Assessment of Tracheostomy and Laryngectomy Knowledge among Non-Otolaryngology Physicians

Objective: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits. Methods: Study Design: Cross-sectional assessment. Setting: Academic medical center. Subjects and Methods: An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis. Results: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% ( P < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% ( P < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% ( P < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment. Discussion: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months. Conclusions: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.

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Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.578 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s84-s84

Author(s):

Lorinda Sheeler ◽

Mary Kukla ◽

Oluchi Abosi ◽

Holly Meacham ◽

Stephanie Holley ◽

...

Keyword(s):

Screening Tool ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

The United States ◽

World Health ◽

Communication Campaign ◽

Electronic Screening ◽

Novel Coronavirus ◽

The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

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Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz018 ◽

2019 ◽

Vol 6 (2) ◽

Cited By ~ 8

Author(s):

Sophia Jung ◽

Mary Elizabeth Sexton ◽

Sallie Owens ◽

Nathan Spell ◽

Scott Fridkin

Keyword(s):

Antibiotic Prescription ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Clinic ◽

Multivariable Logistic Regression Analysis ◽

Comorbid Condition ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Care Clinic ◽

The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

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Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.356 ◽

2019 ◽

Vol 40 (3) ◽

pp. 281-286 ◽

Cited By ~ 11

Author(s):

Satish Munigala ◽

Rebecca Rojek ◽

Helen Wood ◽

Melanie L. Yarbrough ◽

Ronald R. Jackups ◽

...

Keyword(s):

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Temporal Trends ◽

Interrupted Time Series ◽

Vital Role ◽

Order Sets ◽

Urine Testing ◽

The Impact

AbstractObjective:To evaluate the impact of changes to urine testing orderables in computerized physician order entry (CPOE) system on urine culturing practices.Design:Retrospective before-and-after study.Setting:A 1,250-bed academic tertiary-care referral center.Patients:Hospitalized adults who had ≥1 urine culture performed during their stay.Intervention:The intervention (implemented in April 2017) consisted of notifications to providers, changes to order sets, and inclusion of the new urine culture reflex tests in commonly used order sets. We compared the urine culture rates before the intervention (January 2015 to April 2016) and after the intervention (May 2016 to August 2017), adjusting for temporal trends.Results:During the study period, 18,954 inpatients (median age, 62 years; 68.8% white and 52.3% female) had 24,569 urine cultures ordered. Overall, 6,662 urine cultures (27%) were positive. The urine culturing rate decreased significantly in the postintervention period for any specimen type (38.1 per 1,000 patient days preintervention vs 20.9 per 1,000 patient days postintervention; P < .001), clean catch (30.0 vs 18.7; P < .001) and catheterized urine (7.8 vs 1.9; P < .001). Using an interrupted time series model, urine culture rates decreased for all specimen types (P < .05).Conclusions:Our intervention of changes to order sets and inclusion of the new urine culture reflex tests resulted in a 45% reduction in the urine cultures ordered. CPOE system format plays a vital role in reducing the burden of unnecessary urine cultures and should be implemented in combination with other efforts.

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The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116689547 ◽

2017 ◽

Vol 35 (2) ◽

pp. 189-197 ◽

Cited By ~ 7

Author(s):

Elise C. Carey ◽

Ann M. Dose ◽

Katherine M. Humeniuk ◽

Yichen C. Kuan ◽

Ashley D. Hicks ◽

...

Keyword(s):

Medical Center ◽

Care Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Cost Effective ◽

Hospital Death ◽

Personal Care ◽

Predominately White ◽

Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

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Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study

Journal of Opioid Management ◽

10.5055/jom.2018.0464 ◽

2018 ◽

Vol 14 (5) ◽

pp. 317-326

Author(s):

Julianna Fernandez, PharmD, BCPS, CGP ◽

James Douglas Thornton, PhD, PharmD, BCPS ◽

Sanika Rege, MS ◽

Benjamin Lewing, MS ◽

Shweta Bapat, BPharm ◽

...

Keyword(s):

Pain Management ◽

Focus Groups ◽

Geriatric Patients ◽

Medical Center ◽

Academic Medical Center ◽

Monitoring Program ◽

Prescribing Patterns ◽

Cross Sectional ◽

Term Care ◽

The Impact

Objective: To qualitatively assess prescribers’ perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings.Design: This was a cross-sectional study.Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016.Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling.Main outcome measures: Prescribers’ perceptions regarding hydrocodone rescheduling.Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred.Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians’ hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients’ satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.

