Abstract P829: Bi-Directional Quality Review in a Large Telestroke Network: Improving Stroke Care Through Mutual Learning

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jennifer J Majersik ◽  
Erin Ekstrom ◽  
Jaleen R Johnson ◽  
Heather Wicks ◽  
Chona Dart ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Standard Of Care ◽  
Stroke Care ◽  
Case Review ◽  
Hub And Spoke ◽  
Quality Review ◽  
Sentinel Events ◽  
The Individual ◽  
Multiple Health ◽  
Individual Hospital

Introduction: Our hub and spoke telestroke (TS) network consists of 26 sites across 6 states, with >1000 consults/year. Without a shared EMR, patient outcomes are often unknown. We aimed to improve communication of patient outcomes and patient care by implementing multi-disciplinary quality review across multiple health systems. Methods: To determine interest in and format of the review, we first conducted interviews with coordinators from 3 highly engaged sites of varying sizes and capabilities. We had strong consensus that a bi-directional quality review would be helpful and that group-based discussion was preferred over single site review. Coordinators chose review flags of long process metrics, missed treatments, thrombectomies, complications, and mortalities with sentinel events reviewed immediately, off-cycle. A case review sheet is uploaded to HIPAA-compliant Box drive and neuroimaging to PACS. Hub and spoke present cases over Zoom using standard SOAR format: Situation, Outcome, Assessment, Recommendation. The group grades each case as standard of care (SOC) met, exceeded, or not met, +/- opportunities for improvement (OFI). Discussion includes recommendations to the individual hospital or network. Results: From 4/2019-7/2020, we conducted 8 bi-directional case reviews of 21 TS cases with 9 spokes (mean 4.3 spokes/review, range 2-6). Of 47 spoke participants, 43% were stroke coordinators, 34% were ED managers, with rare hospitalists present. Hub participants were 8 vascular neurologists/fellows and 3 TS coordinators/managers. Case content was 33% recognition, 49% acute treatment, and 19% disposition. SOC was rated as met or exceeded in 86% of cases with OFI noted in 100%. The Table details discussion themes. Conclusion: A bi-directional quality review can share knowledge and best practices across a large TS network, improving inter-facility communication and site engagement. We hope next to increase physician attendance and engage more sites.

Abstract TP252: Using Hospital Door-to-Needle Times to Individualize Hospital Bypass Times in Order to Minimize Regional Onset-to-Needle Times

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jin-Moo Lee ◽  
Andria Ford ◽  
Jo-Ann Burns ◽  
Peter Panagos
Keyword(s):  
Patient Outcomes ◽  
Treatment Options ◽  
Stroke Care ◽  
Smartphone Application ◽  
System Level ◽  
Acute Stroke Care ◽  
Web Based ◽  
Arrival Times ◽  
Get With The Guidelines ◽  
Individual Hospital

Introduction: With enhanced treatment options but limited resources, acute stroke care is becoming regionalized. Regional pre-hospital triage plans are being developed to permit bypass of certain hospitals in order to deliver patients to hospitals with higher-level resources for advanced treatment options. One of the most contentious issues in these plans is the “bypass time”_time allowed for EMS to bypass one hospital in order to transport to a hospital with presumed higher level stroke care. Hypothesis: Incorporating transport times and individual hospital door-to-needle times (DNTs) into regional pre-hospital triage bypass plans will expedite regional treatment times which may lead to improved patient outcomes at the system level. Methods: To minimize onset-to-needle times (ONTs), it is essential not only to find the fastest route to the nearest capable hospital, but to find the nearest capable hospital with the shortest DNTs. We examined specific time components comprising ONT, including Onset-to-Arrival times (OATs) and DNTs using Get-with-the-Guidelines data (GWTG), comparing the hospital with fastest DTN times (Hospital A) with that of the average in the St. Louis metropolitan area. Results: Hospital A had a mean DNT that was 20 min faster than the average St. Louis DNT (31 min vs. 51 min, p<.0.001), while OATs were not different. This 20 min advantage might be translated into a longer bypass time specifically for hospital A, to provide equivalent or faster ONTs for patients in the region. Conclusion: The incorporation of hospital DNTs into regional pre-hospital triage plans can individualize bypass times for each hospital. This practice may accelerate treatment times throughout a region, and could be trialed with the aid of web-based smartphone application that could provide EMS with important information that could minimize both transport times and DNTs.

scholarly journals Influence of trends in hospital volume over time on patient outcomes for high-risk surgery

2020 ◽  
Author(s):  
Cécile Payet ◽  
Stéphanie Polazzi ◽  
Jean-Christophe Lifante ◽  
Eddy Cotte ◽  
Daniel Grinberg ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Learning Effect ◽  
Real World Data ◽  
Hazard Ratios ◽  
Procedure Volume ◽  
The Individual ◽  
Individual Hospital ◽  
Over Time

Abstract Background The “practice makes perfect” concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods We included all patients who underwent one of ten digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. Results Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). Conclusions Trend in hospital volume over time does not appear to influence patient outcomes based on real-world data.

