Expanding Pharmacy Services With an Intern Program at an Academic Medical Center

2020 ◽  
pp. 089719002094942
Author(s):  
Hanlin Li ◽  
Vickie Powell ◽  
Demetra Tsapepas
Keyword(s):  
Patient Experience ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Hospital Pharmacist ◽  
Organ Transplant ◽  
Solid Organ ◽  
Pharmacy Services ◽  
Digital Tool

Background: Organizations that implement pharmacy services to provide patient education have reduced hospital readmissions and improved the patient experience. The term “pharmacy extender” has been used to describe pharmacy technicians and pharmacy students who alleviate the workload of a pharmacist, enhance pharmacy visibility throughout an organization, and foster professional development for the individual. Objective: The objective of this pharmacy intern-driven program is to increase pharmacy reach for medication teaching. Methods: This is a single-center, IRB-approved retrospective cohort analysis. Pharmacist-led medication teaching is currently available to select high-risk populations including solid organ transplant and bone marrow transplant recipients at our organization. Clinicians working in the pharmacy satellites have structured operational and distributional workflow responsibilities, which precludes them from directly engaging with patients. Pharmacy interns can serve as extenders that can participate in medication teaching. An internally created digital medication teaching tool will be employed to expand the pharmacy reach for medication education. Results: During the period of study, the pharmacy interns screened 3,993 patients and educated 2,868 patients. Two-thirds of the pharmacy interns that participated in the program pursued post-graduate residency or fellowship training, while the rest assumed hospital pharmacist positions. Conclusion: Deploying pharmacy interns as extenders for distribution of an internally created digital tool that provides general medication teaching has shown positive outcomes including greater pharmacy presence and visibility, better patient experience, and higher patient satisfaction. Continuous data collection and monitoring are warranted to demonstrate the benefits of the program once sustained and potentially justify more resources for further expansion.

scholarly journals 1705. Clinical Characteristics and Outcomes of Cryptococcosis in a Tertiary Care Center in Kentucky, 2005 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S624-S625
Author(s):  
Mahesh Bhatt ◽  
Julie A Ribes ◽  
Vaneet Arora ◽  
Thein Myint
Keyword(s):  
Liver Disease ◽  
Cryptococcal Meningitis ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Positive Culture ◽  
Solid Organ ◽  
India Ink

Abstract Background Cryptococcosis is an invasive fungal infection that causes pneumonia and extrapulmonary infection. This study explores its presentations, diagnostic tests, and outcome in different groups over a 12-year period at an academic medical center. Methods This was a retrospective study of the patients treated at University of Kentucky HealthCare from October 16, 2005 to October 15, 2017. Inclusion criteria were positive cryptococcal antigen (Ag), positive culture, or presence of yeast morphologically consistent with Cryptococcus on cyto- or histopathology. Patients were divided into HIV-infected, solid-organ transplant (SOT) recipients, and non-HIV/non-transplant groups. Cryptococcal meningitis comprised of either positive CSF Ag, culture, cytology or histopathology. Results A total of 114 patients were identified; 23 HIV-infected, 11 SOT recipients and 80 non-HIV/non-transplant patients (Table 1). Cryptococcus neoformans was the most common yeast isolated (91.8%). Cryptococcal meningitis was seen in 56% of total patients whereas 27% had isolated cryptococcal pneumonia (P < 0.01). Blood cultures and serum Ag were positive in 34% and 70%, respectively. Only 8.7% of HIV-infected patients had isolated pulmonary cryptococcosis compared with 36.4% in SOT recipients (P < 0.01). In patients with cryptococcal meningitis, abnormal CSF cell count, protein, or glucose was noted in 85.3%; India ink was positive in 61.3% and CSF culture was positive in 73.4% (Table 2, Figure 1). CSF cryptococcal Ag was detected in 95.6% cases if CSF cultures were positive, whereas serum Ag was positive in only 85.1% of meningitis cases. Mortality was seen in 48.6% (17/35) of patients with cirrhosis/liver disease, compared with 21.5% (17/79) of non-cirrhosis/liver disease (P = 0.003). Transplant group had 54.5% mortality compared with 26.1% in HIV group (P = 0.016). Conclusion Cryptococcal meningitis was the most common presentation for cryptococcal disease in all three groups. Isolated pulmonary disease was least common in the HIV-infected group. Inpatient mortality rate was higher in patients with cirrhosis/liver disease and transplant group compared with those without cirrhosis/liver disease and HIV group, respectively. It is imperative to rule out meningitis in immunosuppressed patients with cryptococcal pneumonia. Disclosures All authors: No reported disclosures.