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Hyperparathyroidism in Patients with Primary Aldosteronism: Cross-Sectional and Interventional Data from the GECOH Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-2183 ◽

2012 ◽

Vol 97 (1) ◽

pp. E75-E79 ◽

Cited By ~ 64

Author(s):

Stefan Pilz ◽

Katharina Kienreich ◽

Christiane Drechsler ◽

Eberhard Ritz ◽

Astrid Fahrleitner-Pammer ◽

...

Keyword(s):

Primary Aldosteronism ◽

Mineralocorticoid Receptor ◽

Care Center ◽

Tertiary Care ◽

Experimental Studies ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Vitamin D Metabolism ◽

Cross Sectional ◽

The Impact

Context: Experimental studies suggest that aldosterone induces hypercalciuria and might contribute to hyperparathyroidism. Objective: We aimed to test for differences in PTH levels and parameters of calcium and vitamin D metabolism in patients with primary aldosteronism (PA) compared with patients with essential hypertension (EH) and to evaluate the impact of PA treatment on these laboratory values. Design, Setting, and Participants: The Graz Endocrine Causes of Hypertension study includes hypertensive patients referred for screening for endocrine hypertension at a tertiary care center in Graz, Austria. Main Outcome Measures: Differences in PTH levels between patients with PA and EH. Results: Among 192 patients, we identified 10 patients with PA and 182 with EH. PTH levels (mean ± sd in picograms per milliliter) were significantly higher in PA patients compared with EH (67.8 ± 26.9 vs. 46.5 ± 20.9; P = 0.002). After treatment of PA with either adrenal surgery (n = 5) or mineralocorticoid receptor antagonists (n = 5), PTH concentrations decreased to 43.9 ± 14.9 (P = 0.023). Serum 25-hydroxyvitamin D concentrations were similar in both groups. Compared with EH, serum calcium concentrations were significantly lower (2.35 ± 0.10 vs. 2.26 ± 0.10 mmol/liter; P = 0.013), and there was a nonsignificant trend toward an increased spot urine calcium to creatinine ratio in PA [median (interquartile range) 0.19 (0.11–0.31) vs. 0.33 (0.12–0.53); P = 0.094]. Conclusions: Our results suggest that PA contributes to secondary hyperparathyroidism. Further studies are warranted to evaluate whether PTH has implications for PA diagnostics and whether mineralocorticoid receptor antagonists have a general impact on PTH and calcium metabolism.

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Utilization and Diagnostic Yield of Neurogenetic Testing at a Tertiary Care Facility

Clinical Chemistry ◽

10.1373/clinchem.2006.083360 ◽

2007 ◽

Vol 53 (6) ◽

pp. 1016-1022 ◽

Cited By ~ 8

Author(s):

Kerstin L Edlefsen ◽

Jonathan F Tait ◽

Mark H Wener ◽

Michael Astion

Keyword(s):

Positive Result ◽

Diagnostic Yield ◽

Medical Center ◽

Care Center ◽

Academic Medical Center ◽

Molecular Genetic ◽

Tertiary Care ◽

Care Facility ◽

Utilization Review ◽

Tertiary Care Facility

Abstract Background: Institutions face increasing charges related to molecular genetic testing for neurological diseases. The literature contains little information on the utilization and performance of these tests. Methods: A retrospective utilization review was performed to determine the diagnostic yield of neurogenetic tests ordered during calendar year 2005 at a large academic medical center in the western United States. Results: Overall, a relevant mutation was identified in 30.2% of the 162 patients tested and in 21.5% of the 121 probands, defined as patients for whom no mutation has been previously identified in a family member. Patients with muscle weakness (n = 65) had a mutation detected in 26.2% of all patients and 23.5% of probands (n = 51), with an estimated testing cost per positive result of $3190. Patients tested for neuropathy (n = 36) had a mutation detected in 27.8% of patients and 22.6% of probands (n = 31), with an estimated cost per positive result of $5955. Patients with chorea (n = 25) had a positive result obtained in 68% of patients and 71.4% of probands (n = 7); the estimated cost per positive test was $440. Other diagnostic categories evaluated include ataxias (n = 18; yield, 11.1%; $7620 per positive), familial stroke or dementia syndromes (n = 8; yield, 12.5%; $6760 per positive), and multisystem mitochondrial disorders (n = 10; yield, 20%; $6485 per positive). Conclusions: Expert clinicians at a tertiary care center who ordered neurogenetic tests obtained a positive result in 21.5% of patients without previously identified familial mutations. These results can be used for comparison and to help establish utilization guidelines for neurogenetic testing.