In silico modeling of cellular probabilistic nanoparticle radiosensitization in head and neck cancers

Nanomedicine ◽  
2020 ◽  
Vol 15 (29) ◽  
pp. 2837-2850
Author(s):  
Myxuan Huynh ◽  
Ivan Kempson ◽  
Eva Bezak ◽  
Wendy Phillips
Keyword(s):  
Head And Neck ◽  
Patient Outcomes ◽  
Head And Neck Cancers ◽  
New Approach ◽  
Treatment Regimens ◽  
Therapeutic Benefits ◽  
In Silico Modeling ◽  
The Individual ◽  
Dose Deposition ◽  
Therapy Treatment

Background: The use of gold nanoparticles (AuNPs) as radiosensitizers may offer a new approach in the treatment of head and neck cancers; minimizing treatment-associated toxicities and improving patient outcomes. AuNPs promote localized dose deposition; permitting improved local control and/or dose reduction. Aim: This work aimed to address the theoretical optimization of radiation doses, fractionation and nanoparticle injection schedules to maximize therapeutic benefits. Materials & methods: Probabilistic nanoparticle sensitization factors were incorporated into the individual cell-based HYP-RT computer model of tumor growth and radiotherapy. Results: Total dose outcomes across all radiation therapy treatment regimens were found to be significantly reduced with the presence of AuNPs, with bi-weekly injections showing the most decrease. Conclusion: Outcomes suggest the need for regular AuNP administration to permit effective radiosensitization.

scholarly journals 179 Evaluating a Clinical Pharmacist Service in a Residential Care Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Claire Kavanagh ◽  
Eimear O'Dwyer ◽  
Róisín Purcell ◽  
Niamh McMahon ◽  
Morgan Crowe ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Patient Outcomes ◽  
Residential Care ◽  
Clinical Pharmacist ◽  
Comparative Evaluation ◽  
Positive Impact ◽  
Standard Of Care ◽  
Pharmacist Interventions ◽  
Medication Reviews

Abstract Background This study assessed the pharmacist role in an 80 bed residential care unit by: Quantifying the number and type of pharmacist interventions made and their acceptance rate.Assessing impact of pharmacist interventions on patient care.Assessing staff attitudes towards the clinical pharmacist service. Methods This was a non-blinded, non-comparative evaluation of the existing clinical pharmacist service in the unit. All residents were included. All pharmacist interventions over a 10-week period were recorded, then graded according to the Eadon scale1 by a consultant gerontologist and an experienced pharmacist to assess their impact on patient care. Results There were 615 pharmacist interventions. The most common interventions were: Drug Therapy Review, 34% (n=209) Technical Prescription, 26.5% (n=163) Administration, 15.3% (n=94) Drug Interaction, 10.4% (n=64) Medication Reconciliation, 8.5% (n=52) 98% (n=596) of interventions were rated as having significance to patient care, of which: 48.4% (n=298) and 41.8% (n=257) of the interventions rated as ‘significant and resulting in an improvement in the standard of care’1% (n=6) and 0.5% (n=3) rated as ‘very significant and preventing harm’. There was a statistically significant agreement between the evaluators, κw = 0.231 (95% CI, 0.156 to 0.307), p < .0005. The strength of agreement was fair. Of interventions requiring acceptance by medical team (n=335), 89.9% (n=301) were accepted. 95% (n=36) of staff who responded agreed or strongly agreed that improved patient safety resulted from the pharmacist’s involvement in multidisciplinary medication reviews. Over 92% (n=35) agreed or strongly agreed that their experience of the pharmacist was positive. Conclusion The pharmacist has an important role in our residential care unit. Their involvement in the medicines optimisation process positively impacts patient outcomes and prevents harm. Staff perceived a positive impact of the clinical pharmacist service provided on patient care and patient safety.

scholarly journals Ensovibep, a novel trispecific DARPin candidate that protects against SARS-CoV-2 variants

2021 ◽  
Author(s):  
Michael Stumpp
Keyword(s):  
Single Agent ◽  
Standard Of Care ◽  
Cooperative Binding ◽  
Wild Type ◽  
Inhibitory Potency ◽  
Alpha Variant ◽  
The Individual ◽  
Very High ◽  
Comprehensive Study

Abstract SARS-CoV-2 has infected millions of people globally and continues to undergo evolution. Emerging variants can be partially resistant to vaccine induced and therapeutic antibodies, emphasizing the urgent need for accessible, broad-spectrum therapeutics. Here, we report a comprehensive study of ensovibep, the first trispecific clinical DARPin candidate, that can simultaneously engage all three units of the spike protein trimer to potently inhibit ACE2 interaction, as revealed by structural analyses. The cooperative binding of the individual modules enables ensovibep to retain inhibitory potency against all frequent SARS-CoV-2 variants, including Omicron, as of December 2021. Moreover, viral passaging experiments show that ensovibep, when used as a single agent, can prevent development of escape mutations comparably to a cocktail of monoclonal antibodies (mAb). Finally, we demonstrate that the very high in vitro antiviral potency also translates into significant therapeutic protection and reduction of pathogenesis in Roborovski dwarf hamsters infected with either the SARS-CoV-2 wild-type or the Alpha variant. In this model, ensovibep prevents fatality and provides substantial protection equivalent to the standard of care mAb cocktail. These results support further clinical evaluation and indicate that ensovibep could be a valuable alternative to mAb cocktails and other treatments for COVID-19.

