scholarly journals Transition to Subspecialty Sign-Out at an Academic Institution and Its Advantages

2017 ◽  
Vol 4 ◽  
pp. 237428951771476 ◽  
Author(s):  
Joanna L. Conant ◽  
Pamela C. Gibson ◽  
Janice Bunn ◽  
Abiy B. Ambaye
Keyword(s):  
Quality Assurance ◽  
Medical Center ◽  
Turnaround Time ◽  
Support Staff ◽  
Surgical Pathology ◽  
Clinician Satisfaction ◽  
Multidisciplinary Conference ◽  
The University ◽  
University Of Vermont ◽  
General Sign

Many pathology departments are introducing subspecialty sign-out in surgical pathology. In 2014, the University of Vermont Medical Center transitioned from general sign-out to partial subspecialty sign-out to include gastrointestinal and breast/cervix subspecialty benches; other specimens remained on general benches. Our experiences with the transition are described, including attending pathologist, trainee, support staff, and clinician satisfaction. A survey was e-mailed to all University of Vermont Medical Center anatomic pathology attendings, pathology trainees, pathologist assistants and grossing technicians, and clinicians who send surgical pathology specimens, immediately before and 1 year after transitioning to partial subspecialty sign-out. Quality assurance metrics were obtained for the 18 months prior to and following the transition. Gastrointestinal and breast/cervix attendings were more satisfied with partial subspecialty sign-out compared to those on the general benches. Overall, trainees were more satisfied with general sign-out because of the rotation schedule but preferred partial subspecialty sign-out due to improved teaching and more focused learning while on subspecialty benches. Clinicians remained very satisfied with our department and our reports; no differences were observed. Turnaround time was unchanged. After switching to partial subspecialty sign-out, there were significantly fewer discrepancies following multidisciplinary conference review for gastrointestinal and breast/cervix cases but remained the same for general cases. Fewer formal internal consults were performed after transitioning to partial subspecialty sign-out across all areas, but more notable for gastrointestinal and breast/cervix cases. Our data show improved quality assurance metrics and trainee education in a subspecialty sign-out setting compared to general sign-out setting.

The Cardiac Rehabilitation Program of the University of Vermont Medical Center

1986 ◽  
Vol 6 (7) ◽  
pp. 265-277 ◽  
Author(s):  
Philip A. Ades ◽  
Cathy P. Meacham ◽  
Mary A. Handy ◽  
William E. Nedde ◽  
John S. Hanson
Keyword(s):  
Cardiac Rehabilitation ◽  
Medical Center ◽  
Rehabilitation Program ◽  
Cardiac Rehabilitation Program ◽  
The University ◽  
University Of Vermont

scholarly journals All Hands-On Deck and All Decks on Hand: Surmounting Supply Chain Limitations During the COVID-19 Pandemic

2021 ◽  
Vol 8 ◽  
pp. 237428952110119
Author(s):  
Jill S. Warrington ◽  
Jessica W. Crothers ◽  
Andrew Goodwin ◽  
Linda Coulombe ◽  
Tania Hong ◽  
...  
Keyword(s):  
Supply Chain ◽  
Medical Center ◽  
Clinical Care ◽  
Disease Outbreaks ◽  
Full Time ◽  
Sample Collection ◽  
Full Time Equivalent ◽  
Laboratory Staff ◽  
The University ◽  
University Of Vermont