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Riots in Beirut: Description of the Impact of a New Type of Mass Casualty Event on the Emergency System in Lebanon

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.162 ◽

2019 ◽

Vol 13 (5-6) ◽

pp. 849-852

Author(s):

Mohamad El Warea ◽

Roula Sasso ◽

Rana Bachir ◽

Mazen El Sayed

Keyword(s):

Emergency Department ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Patient Characteristics ◽

Mass Casualty ◽

Control Measures ◽

Body Region ◽

Mass Casualty Event ◽

The Impact

ABSTRACTIntroduction:In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country.Methods:A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed.Results:Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival.Conclusions:Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.

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Effect of Female and Male Body Mass index on Cumulative Live Birth Rates in the Freeze-all Strategy

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab858 ◽

2021 ◽

Author(s):

Xi Shen ◽

Yating Xie ◽

Di Chen ◽

Wenya Guo ◽

Gang Feng ◽

...

Keyword(s):

Live Birth ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Live Birth Rate ◽

Male Body ◽

Cumulative Live Birth Rate ◽

Cumulative Live Birth ◽

The Impact ◽

High Bmi

Abstract Context The impact of parental overweight/obese on cumulative live birth rate in IVF/ICSI using a freeze-all strategy is still unknown. Objective To explore the effect of parental BMI on CLBR in a freeze-all strategy over 1.5 years. Design A retrospective study. Setting Tertiary-care academic medical center Patients or Other Participants 23482 patients (35289 FET cycles) were divided into four groups according to Asian BMI classification. Intervention(s) None. Main Outcome Measure(s) CLBR. Results Female overweight/obesity had the lower tendency in CLBR (groups1-4: optimistic: 69.4%, 67.9%, 62.3%, and 65.7%; conservative: 62.9%, 61.1%, 55.4%, and 57.6%) and the prolonged time (groups 1-4: 11.0, 12.2, 15.9, and 13.8 months for 60% CLBR in optimistic method; 8.7, 9.5, 11.7, 11.0 months for 50% CLBR in conservative method). The same trend with less extent was also observed in male BMI groups. When combining parental BMI, “parental overweight/obesity” had lower CLBR and longer time for reaching CLBR>50% (optimistic: 4.5 months for 60% CLBR; conservative: 3 months for 50% CLBR), the next was “only female high BMI” (optimistic: 2.1 months for 60% CLBR; conservative: 1.7 months for 50% CLBR), while “only male high BMI” couldn’t influence these. Conclusions Our results firstly showed that the priorities of parental BMI, female BMI and male BMI on affecting the 1.5-year CLBR in freeze-all strategy, and the postponed time to reach up the certain CLBR (60% in optimistic, 50% in conservative) for overweight and obese patients was only several months, not so uncertain and long as losing weight.

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Identifying Disincentives to Ethics Consultation Requests Among Physicians, Advance Practice Providers, and Nurses

10.21203/rs.3.rs-78189/v1 ◽

2020 ◽

Author(s):

Lynette Carol Cederquist ◽

Jamie LaBuzetta ◽

Edward Cachay ◽

Lawrence Friedman ◽

Cassia Yi ◽

...

Keyword(s):

Online Survey ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Ethics Consultation ◽

Consult Service ◽

Consultation Process ◽

Cross Sectional ◽

Improvement Project ◽

Academic Medical

Abstract Background: Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service at our urban academic medical center which might contribute to underutilization.Methods: This was a cross-sectional single-center, anonymous written online survey, developed by the UCSD Ethics committee, distributed by Survey Monkey, in January 2019, to a total of 3,800 clinicians at a tertiary care academic medical center. This was a quality improvement project, so IRB approval was waived. Results: Approximately 3,800 surveys were sent to physicians, advance practice providers (APPs) and nurses with a return rate of 5.5 - 10%. The majority of respondents had encountered an ethical dilemma although only half had ever requested an ethics consult. We found that there were 4 general reasons people did not consult Ethics: 1.) unawareness of the existence of or means of contacting the Ethics service. 2.) a priori perceptions that an Ethics consult would not be helpful or might slow down decision making. 3.) experiencing a poor quality consult in the past, including variability in knowledge and ability among various consultants, 4) a consult did not improve the situation, or lacked specific guidance from the consultant.Conclusions: Based on our survey results, we proposed the following methods of reducing barriers to use of an Ethics consult service: 1) Consults need to offer specific recommendations 2) set expectations for the consultation process and outcome; 3) ensure that Ethics consultants have strong training; 4) more actively engage nursing staff, and 5) better inform clinicians about the availability of the Ethics consult service.

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