scholarly journals The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era

2005 ◽  
Vol 46 (5) ◽  
pp. 431-439 ◽  
Author(s):  
James A. Bourgeois ◽  
William S. Kremen ◽  
Mark E. Servis ◽  
Jacob A. Wegelin ◽  
Robert E. Hales
Keyword(s):  
Managed Care ◽  
Length Of Stay ◽  
Psychiatric Diagnosis ◽  
Medical Center ◽  
The Impact

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if norepinephrine or vasopressin were not the last 2 vasoactive agents used or if the patient expired or care was withdrawn.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.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 35 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Jason M. Pogue ◽  
Ryan P. Mynatt ◽  
Dror Marchaim ◽  
Jing J. Zhao ◽  
Viktorija O. Barr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Intervention Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Objective.To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.Design.Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.Setting.Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.Patients.All patients with monomicrobial gram-negative bacteremia during the study period.Intervention.Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).Results.Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).Conclusions.Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

The Changing Health Care Environment: Implications for Residency Training

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_3) ◽  
pp. 795-804 ◽  
Author(s):  
Seth Frazier ◽  
Daniel Hyman ◽  
Steven Altschuler
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Delivery System ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Pediatric Care ◽  
Health Care Environment ◽  
The Impact

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

scholarly journals Impact of Targeted Educational Interventions on Clostridium difficile Infection Treatment in Critically Ill Adults

2016 ◽  
Vol 51 (11) ◽  
pp. 901-906 ◽  
Author(s):  
Drayton A. Hammond ◽  
Catherine A. Hughes ◽  
Jacob T. Painter ◽  
Rose E. Pennick ◽  
Kshitij Chatterjee ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Care Providers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Strategy ◽  
Educational Interventions ◽  
Hospital Length Of Stay ◽  
Care Providers ◽  
The Impact ◽  
Post Period

Background Clostridium diffcile infection (CDI) is a growing clinical and economic burden throughout the world. Pharmacists often are members of the primary care team in the intensive care unit (ICU) setting; however, the impact of pharmacists educating other health care providers on appropriateness of CDI treatment has not been previously examined. Objective This study was performed to determine the impact of structured educational interventions on CDI treatment on appropriateness of CDI treatment and clinical outcomes. Methods This was a single-center, retrospective, cohort study of patients with CDI in the medical ICU at an academic medical center between January and June 2014 (pre-period) and 2015 (post-period). All patients were evaluated for appropriate CDI treatment before and after implementing pharmacist-provided educational interventions on CDI treatment. Results Patients in the post-period were prescribed appropriate CDI treatment more frequently than patients in the pre-period (91.7% vs 41.7%; p = .03) and received fewer inappropriate doses of a CDI treatment agent (14 doses vs 30 doses). Patients in the pre-period had a shorter ICU length of stay [1.5 days (range, 1–19) vs 3.5 days (range, 2–36); p = .01] and a similar hospital length of stay [9.5 days (range, 4–24) vs 11.5 days (range, 3–56); p = .30]. Total time spent providing interventions was 4 hours. Conclusion Patients had appropriate CDI treatment initiated more frequently in the post-period. This low-cost intervention strategy should be easy to implement in institutions where pharmacists interact with physicians during clinical rounds and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

scholarly journals 1549. Impact of New Fluoroquinolone Breakpoints on Enterobacteriaceae Susceptibility Rates and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S565-S565
Author(s):  
Natasha N Pettit ◽  
Cynthia T Nguyen ◽  
Jennifer Pisano ◽  
Angella Charnot-Katsikas
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Single Center ◽  
Blood Isolate ◽  
Single Center Study ◽  
Potential Impact ◽  
Poor Outcomes ◽  
The Impact ◽  
Center Study