scholarly journals 2484. Pre-Transplant Vaccination Adherence in Pediatric Solid Organ Transplant Patients at a Large Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S745-S745
Author(s):  
Eric Fela ◽  
Kaitlyn Rivard ◽  
Andrea Pallotta ◽  
Michael Spinner ◽  
Maryjoy Lepak ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Patients ◽  
Academic Medical

scholarly journals 735. Trends and Cost Analysis of Aspergillus Galactomannan testing at a Tertiary Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S417-S417
Author(s):  
Peyton R Treutel ◽  
Anna Carr ◽  
Pradeep Bathina
Keyword(s):  
Stem Cell ◽  
Hematologic Malignancy ◽  
Medical Center ◽  
Organ Transplant ◽  
The Self ◽  
Solid Organ ◽  
Data Set ◽  
Hematopoietic Stem ◽  
Patients Âgés ◽  
Optical Density Index

Abstract Background Aspergillus is a fungus spread by inhalation of spores that can lead to invasive (IA), chronic, or allergic aspergillosis. Risk factors for IA include neutropenia, hematological malignancy, allogenic stem cell (HSCT) or solid organ transplant, severe immunodeficiency, or prolonged steroid use. An alternative to invasive tissue sampling, the serum Galactomannan (AGM) test detects a polysaccharide cell wall component of Aspergillus and can be used to determine a probable diagnosis of IA. Accuracy of AGM is related to disease burden and thus has the highest sensitivity and specificity in patients with hematologic malignancy or Hematopoietic stem cell transplantation (HSCT) at 70-82% and 86-92%, respectively. Studies have shown sensitivity to decline in other populations, with solid organ transplants as low as 20%. Methods We performed a retrospective study of all patients who received the AGM test at UMMC from January 3, 2013 to December 31, 2019. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained the number of encounters and patients on whom the AGM test was performed along with other variables. Billing offices provided the self-pay cost per AGM test. Results A total of 6,404 AGM tests were performed on 2,126 patients during 4,315 encounters in the study period. With a total of 499, 574, 984, 1140, 851, 1175 and 1181 tests done respectively from 2013 to 2019, a increasing trend was noted. The patients ages ranged from 1 to 89 with a median age of 52 years. A total of 3,055 tests were ordered in females, and 3,349 were ordered in males. At a cut off value (optical density index) of &gt; 0.5, 183 AGM tests resulted positive in 108 patients and at a cut of &gt; 1.0, 113 tests are positive in 70 patients. The rate of a positive AGM tests at &gt; 0.5 was at 2.85% and at &gt; 1.0 was at 1.76% over the study period. With the self-pay cost of each test at $134.54 in 2019 USD, the total cost of 6,404 tests was $861,594.16. Conclusion To our knowledge this data set constitutes the largest sample size of AGM testing. From our data, it seems that the rate of ordering this test has increased yearly. Relatively low percentage of these tests are positive, suggesting that it is most likely a large amount of these tests could have been ordered inappropriately or in the wrong clinical context. Disclosures All Authors: No reported disclosures

scholarly journals Categorizing and Rating Patient Complaints: An Innovative Approach to Improve Patient Experience

2021 ◽  
Vol 8 ◽  
pp. 237437352199862
Author(s):  
Stephanie Bayer ◽  
Paul Kuzmickas ◽  
Adrienne Boissy ◽  
Susannah L. Rose ◽  
Mary Beth Mercer
Keyword(s):  
Patient Experience ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Experiences ◽  
Innovative Approach ◽  
Satisfaction Survey ◽  
Patient Complaints ◽  
Academic Medical ◽  
Survey Results ◽  
Improve Patient

The Ombudsman Office at a large academic medical center created a standardized approach to manage and measure unsolicited patient complaints, including methods to identify longitudinal improvements, accounting for volume variances, as well as incident severity to prioritize response needs. Data on patient complaints and grievances are collected and categorized by type of issue, unit location, severity, and individual employee involved. In addition to granular data, results are collated into meaningful monthly leadership reports to identify opportunities for improvement. An overall benchmark for improvement is also applied based on the number of complaints and grievances received for every 1000 patient encounters. Results are utilized in conjunction with satisfaction survey results to drive patient experience strategies. By applying benchmarks to patient grievances, targets can be created based on historical performance. The utilization of grievance and complaint benchmarking helps prioritize resources to improve patient experiences.

