and implementation of the Simulation Procedural Program at the University of Rochester Medical Center. In addition to contributing to the education of our providers, such a program can lead to improved patient quality, safety, and outcomes through the standardization of patient care. The innovative use of simulation can lead to effective heath care education and improvement in patient safety.

Small Hours in the Meatpacking District

2011 ◽  
Vol 11 (4) ◽  
pp. 23-25
Author(s):  
Barry Goldstein
Keyword(s):  
Medical Humanities ◽  
Medical Center ◽  
Associate Professor ◽  
The Past ◽  
Historical District ◽  
Rochester Medical ◽  
The Hours ◽  
The University ◽  
Photo Essay ◽  
Washington Street

New York's Meatpacking District, on Manhattan's west side south of Fourteenth Street, has gone through several incarnations. In the early twentieth century, it was home to hundreds of butchers and processors. During the past decade, development exploded, and today, only seven meat wholesalers and distributers remain. The area was designated a historical district in 2003, and even this remnant will soon diminish, displaced by a new home for the Whitney Museum. But between the hours of 2:00 and 10:00 a.m., tractor-trailers still idle on Washington Street, whole carcasses are loaded into large refrigerated workrooms, and men who commute from Jersey and outlying boroughs still labor under cold fluorescents over bloodied power saws. A photo essay showing activities in DeBragga and Spitler, Inc. and J.T. Jobbagy, Inc., two of the remaining meat wholesalers and butchers in New York's Meatpacking district. Photographer Barry Goldstein is the author of Gray Land: Soldiers on War (W.W. Norton & Co., 2009). He is Associate Professor of Medical Humanities at the University of Rochester Medical Center, and Visiting Professor of Humanities at Williams College.

scholarly journals Impact of the Sequence of Norepinephrine and Vasopressin Discontinuation in Patients Recovering From Septic Shock

2018 ◽  
Vol 55 (1) ◽  
pp. 26-31
Author(s):  
Benjamin E. Bredhold ◽  
Shauna D. Winters ◽  
John C. Callison ◽  
Robert E. Heidel ◽  
Lauren M. Allen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Medical Condition ◽  
Medical Center ◽  
Secondary Outcome ◽  
University Of Tennessee ◽  
Icu Length Of Stay ◽  
Significant Difference ◽  
The University ◽  
The Impact

Background: Septic shock is a serious medical condition affecting millions of people each year and guidelines direct vasopressor use in these patients. However, there is little information as to which vasopressor should be discontinued first. Objective: The objective of this study was to assess the impact of the sequence of norepinephrine and vasopressin discontinuation on intensive care unit (ICU) length of stay. Methods: This was a single-center retrospective cohort study conducted at The University of Tennessee Medical Center in Knoxville, Tennessee. Patients included in this study were adults 18 years of age and older with a diagnosis of septic shock who received norepinephrine in combination with vasopressin. Patients were excluded if norepinephrine or vasopressin were not the last 2 vasoactive agents used or if the patient expired or care was withdrawn. Measurements and Main Results: A total of 86 patients were included in this study, with 34 patients in the norepinephrine discontinued first group (NDF) and 52 in the vasopressin discontinued first group (VDF). For the primary outcome of ICU length of stay, no statistically significant difference was found between the NDF and the VDF groups (9.38 days vs 11.07 days, P = .313). The secondary outcome of the dose of norepinephrine at which vasopressin was initiated was also found to not be significant between the NDF and VDF groups (22 µg/min vs 31.1 µg/min, P = .11). The rates of hypotension within 24 hours of discontinuation of the first agent were also not significant between the NDF and VDF groups (17% vs 31%, P = .38). Conclusions: Based on the results of this study, there was significant no difference in ICU length of stay based on the sequence of discontinuation between norepinephrine and vasopressin in patients recovering from septic shock.