Abstract Background In January 2019, the Clinical and Laboratory Standards Institute (CLSI) lowered the Fluoroquinolone (FQ) susceptibility breakpoints for Enterobacteriaceae. The new breakpoints were updated primarily based on FQ pharmacodynamics, and only limited clinical data. We sought to evaluate clinical outcomes among patients who received an FQ for infection with Enterobacteriaceae with MIC values that would now be considered resistant, using the new interpretive criteria. We also assessed the potential impact of the new breakpoints on overall blood and urine Enterobacteriaceae susceptibility rates at our medical center. Methods All positive blood and urine cultures with Enterobacteriaceae between September 1, 2018 and February 28, 2019 were included. Enterobacteriaceae isolates with ciprofloxacin MICs of 0.5 and 1 µg/mL (based on new breakpoints, now considered non-susceptible) were identified. We assessed the length of stay (LOS), mortality, and 30-day readmissions among patients who received an FQ for treatment. The impact of the new breakpoints on overall Enterobacteriaceae susceptibilities from urine and blood isolates was also determined. Results A total of 1,761 cultures (191 blood, 1,570 urine) grew Enterobacteriaceae. One-hundred and twenty-five (7%) cultures grew isolates with a ciprofloxacin MIC of 0.5 or 1 µg/mL. Eighteen patients with Enterobacteriaceae isolated (4 blood, 14 urine) received an FQ. Among these patients, the median LOS was 4 days; one patient was readmitted within 30 days, and 0% mortality was observed. The patient readmitted within 30 days received an FQ for a blood isolate with MIC 0.5. Overall, with the revised breakpoints, we observed a 4.2% decrease in the number of Enterobacteriaceae that would be susceptible to ciprofloxacin (Figure 1). Conclusion The new FQ breakpoints for Enterobacteriaceae will have a marginal impact on overall FQ susceptibility rates at our medical center. In this single-center study, patients that received FQ antibiotics for Enterobacteriaceae with MIC values now considered intermediate or resistant did not appear to experience poor outcomes. Disclosures All authors: No reported disclosures.

Impact of Nosocomial Infection on Cost of Illness and Length of Stay in Intensive Care Units

2005 ◽  
Vol 26 (3) ◽  
pp. 281-287 ◽  
Author(s):  
Yin-Yin Chen ◽  
Yi-Chang Chou ◽  
Pesus Chou
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Intensive Care Units ◽  
Cost Of Illness ◽  
Nosocomial Infections ◽  
Medical Center ◽  
Tertiary Care ◽  
The Cost ◽  
The Impact

AbstractObjective:Economic evaluation has become increasingly important in healthcare and infection control. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs).Design:A retrospective cohort study.Setting:Medical, surgical, and mixed medical and surgical ICUs in a tertiary-care referral medical center.Patients:Patients admitted to adult ICUs between October 2001 and June 2002 were eligible for the study.Methods:Estimates of the cost and LOS for patients who acquired a nosocomial infection were computed using a stratified analysis and regression approach.Results:During the study period, 778 patients were admitted to the ICUs. Total costs for patients with and without nosocomial infections (median cost, $10,354 and $3,985, respectively) were significantly different (P < .05). The costs stratified by infection site (median differences from $4,687 to $7,365) and primary diagnosis (median differences from $5,585 to $16,507) were also significantly different (P < .05) except for surgical-site infection. After covariates were adjusted for in the multiple linear regression, nosocomial infection increased the total costs by $3,306 per patient and increased the LOS by 18.2 days per patient (P < .001). Each additional day spent in the ICU increased the cost per patient by $353 (P < .001).Conclusions:Nosocomial infections are associated with increased cost of illness and LOS. Prevention of nosocomial infections should reduce direct costs and decrease the LOS.

scholarly journals 391. Small Towns, Big Cities: Rural and Urban Disparities Among Hospitalized Patients with COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S297-S298
Author(s):  
Caroline Hamilton ◽  
Deepak Nag Ayyala ◽  
David Walsh ◽  
Christian-Jevon Bramwell ◽  
Christopher Walker ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Census Data ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Level Of Care ◽  
P Value ◽  
Rural And Urban ◽  
The Impact

Abstract Background More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals; however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Baseline Characteristics of Hospitalized Patients with COVID-19 Day 30 Outcomes and Characteristics Level of Care at Time of Admission Conclusion This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes. Disclosures All Authors: No reported disclosures

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