scholarly journals Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Jennifer P Stevens ◽  
Oren Mechanic ◽  
Lawrence Markson ◽  
Ashley O'Donoghue ◽  
Alexa B Kimball
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Disparities ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Race And Gender ◽  
Asian Patients ◽  
Academic Medical

BACKGROUND During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. OBJECTIVE Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. METHODS Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. RESULTS At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. CONCLUSIONS Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities.

scholarly journals Integration of an Academic Medical Center and a Large Health System: Implications for Pharmacy

2019 ◽  
Vol 54 (3) ◽  
pp. 170-174
Author(s):  
Brian L. Erstad ◽  
Tina Aramaki ◽  
Kurt Weibel
Keyword(s):  
Health System ◽  
Health Systems ◽  
Integration Method ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lessons Learned ◽  
Faculty Members ◽  
Pharmacy Services ◽  
Academic Medical ◽  
High Level

Objective: To provide lessons learned for colleges of pharmacy and large health systems that are contemplating or in the process of undergoing integration. Method: This report describes the merger of an academic medical center and large health system with a focus on the implications of the merger for pharmacy from the perspectives of both a college of pharmacy and a health system’s pharmacy services. Results: Overarching pharmacy issues to consider include having an administrator from the college of pharmacy directly involved in the merger negotiation discussions, having at least one high-level administrator from the college of pharmacy and one high-level pharmacy administrator from the health system involved in ongoing discussions about implications of the merger and changes that are likely to affect teaching, research, and clinical service activities, having focused discussions between college and health system pharmacy administrators on the implications of the merger on experiential and research-related activities, and anticipating concerns by clinical faculty members affected by the merger. Conclusion: The integration of a college of pharmacy and a large health system during the acquisition of an academic medical center can be challenging for both organizations, but appropriate pre- and post-merger discussions between college and health system pharmacy administrators that include a strategic planning component can assuage concerns and problems that are likely to arise, increasing the likelihood of a mutually beneficial collaboration.

Comparison of Vasopressor Duration in Septic Shock Patients With and Without Cirrhosis

2020 ◽  
pp. 106002802098072
Author(s):  
Melissa M. Durst ◽  
Elizabeth A. Eitzen ◽  
Scott T. Benken
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Discharge Disposition ◽  
Increase Risk ◽  
Vasopressor Use

Background Patients with cirrhosis have immune dysfunction, altered inflammatory response, and hemodynamic changes which increase risk of septic shock and potentially prolong management with fluids, vasopressors, and other therapies. Due to limited available guidance, this study aimed to characterize vasopressor use in patients with cirrhosis in relation to patients without cirrhosis in septic shock. Methods This was a retrospective matched cohort analysis of 122 patients admitted to the intensive care unit (ICU) at an academic medical center from January 2015 to November 2017. Patients were grouped based on the presence or absence of cirrhosis and matched based on severity of illness scoring. The primary outcome was vasopressor duration. Secondary comparisons included total vasopressor requirement, length of hospital and ICU stay, in-hospital mortality, change in organ function, and discharge disposition. Results The group with cirrhosis had significantly longer median (interquartile range [IQR]) durations of vasopressor therapy compared with the group without cirrhosis (86.0 [42.0-164.5] vs 39.0 [14.5-82.0] hours; P = 0.003) leading to increased median (IQR) vasopressor exposure (71.7 [15.5-239.5] vs 24.7 [5.3-77.9] mg norepinephrine [NE] equivalents; P = 0.003). No difference was found in in-hospital mortality between groups. However, regression analysis showed vasopressor exposure was associated with in-hospital mortality. Conclusion and Relevance Patients with cirrhosis in septic shock have increased vasopressor durations and overall requirements compared with patients without cirrhosis. Increased durations and requirements is associated with poorer outcomes independent of presence of cirrhosis. Future studies are needed to improve vasopressor treatment strategies and end points utilized in cirrhosis.

