scholarly journals Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience

2021 ◽  
pp. 014556132110167
Author(s):  
Kevin P. Stavrides ◽  
Timothy L. Lindemann ◽  
Evan J. Harlor ◽  
Thorsen W. Haugen ◽  
Nicholas Purdy
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Time Estimation ◽  
Patient Characteristics ◽  
Endocrine Surgery ◽  
Time Averaging ◽  
Tertiary Care Facility ◽  
Mean Differences

Objective: To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. Methods: Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon’s previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. Results: A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging ( P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. Conclusion: As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.

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

2007 ◽  
Vol 53 (6) ◽  
pp. 1016-1022 ◽  
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.

scholarly journals Bleb-Related Endophthalmitis: A 15-Year Review

2018 ◽  
Vol 3 (1) ◽  
pp. 21-27
Author(s):  
Lekha K. Mukkamala ◽  
Tian Xia ◽  
Rana Mady ◽  
Lisa Athwal ◽  
Marco A. Zarbin ◽  
...  
Keyword(s):  
Open Angle Glaucoma ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Patient Characteristics ◽  
Light Perception ◽  
Hand Motion ◽  
Tertiary Care Facility ◽  
Systemic Antibiotics

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.

scholarly journals Characteristic of COVID-19 infection in pediatric patients: early findings from a tertiary care center, Nagercoil, Tamil Nadu, India

2020 ◽  
Vol 7 (10) ◽  
pp. 2048
Author(s):  
Babitha Rexlin G. ◽  
Suresh P. M.
Keyword(s):  
Tamil Nadu ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Family Welfare ◽  
P Value ◽  
Mild Disease ◽  
Tertiary Care Facility

Background: The planet faces a new challenge with COVID-19 disease caused by novel SARS-CoV2. Pediatric COVID-19 is considered to be mild. Methods: The study aim was to describe the clinical presentation, diagnostic findings and outcome of a cohort of paediatric patients according to Ministry of health and family welfare (MOHFW) criteria, at KKGMCH a tertiary care facility in Kanyakumari district. It’s a retrospective chart review including data of children aged 0 to 12 years with COVID-19 from 20 March to 19 July 2020. Results: Of the 137 children with COVID-19, 17 (12.45%) were infants, 65 (35%) were 1-5 years and 72 (52.55%) were 6-12 years. Age didn’t have influence on acquiring the illness as p value is 0.125. Age had no influence on severity too as p value is 0.28. 46.7% were female and 53.3% were male. There was an apparent male preponderance with (OR 1.63, 95% CI 1.00 to 2.21) but a non-significant p value of 0.54. of the 34 (24.8%) mild symptomatic, 22 (64.7%) were males and 12 (35.2%) were females. The p value is 0.086 stating gender non-influential on severity. 129 (94.1%) children had contact history. The contacts were parents or close relatives. No child with comorbidity presented during this period. Most common clinical features were fever (8.76%), cough (6.6%), rhinorrhoea (2.2%), vomiting (2.9%) and diarrhoea (1.5%). Children never progressed to severe respiratory illness requiring intensive care as per MOHFW criteria. 1 (0.7%) presented with focal consolidation in chest x-ray. All 137 (100%) children got cured.Conclusion: Study concludes pediatric COVID-19 is a mild disease without mortality at beginning of pandemic in Kanyakumari district. Factors like age and gender neither influenced the occurrence of the disease nor the severity.

Emergency General Surgery Regionalization: Retrospective Cohort Study of Emergency General Surgery Patients at a Tertiary Care Center

2021 ◽  
pp. 000313482110385
Author(s):  
Sullivan A. Ayuso ◽  
Sharbel A. Elhage ◽  
Kyle W. Cunningham ◽  
A. Britton Christmas ◽  
Ronald F. Sing ◽  
...  
Keyword(s):  
General Surgery ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographic Origin ◽  
Care Facility ◽  
Care Hospital ◽  
Emergency General Surgery ◽  
Tertiary Care Facility ◽  
Tertiary Care Hospitals

