Development and Implementation of a Piperacillin-Tazobactam Extended Infusion Guideline

2011 ◽  
Vol 24 (6) ◽  
pp. 571-576 ◽  
Author(s):  
Lynley S. Heinrich ◽  
Sheri Tokumaru ◽  
Nina M. Clark ◽  
John Garofalo ◽  
Jamie L. Paek ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Drug Expenditure ◽  
Academic Medical ◽  
Potential Improvement ◽  
Scheduled Time ◽  
Extended Infusion

Administration of β-lactam antibiotics by extended infusion optimizes the pharmacodynamic properties and bactericidal activity of these agents resulting in a potential improvement in patient outcomes and reduction in drug expenditure. Consequently, a pharmacist-led piperacillin-tazobactam extended 4-hour infusion guideline was implemented hospital-wide at a 500-bed academic medical center. Each piperacillin-tazobactam infusion was prospectively monitored for 5 weeks to ensure accurate administration and identify barriers to guideline adherence. Overall, a total of 103 patients received 1215 doses of piperacillin-tazobactam by extended infusions. In all, 98% of the doses were administered at the correct extended infusion rate and 94% of the doses were given at the scheduled time. There were a total of 20 missed doses and 53 delayed doses, accounting for 2% and 4% of the total administered doses, respectively. The primary barrier to adherence was the patient not being on the unit at the time of the scheduled dose followed by the piperacillin-tazobactam dose not being available on the floor. While insufficient power prevented meaningful evaluation of clinical outcomes, we anticipate a conservative annual estimated cost savings of $108 529. Key elements contributing to our success included consistent pharmacy leadership, multidisciplinary involvement, thorough inservicing to health care professionals, hospital-wide implementation, and extensive quality assurance monitoring.

Evaluation of Patient Experience from Telemedicine Use for an Anesthesiology Pain Division: Time, Cost, and Patient Satisfaction Analysis (Preprint)

2021 ◽  
Author(s):  
Laleh Jalilian ◽  
Irene Wu ◽  
Jakun Ing ◽  
Xuezhi Dong ◽  
George Pan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Travel Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Travel Distance ◽  
Patient Cost ◽  
Academic Medical ◽  
Pain Patients

BACKGROUND An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, healthcare providers have utilized telemedicine for pain management of both interventional and chronic pain patients. OBJECTIVE This study describes telemedicine implementation for pain management at an academic pain division in a large metropolitan area. The study estimates patient cost savings from telemedicine, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction with telemedicine for pain management care. METHODS This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1,398 patients and conducted 2,948 video visits for remote pain management care. We utilize publicly available IRS Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimate median travel time, travel distance, direct cost of travel, and time-based opportunity savings and report patient satisfaction scores. RESULTS Telemedicine patients avoided an estimated median roundtrip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within sample, the median hourly earnings was $28/hr. Patients saved a median of $22 on gas and parking and a total of $52 per telemedicine visit based on estimated hourly earnings and travel time. Patients evaluated serially with telemedicine for medication management saved a median of $156 over three visits. 91% of patients surveyed (n = 313) were satisfied with their telemedicine experience. CONCLUSIONS Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for pain patients. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings.

scholarly journals Patient Centered Medical Home transformation at an academic medical center

2015 ◽  
Vol 5 (1) ◽  
pp. 34
Author(s):  
Randy Wexler ◽  
Jennifer Lehman ◽  
Mary Jo Welker
Keyword(s):  
Family Medicine ◽  
Patient Outcomes ◽  
Medical Home ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Patient Centered Medical Home ◽  
Model Of Care ◽  
Patient Centered ◽  
Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

scholarly journals Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

2021 ◽  
Vol 12 (2) ◽  
pp. 13
Author(s):  
Melanie Berry ◽  
Amy Gustafson ◽  
Maya Wai ◽  
Alex J. Luli
Keyword(s):  
Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Acceptance Rate ◽  
Demographic Information ◽  
Consult Service ◽  
Descriptive Data ◽  
Academic Medical ◽  
Patient Demographic Information

Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service.  Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.

Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Merilyn S Varghese ◽  
Jordan B Strom ◽  
Sarah Fostello ◽  
Warren J Manning
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Hospital Systems ◽  
The Impact ◽  
At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

scholarly journals Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

2019 ◽  
Vol 8 ◽  
pp. 216495611983748 ◽  
Author(s):  
Susanne M Cutshall ◽  
Tejinder K Khalsa ◽  
Tony Y Chon ◽  
Sairey M Vitek ◽  
Stephanie D Clark ◽  
...  
Keyword(s):  
Health Care ◽  
Integrative Medicine ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Curricular Development ◽  
Medical Needs ◽  
Academic Medical ◽  
Number Of Patients ◽  
Prevention And Health Promotion

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center

2020 ◽  
Vol 102 (8) ◽  
pp. 654-663
Author(s):  
Gregory Glauser ◽  
Benjamin Osiemo ◽  
Stephen Goodrich ◽  
Scott D. McClintock ◽  
Kristy L. Weber ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Orthopaedic Surgery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Short Term ◽  
Academic Medical