Testing during the COVID-19 pandemic has been crucial to public health surveillance and clinical care. Supply chain constraints—spanning limitations in testing kits, reagents, pipet tips, and swabs availability—have challenged the ability to scale COVID-19 testing. During the early months, sample collection kits shortages constrained planned testing expansions. In response, the University of Vermont Medical Center, University of Vermont College of Medicine, Vermont Department of Health Laboratory, Aspenti Health, and providers across Vermont including 16 area hospitals partnered to surmount these barriers. The primary objectives were to increase supply availability and manage utilization. Within the first month of Vermont’s stay-at-home order, the University of Vermont Medical Center laboratory partnered with College of Medicine to create in-house collection kits, producing 5000 per week. University of Vermont Medical Center reassigned 4 phlebotomists, laboratory educators, and other laboratory staff, who had reduced workloads, to participate (requiring a total of 5.3-7.6 full-time equivalent (FTE) during the period of study). By August, automation at a local commercial laboratory produced 22,000 vials of media in one week (reducing the required personnel by 1.2 FTE). A multisite, cross-institutional approach was used to manage specimen collection kit utilization across Vermont. Hospital laboratory directors, managers, and providers agreed to order only as needed to avoid supply stockpiles and supported operational constraints through ongoing validations and kit assembly. Throughout this pandemic, Vermont has ranked highly in number of tests per million people, demonstrating the value of local collaboration to surmount obstacles during disease outbreaks and the importance of creative allocation of resources to address statewide needs.

Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings

2019 ◽  
Vol 9 (2) ◽  
pp. e13-e13
Author(s):  
Macaulay Amechi Chukwukadibia Onuigbo
Keyword(s):  
Renal Failure ◽  
Elderly Patients ◽  
Medical Center ◽  
Cardiorenal Syndrome ◽  
Loop Diuretics ◽  
Recent Experience ◽  
Resource Poor ◽  
The University ◽  
University Of Vermont

Over the last decade or more, there has grown a body of evidence demonstrating that renal dysfunction in heart failure is a combination of forward failure from reduced cardiac output and therefore reduced glomerular filtration rate, as well as "congestive renal failure" secondary to renal venous hypertension. We had demonstrated the efficacy of combination intravenous loop diuretics used concurrently with intravenous chlorothiazide to achieve significant renal salvage in such patients at the Mayo Clinic Health System in Northwestern Wisconsin. We describe a similar recent experience with three consecutive elderly patients at the University of Vermont Medical Center, Burlington, VT, USA. We posit that this paradigm of care is underutilized. We argue that aggressive decongestive therapy with combination intravenous loop and thiazide diuretics is a neglected and underutilized mechanism and must be utilized more frequently in the treatment of worsening renal failure with type 1 cardiorenal syndrome. This imperative is even most compelling in resource-poor settings where mechanical ultrafiltration with dialysis or similar machines is not available or simply not affordable. Moreover, we had also demonstrated that accelerated rising Pro B natriuretic peptide (Pro-BNP) in such patients portends a good prognosticator for renal salvage. We present here three consecutive elderly patients recently so managed successfully at the University of Vermont Medical Center in Burlington, VT, USA.

scholarly journals Undiagnosed Malignancy and Therapeutic Complications in Oncology Patients: A 10-Year Review of Autopsy Cases

2021 ◽  
Author(s):  
Noman Javed ◽  
Justin Rueckert ◽  
Sharon Mount
Keyword(s):  
Retrospective Study ◽  
Cancer Patients ◽  
Cause Of Death ◽  
Medical Therapy ◽  
Medical Errors ◽  
Incidental Finding ◽  
Medical Center ◽  
Postmortem Examination ◽  
The University ◽  
University Of Vermont

Context.— Despite technologic and medical advancements, autopsies are essential to uncover clinically unsuspected diagnoses, to advance our understanding of disease processes, and to help reduce medical errors. Objective.— To investigate the percentage of malignancy clinically diagnosed and undiagnosed in a series of hospital autopsies. Secondarily, to explore the therapeutic complications directly contributing to death in cancer patients. Design.— A 10-year retrospective study (2008–2018). All nonforensic autopsies performed at the University of Vermont Medical Center during this period were reviewed by 2 pathologists, and data, including antemortem diagnoses of malignancy, and autopsy findings, including therapeutic complications, were collected. Results.— A total of 246 cases documented a diagnosis of malignancy. In 34.5% (85 of 246) of cases a tissue diagnosis of malignancy was first documented following postmortem examination. In 41.2% (35 of 85) of cases there was clinical antemortem suspicion of malignancy, whereas in 58.8% (50 of 85) clinically unsuspected malignancy was first diagnosed after postmortem examination. In 16.0% (8 of 50) of cases the undiagnosed malignancy was the primary cause of death. The overall rate of therapeutic complication related to the treatment of oncologic disease in patients that resulted in death was 21.7% (35 of 161). Conclusions.— Our study shows the percentage of clinically unsuspected malignancies revealed by postmortem examination to be 5% (50 of 1003) of all autopsy cases. In 16% (8 of 50) of cases, the cause of death was due to the clinically undiagnosed malignancy, and hence not an incidental finding. Despite advances in medical therapy in the management of oncologic disease, in up to 21.7% (35 of 161) of cases therapeutic complications directly contributed to death.