Safety of Intravenous Push Lacosamide Compared With Intravenous Piggyback at a Tertiary Academic Medical Center

2020 ◽  
Vol 55 (2) ◽  
pp. 181-186
Author(s):  
Kevin McLaughlin ◽  
Shannon Carabetta ◽  
Nicholas Hunt ◽  
Brian R. Schuler ◽  
Clara Ting ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Cardiovascular Effects ◽  
Reaction Rates ◽  
Infusion Site ◽  
Safe Alternative ◽  
End Points

Background: There are limited data regarding the incidence of adverse events associated with administering lacosamide by intravenous push (IVP) compared with IV piggyback (IVPB). Objective: The objective of this analysis was to compare the safety profile, including cardiovascular effects, sedative effects, and IV site reactions of IVP and IVPB lacosamide administration. Methods: A retrospective pre/post cohort analysis comparing patients who received lacosamide via IVP and IVPB was conducted. Safety end points included hypotension, bradycardia, medication-related sedation, and IV site reactions. The relationship between patient characteristics and the incidence of safety end points was analyzed using the Student t-test and χ2 test as appropriate. Results: Bradycardia occurred after 0.19% of IVP administrations and 1.09% of IVPB administrations assessed ( P = 0.07). Hypotension was observed in 3.16% of IVP administrations compared to 1.59% in the IVPB cohort ( P = 0.12). Post lacosamide-related sedation was noted in 11.32% and 11.68% of the IVP and IVPB cohorts, respectively ( P = 0.87). Infusion site reaction rates of 1.80% and 0.84% were documented in the IVP and IVPB cohorts, respectively ( P = 0.33). Of note, only 1 adverse event required clinical intervention. One 200-mg dose in the IVP cohort required a fluid bolus postadministration. Conclusion and Relevance: IVP lacosamide was associated with a similar incidence of cardiovascular, neurological, and infusion site–related adverse events compared with IVPB, in which nearly every adverse event was deemed clinically insignificant. Lacosamide administered via IVP may be considered a safe alternative method of administration in the acute care setting.

Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions

2020 ◽  
pp. 089719002095826
Author(s):  
Katherine L. March ◽  
Michael J. Peters ◽  
Christopher K. Finch ◽  
Lauchland A. Roberts ◽  
Katie M. McLean ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Control Group ◽  
Readmission Rates ◽  
Improve Patient Satisfaction ◽  
Phone Calls ◽  
Improve Patient

Background: Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. Methods: Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for “Communication about Medicines” and “Care Transitions.” Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. Results: Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions “staff told you what the medicine was for” (14.2%; p = 0.018), “staff describe possible effects” (21.2%; p = 0.004), and “understood the purpose of taking medications” (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. Conclusions: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.

scholarly journals Time is money: quantifying savings in outpatient appendectomy

2018 ◽  
Vol 3 (1) ◽  
pp. e000222 ◽  
Author(s):  
Elise Taylor Bernard ◽  
Daniel L Davenport ◽  
Courtney M Collins ◽  
Bethany A Benton ◽  
Andrew C Bernard
Keyword(s):  
Laparoscopic Appendectomy ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Postanesthesia Care Unit ◽  
Total Hospital Cost ◽  
Outpatient Basis ◽  
Success Rates ◽  
Level Of Evidence

BackgroundLaparoscopic appendectomy can be performed on a fast-track, short-stay, or outpatient basis with high success rates, low morbidity, low readmission rates, and shorter length of hospital stay. Cost savings from outpatient appendectomy have not been well described. We hypothesize that outpatient laparoscopic appendectomy is associated with cost savings.MethodsWe performed an original retrospective cohort analysis of patients undergoing laparoscopic appendectomy between June 2013 and April 2017 at our academic medical center before and after implementation of an outpatient protocol which began on January 1, 2016. We assessed appendicitis grade, length of stay (LOS), cost, net revenue, and profit margin.ResultsAfter protocol implementation, the percentage of patients discharged from the the postanesthesia care unit (PACU) increased from 3.7% to 29.7% (χ2 p<0.001). The proportion of inpatient admissions and admissions to observation decreased by 5.7% and 20.3%, respectively. On average, PACU-to-home patients had a total hospital cost of $4734 compared with $5781 in patients admitted to observation, for an estimated savings of $1047 per patient (p<0.001). Comparing the time periods, the mean LOS decreased for all groups (p<0.001). Appendicitis grade was higher in those who required inpatient admission, but could not distinguish which patients required an observation bed.DiscussionOutpatient appendectomy saves approximately $1000 per patient. Adoption of an outpatient appendectomy pathway is likely to be gradual, but will result in incremental improvement in resource utilization immediately. Grade does not predict which patients should be observed. Considering established safety, our data support widespread implementation of this protocol.Level of evidenceIII.

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