Stroke Care Using a Hub and Spoke Model with Telemedicine

2014 ◽  
Vol 26 (4) ◽  
pp. 469-475 ◽  
Author(s):  
Penny Huddleston ◽  
Mary Beth Zimmermann
Keyword(s):  
Stroke Care ◽  
Hub And Spoke

scholarly journals Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

2016 ◽  
Vol 44 (1) ◽  
pp. 194-204 ◽  
Author(s):  
Gary E. Marchant ◽  
Kathryn Scheckel ◽  
Doug Campos-Outcalt
Keyword(s):  
Precision Medicine ◽  
New Technologies ◽  
Clinical Care ◽  
Large Body ◽  
Standard Of Care ◽  
Genetic Profile ◽  
Legal Standards ◽  
Standards Of Evidence ◽  
The Individual

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed.

Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Carol J Parker ◽  
Mathew J Reeves
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Base ◽  
Quality Metrics ◽  
Care Quality ◽  
Stroke Recurrence ◽  
The Impact ◽  
The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

Abstract TP303: Real-world Eligibility for Revascularization in Acute Stroke: A 12 Year Single Center Statistics

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Peter Vanacker ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Patrik Michel
Keyword(s):  
Time Windows ◽  
Standard Of Care ◽  
Stroke Care ◽  
Regional Level ◽  
Effective Number ◽  
Single Center ◽  
Resource Needs ◽  
Liberal Approach ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Aims: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is the new standard of care for well selected, large vessel occlusive strokes. Hypothesis: We aimed to determine the frequency of patients potentially eligible for IV thrombolysis (IVT) and EVT based on the latest AHA/ASA guidelines. Methods: Data from a prespecified consecutive AIS registry (ASTRAL, 2003-2014) of a single comprehensive stroke center were examined. All AIS admitted <24hours and sufficient data to determine EVT-eligibility according to AHA/ASA guidelines (class I and IIa recommendations) on IVT and EVT were selected. Another set of more liberal criteria from different EVT trials and clinical practice was also tested. Time windows for EVT-eligibility was 4.5h (allowing for a door-to-groin delay ≤90min) and for IVT 3.5h (door-to-needle delay ≤60min). Results: A total of 2’704 AIS were included, of whom 26.8% were secondary transferrals. Proportion of IVT-eligible patients was 12.4% for all AIS, and 24.6% and 36.2% for patient arriving <24h and 6h respectively. Frequency of EVT-eligibility differed between the AHA/ASA guideline and the more liberal approach: 2.9% vs. 4.9% of all AIS and 10.5% vs. 17.7% of all patients arriving <6hours. These numbers are in line with the effective number of EVT applied in 2013 (15%) and 2014 (12%). Conclusions: Of patients arriving within 6h at a comprehensive stroke center, 10.5% are EVT eligible according to AHA/ASA criteria, nearly double (17.7%) with more liberal criteria, and again double for IV thrombolysis (36.2%). These figures may be useful for planning resource needs of stroke care on a regional level.

Unexpected serious aplastic anemia from PD-1 inhibitors: beyond what we know

2019 ◽  
Vol 105 (6) ◽  
pp. NP48-NP51 ◽  
Author(s):  
Marco Filetti ◽  
Raffaele Giusti ◽  
Arianna Di Napoli ◽  
Daniela Iacono ◽  
Paolo Marchetti
Keyword(s):  
Aplastic Anemia ◽  
Patient Outcomes ◽  
Case Reports ◽  
Stage Iv ◽  
Standard Of Care ◽  
Real World Data ◽  
Case Presentation ◽  
Lung Cancers ◽  
Insight Into ◽  
Made In

Introduction: The recent introduction of checkpoint inhibitor–based immunotherapy has revolutionized the treatment of advanced lung cancers, becoming standard of care in both first- and second-line treatment. New types of toxicity are emerging with the increasingly widespread use of these inhibitors. Case presentation: We describe a case of aplastic anemia in a patient with stage IV non-small cell lung cancer after a single administration of nivolumab. Conclusions: Several similar case reports reported in literature show an increasing rate of toxicities from immunotherapy in this setting. These real-world data provide an insight into patient outcomes and treatment decisions being made in clinical practice.

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