scholarly journals Liquid materials for biomedical research: a highly IT-integrated and automated biobanking solution

2019 ◽  
Vol 43 (6) ◽  
pp. 347-354 ◽  
Author(s):  
Daniela Popp ◽  
Romanus Diekmann ◽  
Lutz Binder ◽  
Abdul R. Asif ◽  
Sara Y. Nussbeck
Keyword(s):  
Life Cycle ◽  
Medical Center ◽  
Research Results ◽  
Long Term Storage ◽  
Medical Centers ◽  
It Systems ◽  
Complete Life Cycle ◽  
The University ◽  
Term Storage

Abstract Various information technology (IT) infrastructures for biobanking, networks of biobanks and biomaterial management are described in the literature. As pre-analytical variables play a major role in the downstream interpretation of clinical as well as research results, their documentation is essential. A description for mainly automated documentation of the complete life-cycle of each biospecimen is lacking so far. Here, the example taken is from the University Medical Center Göttingen (UMG), where the workflow of liquid biomaterials is standardized between the central laboratory and the central biobank. The workflow of liquid biomaterials from sample withdrawal to long-term storage in a biobank was analyzed. Essential data such as time and temperature for processing and freezing can be automatically collected. The proposed solution involves only one major interface between the main IT systems of the laboratory and the biobank. It is key to talk to all the involved stakeholders to ensure a functional and accepted solution. Although IT components differ widely between clinics, the proposed way of documenting the complete life-cycle of each biospecimen can be transferred to other university medical centers. The complete documentation of the life-cycle of each biospecimen ensures a good interpretability of downstream routine as well as research results.

scholarly journals Hand Hygiene Compliance Study at a Large Central Hospital in Vietnam

2019 ◽  
Vol 16 (4) ◽  
pp. 607 ◽  
Author(s):  
Cam Le ◽  
Erik Lehman ◽  
Thanh Nguyen ◽  
Timothy Craig
Keyword(s):  
Quality Assurance ◽  
Hand Hygiene ◽  
Healthcare Workers ◽  
Medical Center ◽  
Compliance Rate ◽  
World Health ◽  
Limiting Factors ◽  
Cultural Attitudes ◽  
Knowledge And Attitude ◽  
Hygiene Compliance

Lack of proper hand hygiene among healthcare workers has been identified as a core facilitator of hospital-acquired infections. Although the concept of hand hygiene quality assurance was introduced to Vietnam relatively recently, it has now become a national focus in an effort to improve the quality of care. Nonetheless, barriers such as resources, lack of education, and cultural norms may be limiting factors for this concept to be properly practiced. Our study aimed to assess the knowledge and attitude of healthcare workers toward hand hygiene and to identify barriers to compliance, as per the World Health Organization’s guidelines, through surveys at a large medical center in Vietnam. In addition, we aimed to evaluate the compliance rate across different hospital departments and the roles of healthcare workers through direct observation. Results showed that, in general, healthcare workers had good knowledge of hand hygiene guidelines, but not all believed in receiving reminders from patients. The barriers to compliance were identified as: limited resources, patient overcrowding, shortage of staff, allergic reactions to hand sanitizers, and lack of awareness. The overall compliance was 31%; physicians had the lowest rate of compliance at 15%, while nurses had the highest rate at 39%; internal medicine had the lowest rate at 16%, while the intensive care unit had the highest rate at 40%. In summary, it appears that addressing cultural attitudes in addition to enforcing repetitive quality assurance and assessment programs are needed to ensure adherence to safe hand washing.

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