Medical Students’ Commitment during the SARS-CoV-2 Pandemic: Preparedness, Motivation, and Impact on Students’ Skills

2020 ◽  
Author(s):  
Lukas Müller ◽  
Markus Heymanns ◽  
Laura Harder ◽  
Julia Winter ◽  
Stephan Gehring ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Students ◽  
Medical School ◽  
Medical Curriculum ◽  
Medical Center ◽  
Care Staff ◽  
Health Care Staff ◽  
Web Based ◽  
The University ◽  
The Impact

Abstract Background: During the SARS-CoV-2 pandemic, many authors have suggested a commitment of medical students to support overworked health care staff. However, whether the students are prepared for such an occupation remains unclear. Therefore, the aim of this study was to evaluate medical students’ preparedness for a commitment in the pandemic and to assess the impact on their skills and attitudes.Methods: In April 2020, the CoronaPreventMainz (CPM) study was initiated to test 3300 employees with direct patient contact at the University Medical Center Mainz. To accomplish the huge logistic effort, medical students were recruited as support staff.Using a web-based questionnaire, the participating students were asked 27 questions covering six different topics.Results: Of the 75 recruited students, 63 (84.0%) participated in this survey. The median age was 24 years, and 66.6% (n = 42) were female. The vast majority agreed that students should be used as voluntary helpers during this crisis (87.3%) and had the feeling of contributing in the fight against the pandemic (90.5%). Most of the students (80.6%) even reported an improvement in their practical skills. Fear of self-infection was low (7.9%), and overextending situations occurred for just 3.2%. However, less than one-fifth (19.4%) of the students felt prepared for the SARS-CoV-2 pandemic by medical school, and two-thirds (67.7%) demanded special preparation. Conclusion: Through their commitment, the medical students felt that they were taking part in the fight against the pandemic. However, only a few felt well-prepared by medical school and the students’ need for special preparation courses is huge. Therefore, single-center initiatives can only be the beginning. Dedicated courses on how to support health care staff in natural disasters should be integrated into the medical curriculum to better prepare medical students for the next crisis.

Abstract TP265: Far-Forward Stroke Care: Parallel Processing in the Prehospital Environment May Achieve Door-to-Needle Times of Less Than 15 Minutes on a Mobile Stroke Treatment Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher Zammit ◽  
Sarah Gallagher ◽  
Jason Burgett ◽  
Christopher Grassman ◽  
Joshua L'Esperance ◽  
...  
Keyword(s):  
Medical Center ◽  
Stroke Care ◽  
Patient Centered ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
Forward Stroke ◽  
Imaging Results ◽  
Iphone Application ◽  
The University ◽  
The City

Introduction: The time from 911 activation (i.e. alarm) to administration of intravenous (IV) alteplase in acute ischemic stroke is associated with functional, patient centered-outcomes. Mobile stroke treatment units (MSTUs) have emerged as a stroke system tool that may hasten treatment times. Optimal workflows on MSTUs remain to fully elucidated. Methods: Retrospective review of a QA database of patients treated on a MSTU with door-to-needle-times (DTN) of </= 15 minutes to describe workflows and team dynamics that were associated with expeditious treatment. Results: In October of 2018 the University of Rochester Medical Center launched a MSTU, initially operating on Monday through Friday in the city of Rochester from 8am until 4 pm. Over the initial 3 months, there were 96 MSTU responses leading to 54 transported patients, 3 of which were treated with IV alteplase. One patient with an initial NIHSS of 17 was treated with IV alteplase within 9 minutes of reaching the MSTU door. Workflow elements felt to hasten treatment included registration of the patient in the electronic health record (EHR) prior to the patient reaching the MSTU and enabling the telestroke provider to listen to the initial history and physical being performed by the MSTU RN at the scene. The later is accomplished by using a telestroke iPhone application that allows for a “3-way-call” between the MSTU RN, the MSTU, and the telestroke provider. The MSTU RN wears a Bluetooth earpiece that captures the conversation with the patient, witnesses on scene, and initial EMS responders and enables the MSTU RN to summarizes key history and exam findings, vitals, and blood glucose results while keeping their hands available for patient care. Simultaneously, the telestroke provider reviews the patient’s chart in the EHR for alteplase contraindications, prior imaging results, and pertinent medical history. Conclusion: Registering the patient in the EHR and integrating the telestroke provider into the initial patient assessment at the scene in the prehospital setting may allow for consistent door to needle times of < 15 minutes on MSTUs, which may further improve patient outcomes.

scholarly journals Adopting the Quadruple Aim: The University of Rochester Medical Center Experience

2018 ◽  
Vol 131 (8) ◽  
pp. 979-986 ◽  
Author(s):  
Allen P. Anandarajah ◽  
Timothy E. Quill ◽  
Michael R. Privitera
Keyword(s):  
Medical Center ◽  
Quadruple Aim ◽  
Rochester Medical ◽  
The University
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