Evaluation of Radiology Reports by the Emergency Department Clinical Providers: A Message to Radiologists

2020 ◽  
pp. 084653712090206 ◽  
Author(s):  
Waleed Abdellatif ◽  
Jeffrey Ding ◽  
Abdelmohsen Radwan Hussien ◽  
Ali Hussain ◽  
Shahin Shirzad ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Reporting Practices ◽  
Radiology Reports ◽  
Standardized Report ◽  
Academic Medical

Objectives: This study is an evaluation of the emergency department (ED) satisfaction with the current radiologic reporting system used at a major Northeastern academic medical center. The radiology reports are the main form of communication and usually the final product of any radiological investigation delivered to clinicians. The aim of this study was to improve current radiology reporting practices and to better tailor reports to match the needs and expectations of ED clinicians. Methods: A 9-question online survey was sent to ED residents, fellows, faculty, and nurse practitioners/advanced practice providers at a major Northeastern academic medical center in the United States. For the open-ended section, coding and emergent theme categorization was conducted for quantification of responses. The survey was designed to evaluate the attitudes toward the structure, style, form, and wording used in reports. Results: The response rate was 48.6% (68/140). The ED respondents were generally satisfied with radiology reports, their language, vocabulary, and clarity. They preferred the impression section to be before the findings in simple examinations and to stratify the reports according to emergency status for complex examinations. They did not like extended differential, hedge terms, and delayed reporting. Additionally, ED respondents recommended focused, fast reporting with considerable changes toward a more standardized report. Conclusions: This evaluation delivered a list of actionable recommendations. The top recommendation is to standardize reporting structure, style, and lexicon, in addition to being focused, timely, and brief.

Abstract 17099: Implementation of a High Sensitivity Troponin-I Assay in an Academic Medical Center: A Qualitative and Quantitative Assessment

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Winchester ◽  
Omkar Betageri ◽  
Patrick Perche ◽  
Brandon Allen ◽  
Ryan Theis
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Sensitivity ◽  
The United States ◽  
Individual Characteristics ◽  
Health Care Facilities ◽  
Clinical Practices ◽  
High Sensitivity Troponin ◽  
Academic Medical

Background: High sensitivity troponin assays (hsTn) have received regulatory approval for use in the United States and health care facilities are beginning to adopt these new assays. Questions remain about how to implement these assays and what affect they may have on demand for cardiovascular services. Methods and Results: We conducted a mixed-methods implementation science-based investigation of hsTn adoption at a single academic medical center. We designed the investigation based on the Consolidated Framework for Implementation Research, exploring clinicians’ perspectives on intervention characteristics, inner setting, individual characteristics, and process of implementation domains. Focus groups were conducted with clinicians from multiple service lines. Participants reported that the new hsTn assay did not fundamentally change processes of care such as cardiology consultations or inpatient admissions. Implementation was facilitated by leveraging the electronic medical record to provide useful suggestions for hsTn management at the point-of-care. Participants expressed satisfaction with the multidisciplinary and collaborative approach taken to educating clinicians prior to implementation. The use of case-based teaching was considered most effective. Emergency department clinicians expressed greater confidence about decisions to discharge to home with the hsTn assay, compared to the older assay. Areas of ongoing concern included management of high risk patients, outpatient follow-up, and feasibility of accelerated diagnostic protocols for early discharge from the emergency department. Deidentified quantitative data on cardiovascular service use were gathered from administrative sources and analyzed on runcharts. A decrease in the number of hsTn assays ordered was observed; no change was noted for admissions, cardiology consultations, or noninvasive cardiac imaging. Conclusions: A comprehensive educational campaign, based on multidisciplinary collaboration can effectively prepare clinicians for implementation of hsTn. New hsTn assays may not have any substantial effect of acute management of patients with cardiac complaints. Many questions remain about best clinical practices for hsTn assays.

scholarly journals Using design and innovation principles to reduce avoidable emergency department visits among employees of a large academic medical center

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 100514
Author(s):  
Krisda H. Chaiyachati ◽  
Katy Mahraj ◽  
Carolina Garzon Mrad ◽  
Christina J. O'Malley ◽  
Marguerite Balasta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Emergency Department Visits ◽  
Academic Medical

scholarly journals Preparing Clinical Text for Use in Biomedical Research

2011 ◽  
pp. 2085-2095
Author(s):  
John P. Pestian ◽  
Lukasz Itert ◽  
Charlotte Andersen
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Text ◽  
Delivery Of Care ◽  
Radiology Reports ◽  
Academic Medical ◽  
Textual Data ◽  
Regulatory Actions

Approximately 57 different types of clinical annotations construct a patient’s medical record. These annotations include radiology reports, discharge summaries, and surgical and nursing notes. Hospitals typically produce millions of text-based medical records over the course of a year. These records are essential for the delivery of care, but many are underutilized or not utilized at all for clinical research. The textual data found in these annotations is a rich source of insights into aspects of clinical care and the clinical delivery system. Recent regulatory actions, however, require that, in many cases, data not obtained through informed consent or data not related to the delivery of care must be made anonymous (as referred to by regulators as harmless), before they can be used. This article describes a practical approach with which Cincinnati Children’s Hospital Medical Center (CCHMC), a large pediatric academic medical center with more than 761,000 annual patient encounters, developed open source software for making pediatric clinical text harmless without losing its rich meaning. Development of the software dealt with many of the issues that often arise in natural language processing, such as data collection, disambiguation, and data scrubbing.

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p < 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p < 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

Impact of Clinical Nurse Specialist Roles on COVID-19 Pandemic Care

2020 ◽  
Vol 14 (3) ◽  
pp. 141-146
Author(s):  
Kathleen Posa-Kearney ◽  
Samantha M. Aranda ◽  
Elizabeth M. Day ◽  
Erin Dowding ◽  
Kristen Fisher ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nurse Specialist ◽  
Critical Care Nursing ◽  
Clinical Nurse ◽  
Certified Registered Nurse Anesthetists ◽  
Practice Nurses ◽  
Clinical Nurse Specialists ◽  
Academic Medical

Advanced practice nurses including nurse practitioners, clinical nurse specialists (CNS), certified registered nurse anesthetists, and certified nurse midwives contribute in many ways to improve care in the intensive care unit. This article reports on the roles of the CNS at an academic medical center and how they contribute to improving patient outcomes and support critical care nursing practice during the COVID-19 pandemic.

Care Coordination

2018 ◽  
pp. 163-167
Keyword(s):  
Emergency Department ◽  
Care Coordination ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Ethnically Diverse ◽  
Medicine Service ◽  
Academic Medical ◽  
Diverse Patient Population ◽  
Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

scholarly journals Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Joesph R Wiencek ◽  
Carter L Head ◽  
Costi D Sifri ◽  
Andrew S Parsons
Keyword(s):  
United States ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibody Test ◽  
The United States ◽  
Molecular Testing ◽  
Antibody Testing ◽  
Academic Medical ◽  
Public Health Epidemiology ◽  
Testing Costs

Abstract Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.

scholarly journals Healthcare personnel absenteeism, presenteeism, and staffing challenges during epidemics

2020 ◽  
pp. 1-4
Author(s):  
Douglas W. Challener ◽  
Laura E. Breeher ◽  
JoEllen Frain ◽  
Melanie D. Swift ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Seasonal Influenza ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Healthcare Personnel ◽  
Linear Regression Models ◽  
Influenza Like Illness ◽  
Healthcare Workforce ◽  
Academic Medical ◽  
Hourly Employees

Abstract: Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Design: Retrospective cohort study. Setting: Large academic medical center in the United States. Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

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