Economic Evaluation of a Pharmacist-Led 5-Day Therapeutic Hold of IV Levothyroxine at an Academic Medical Center

2020 ◽  
pp. 001857872097045
Author(s):  
Blake T. Barlow ◽  
Russel J. Roberts ◽  
Kelly Newman ◽  
Sarah K. Harrison ◽  
Jonathan H. Sin
Keyword(s):  
Medical Center ◽  
Financial Burden ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Surgical Trauma ◽  
Implementation Phase ◽  
Academic Medical ◽  
Pharmacokinetic Properties ◽  
Utilization Data ◽  
Surgical Icu

Objective: Providers often admit patients with active outpatient prescriptions for levothyroxine. During an inpatient admission, providers may instruct critically ill patients to take nothing by mouth, or nil per os (NPO). Thus, they may prescribe the intravenous (IV) formulation of levothyroxine during this period. However, levothyroxine possesses a prolonged half-life of up to 7 days; therefore, immediate transition to IV levothyroxine may not be clinically necessary in the acute NPO setting. Intravenous levothyroxine is significantly more expensive than equivalent oral doses and may prove to be a financial burden for an institution. By understanding the pharmacokinetic properties of levothyroxine, we implemented a cost-saving initiative involving a 5-day therapeutic hold of IV levothyroxine. Methods: This was a retrospective evaluation in 2 intensive care units (ICU): a 20-bed surgical/trauma ICU and an 18-bed mixed medical/surgical ICU. Patient data, utilization data, and documented pharmacist interventions were collected for 6 months prior to implementation of the 5-day IV levothyroxine therapeutic hold and for 6 months post-implementation. All patients prescribed IV levothyroxine during these timeframes were included. Results: During the 6-month pre-implementation phase, 674 doses (691 vials) of IV levothyroxine for 77 unique patients were dispensed from the 2 ICUs. During the 6-month post-implementation phase, 168 doses (188 vials) of IV levothyroxine were dispensed for 44 unique patients. Of the 44 patients (48 orders) who still received IV levothyroxine, 22.9% of orders were deemed clinically necessary by the pharmacist and were not recommended to be held under the protocol, 64.6% were due to the verifying pharmacist being unaware of the protocol, 8.3% of orders were due to protocol non-compliance, and 4.2% were verified after the 5-day hold was complete as the patient remained NPO. This pharmacy-led initiative resulted in a 75% decrease in usage post-implementation and an estimated annualized savings of $80,000. Conclusion: A pharmacy-led initiative comprised of a 5-day therapeutic hold of IV levothyroxine was feasible and led to a 75% reduction in usage and cost over a 6-month period in 2 ICU’s. Future steps include additional staff education for improved protocol adherence and expanding the protocol institution-wide for an even greater cost-savings potential.

scholarly journals Building eConsult (Electronic Consults) Capability at an Academic Medical Center to Improve Efficiencies in Delivering Specialty Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110053
Author(s):  
Matthew A. Thompson ◽  
Anne L. Fuhlbrigge ◽  
Duane W. Pearson ◽  
David R. Saxon ◽  
Linda A. Oberst-Walsh ◽  
...  
Keyword(s):  
Delivery System ◽  
System Integration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Cost Savings ◽  
Models Of Care ◽  
Health Crisis ◽  
Academic Medical ◽  
The Face

As the COVID-19 health crisis continues to reshape healthcare, systems across the country face increasing pressure to adapt their models of care to expand access to care, while also improving efficiency and quality in the face of limited resources. Consequently, many have shown a growing interest and receptivity to the expansion of telehealth models to help meet these demands. Electronic consultations (eConsults) are a telehealth modality that allow for a non-face-to-face asynchronous consultation between a primary care provider (PCP) and a specialist aimed at facilitating specialist input without the need for a patient visit. The aim of this case study is to describe eConsults, how they differ from traditional in person models of care and other models of telemedicine and to review the evidence related to the effectiveness of eConsults by PCPs and clinicians from multiple specialties at the University of Colorado School of Medicine. We have worked to develop an infrastructure, delivery system integration, and care model adaptations that aim to improve delivery system performance by ensuring proper care in appropriate settings and lowering costs through reduced utilization. Lastly, we have increased care coordination, improved collaboration and better care transitions through strengthening of relationships between community-based PCPs and academic medical center-based specialists. This work has resulted in cost savings to patients and positive provider satisfaction.

Self-Perceived End-of-Life Care Competencies of Health-Care Providers at a Large Academic Medical Center

2018 ◽  
Vol 35 (11) ◽  
pp. 1409-1416 ◽  
Author(s):  
Marcos Montagnini ◽  
Heather M. Smith ◽  
Deborah M. Price ◽  
Bidisha Ghosh ◽  
Linda Strodtman
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Academic Medical ◽  
Eol Care

Background: In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. Objective: To assess health-care professionals’ self-perceived competencies regarding the provision of EOL care in hospitalized patients. Methods: Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups. Results: A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers. Conclusions: Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

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