Background Emergency general surgery (EGS) patients presenting at tertiary care hospitals may bypass local hospitals with adequate resources. However, many tertiary care hospitals frequently operate at capacity. We hypothesized that understanding patient geographic origin could identify opportunities for enhanced system triage and optimization and be an important first step for EGS regionalization and care coordination that could potentially lead to improved utilization of resources. Methods We analyzed patient zip code and categorized EGS patients who were cared for at our tertiary care hospital as potentially divertible if the southern region hospital was geographically closer to their home, regional hospital admission (RHA) patients, or local admission (LA) patients if the tertiary care facility was closer. Baseline characteristics and outcomes were compared for RHA and LA patients. Results Of 14 714 EGS patients presenting to the tertiary care hospital, 30.2% were categorized as RHA patients. Overall, 1526 (10.4%) patients required an operation including 527 (34.5%) patients who were potentially divertible. Appendectomy and cholecystectomy comprised 66% of the operations for potentially divertible patients. Length of stay was not significantly different ( P = .06) for RHA patients, but they did have lower measured short-term and long-term mortality when compared to their LA counterparts ( P < .05). Conclusions EGS diagnoses and patient geocode analysis can identify opportunities to optimize regional operating room and bed utilization. Understanding where EGS patients are cared for and factors that influenced care facility will be critical for next steps in developing EGS regionalization within our system.

Review of a Home-Based Palliative Care Program for Children with Malignant and Non-Malignant Diseases

1997 ◽  
Vol 13 (4) ◽  
pp. 28-33 ◽  
Author(s):  
Ernest A. Kopecky ◽  
Sheila Jacobson ◽  
Prashant Joshi ◽  
Maria Martin ◽  
Gideon Koren
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Patient Characteristics ◽  
Palliative Care Program ◽  
Tertiary Care Facility ◽  
Home Based ◽  
At Home

This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986–1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 ± 0.51 years and mean age at death was 5.3 ± 0.55 years. The mean number of days in hospital was 26.5 ± 14.6 while days spent at home averaged 98.4 ± 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 ± 0.9 by pager and 24.0 ± 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.

scholarly journals Innovations in Hemodialysis Care: An Evaluation of Quality and the Patient Experience

2020 ◽  
Vol 7 (6) ◽  
pp. 1278-1285
Author(s):  
Lori Harwood ◽  
Darrin Pye ◽  
Elizabeth Clinton ◽  
Kyle Goettl ◽  
April Mullen ◽  
...  
Keyword(s):  
Patient Experience ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Staff ◽  
Complex Care ◽  
Tertiary Care Facility ◽  
Costly Treatment ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis (HD) performed in a tertiary care facility is the most prevalent and costly treatment for end-stage renal disease in Canada. This life-sustaining treatment is usually performed thrice weekly in an in-center facility. When people on HD also require a rehabilitation/complex care inpatient program, the burden of transportation for dialysis is immense to both the patient and health-care system. To improve the patient experience, create efficiency, and reduce travel costs, the renal team and a team from a rehabilitation/complex care center collaborated to provide HD services in the rehab/complex care setting. A patient/family representative was involved in all aspects of the design through to evaluation of this project. This study used realistic evaluation to examine the efficacy of this program from the perspective of the patient experience, HD staff, rehab/complex care staff and costs. The decreased travel with having dialysis on-site and adequate resources in the HD unit were the mechanisms for success in improved patient experience, quality of life and rehabilitation patient outcomes, decreased costs as well as increased communication and satisfaction.

scholarly journals Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India

2015 ◽  
Vol 3 (1) ◽  
pp. 33-40 ◽  
Author(s):  
V Jithesh ◽  
Shakti Kumar Gupta ◽  
Parmeshwar Kumar ◽  
Aarti Vij
Keyword(s):  
Comparative Study ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Patient Communication ◽  
Tertiary Care Center ◽  
Tertiary Care Facility ◽  
Significant Difference ◽  
Hands On ◽  
Doctors And Nurses

ABSTRACT Background Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if aany, comparative studies on clinical handovers have been conducted in the India. Objective To study clinical handover practices among nurses and doctors in a neurosciences center in India. Design and setting This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India. Materials and methods The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman's correlation coefficient. Results Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories. Conclusion Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes. How to cite this article Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

scholarly journals Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hussein Hassan Rizk ◽  
Ahmed Adel Elamragy ◽  
Ghada Sayed Youssef ◽  
Marwa Sayed Meshaal ◽  
Ahmad Samir ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Facility ◽  
Period 2 ◽  
Peripheral Embolization ◽  
Tertiary Care Facility ◽  
Few Data ◽  
Healthcare Associated ◽  
Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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