Getting in the Flo: My year as a scholar

In November 2016, I was awarded an Emerging Leaders Scholarship from the Florence Nightingale Foundation to help me positively impact patient care and also improve how I lead change within my organisation. This article highlights some of the learning experiences over the last year and the impact that the Scholarship has had.

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The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00207.1 ◽

2015 ◽

Vol 7 (1) ◽

pp. 113-117 ◽

Cited By ~ 20

Author(s):

Anna Podolsky ◽

David T. Stern ◽

Lauren Peccoralo

Keyword(s):

Patient Care ◽

Discharge Planning ◽

Training Session ◽

Mount Sinai Hospital ◽

Published Data ◽

Impact Patient Care ◽

Faculty Time ◽

The Impact ◽

And Training

Abstract Background Communication and courtesy are important elements of consultations, but there is limited published data about the quality of trainee consults. Objectives This study assessed residents' views on consult interactions, evaluated the impact of the consult interactions on patient care, and developed and implemented a pocket card and training on trainee consults. Methods We surveyed resident and fellow physicians at Mount Sinai Hospital to assess perceptions, created a CONSULT card that uses a mnemonic for key elements, and developed a training session for how to call consults. We also conducted a consult training session using the CONSULT card as part of orientation in 2011 for all interns. We assessed the acceptability, feasibility, and sustainability of this intervention. Results Of 1001 trainees, 403 (40%) responded. Respondents reported that the most important components of calling consults included giving patient name, medical record number, and location (91%), and giving a clear question/reason (89%). Respondents also reported that these behaviors are done consistently for only 64%, and 10% of consults, respectively. Trainees reported that consult interactions affect the timeliness of treatment (62%), timeliness of tests performed (57%), appropriateness of diagnosis (56%), and discharge planning (49%). Approximately 300 interns attended the consult training session, and their feedback demonstrated acceptability and utility of the session. Conclusions Trainees believe that consult interactions impact patient care, but important components of the consult call are often missing. Our training and CONSULT card is an acceptable, feasible, and novel training intervention. Once developed, the training session and CONSULT card require minimal faculty time to deliver.

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812. The Impact of Post-Operative Cephalexin on Surgical Site (SSI) Infections During a Cefazolin Shortage

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1008 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S499-S500

Author(s):

Sara Brown ◽

R Brigg Turner ◽

Dominic Chan

Keyword(s):

Patient Care ◽

Primary Outcome ◽

Antimicrobial Prophylaxis ◽

Community Based ◽

Drug Shortages ◽

National Drug ◽

Observational Cohort ◽

Impact Patient Care ◽

Alternative Medications ◽

The Impact

Abstract Background Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin. Methods This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups. Results There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07). Conclusion National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable. Disclosures All Authors: No reported disclosures

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Utilization of Patient Navigators in Breast Imaging Facilities Across the United States: A Survey of Breast Imaging Radiologists

Journal of Breast Imaging ◽

10.1093/jbi/wbz078 ◽

2020 ◽

Vol 2 (1) ◽

pp. 16-21

Author(s):

Amie Y Lee ◽

Donna Plecha ◽

Genevieve A Woodard ◽

Elissa R Price ◽

Jessica H Hayward ◽

...

Keyword(s):

United States ◽

Patient Care ◽

Breast Imaging ◽

Online Survey ◽

The United States ◽

Patient Navigators ◽

Navigation Program ◽

Impact Patient Care ◽

Improving Patient Care ◽

The Impact

Abstract Objective To assess the utilization of patient navigators at breast imaging facilities across the United States. Methods An online survey was distributed to physician members of the Society of Breast Imaging. Questions encompassed use of patient navigators in breast imaging including: presence and qualifications, roles in patient care, perceived benefits, and barriers. Data were analyzed to identify the overall prevalence of patient navigators, their responsibilities and qualifications, and the impact on breast imaging centers. Results Three-hundred and eighty-five board-certified radiologists practicing in the United States completed the survey. The most common practice types were private practice (52%; 201/385) and academic (29%; 110/385). The majority (67%; 256/385) employed navigators, and the most common qualification was a registered nurse (78%; 200/256). Navigators were used for a variety of patient communication and care coordination roles, most commonly to provide educational resources (86%; 219/256), assist patients with scheduling appointments (80%; 205/256), explain the biopsy process (76%;195/256), and communicate biopsy results (64%). Nearly all (99%; 254/256) respondents ranked patient navigators as valuable to extremely valuable in improving patient care and indicated they would recommend implementation of a patient navigation program to other breast imaging practices. The most common barrier to employing a navigator was the financial cost. Conclusion Patient navigators have been widely adopted in breast imaging practices across the United States, with two-thirds of respondents reporting use of a navigator. Although navigator roles varied by practice, nearly all radiologists utilizing patient navigators found that they positively impact patient care and would recommend them to other breast imaging practices.

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The Impact of Undetected In Vitro Hemolysis or Sample Contamination on Patient Care and Outcomes in Point-of-Care Testing: A Retrospective Study

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfz020 ◽

2020 ◽

Vol 5 (2) ◽

pp. 332-341

Author(s):

Matthew O’Hara ◽

Elizabeth G Wheatley ◽

Steven C Kazmierczak

Keyword(s):

Retrospective Study ◽

Patient Care ◽

Patient Management ◽

Point Of Care ◽

Improve Patient Care ◽

Sample Collection ◽

Repeated Testing ◽

Impact Patient Care ◽

The Impact

Abstract Background Point-of-care (POC) testing is an integral diagnostic component in clinical settings like the emergency department (ED). However, most POC testing devices are unable to detect endogenous interferents such as hemolysis, which typically occurs during sample collection and handling and can falsely increase measured potassium (pseudohyperkalemia), a phenomenon we hypothesized may significantly impact patient care. Methods In this retrospective study, we evaluated 100 unique admissions to the Oregon Health & Science University ED, presenting with elevated potassium measured at the POC. To evaluate whether in vitro hemolysis had occurred, POC test results were compared to repeat testing of the original specimen, or other specimens tested within 90 minutes in the Core laboratory. Review of associated Electronic Health Records determined whether elevated potassium initially measured using the POC analyzer was real, or due to in vitro hemolysis or contamination, and whether pseudohyperkalemia impacted patient management or care. Results Of the 100 admissions with hyperkalemia measured using a POC analyzer, 40% were found to have pseudohyperkalemia due to hemolysis or contamination. Of these 40 patients, 6 experienced repeated testing, and an additional 5 were noted to have altered patient management, specifically due to pseudohyperkalemia. Conclusions This study demonstrates the incidence of in vitro hemolysis, which is unknown to the POC operator, is high in patients who show an elevated potassium as measured at the POC. Furthermore, in vitro hemolysis can significantly impact patient management, suggesting that minimizing the incidence of unrecognized hemolysis will benefit hospital efficiency, decrease waste, and improve patient care.

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