scholarly journals Expanding access for COVID-19 patients by transforming a burn unit into a closed-circuit unit for surgical patients: experience from an academic medical center in Jordan

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Diab Bani Hani ◽  
Omar Altal ◽  
Abdelwahab Aleshawi ◽  
Ala”a Alhowary ◽  
Basil Obeidat
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Closed Circuit ◽  
Surgical Patients ◽  
Academic Medical ◽  
Burn Unit ◽  
Patients Experience

Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center

2009 ◽  
Vol 10 (7) ◽  
pp. 753-758 ◽  
Author(s):  
Kevin J. Finkel ◽  
Adam C. Searleman ◽  
Heidi Tymkew ◽  
Christopher Y. Tanaka ◽  
Leif Saager ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Medical Center ◽  
Academic Medical Center ◽  
Surgical Patients ◽  
Academic Medical ◽  
Obstructive Sleep

Agency for Healthcare Research and Quality Patient Safety Indicators and Mortality in Surgical Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 801-804 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Patricia Leavell ◽  
Luke G. Wolfe ◽  
Therese M. Duane
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Length ◽  
Healthcare Research ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Patient Safety Indicators ◽  
Academic Medical

Patient safety indicators (PSI), developed by the Agency for Healthcare Research and Quality, use administrative billing data to measure and compare patient safety events at medical centers. We retrospectively examined whether PSIs accurately reflect patients’ risk of mortality, hospital length of stay, and intensive care unit (ICU) requirements at an academic medical center. Surgical patient records with PSIs were reviewed between October 2011 and September 2012 at our urban academic medical center. Primary outcomes studied included mortality, hospital length of stay, and ICU requirements. Subset analysis was performed for each PSI and its association with the outcome measures. PSIs were more common among surgical patients who died as compared with those alive at discharge (35.3 vs 2.7 PSIs/100 patients, P < 0.01). Although patients who died with PSIs had shorter hospital courses, they had a significantly greater ICU requirement than those without a PSI (96.0 vs 61.1%, P < 0.01) and patients who were alive at discharge (96.0 vs 48.0%, P < 0.01). The most frequently associated PSIs with mortality were postoperative metabolic derangements (41.7%), postoperative sepsis (38.5%), and pressure ulcers (33.3%). PSIs occur at a higher frequency in surgical patients who die and are associated with increased ICU requirements.

scholarly journals Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System

2014 ◽  
Vol 121 (3) ◽  
pp. 501-509 ◽  
Author(s):  
Steven M. Frank ◽  
Michael J. Oleyar ◽  
Paul M. Ness ◽  
Aaron A. R. Tobian
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Substantial Reduction ◽  
Information Management System ◽  
Surgical Patients ◽  
Release System ◽  
Time Period ◽  
Academic Medical ◽  
Utilization Data ◽  
Transfusion Ratio

Abstract Background: Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs. Methods: At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe®; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. Results: Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P &lt; 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P &lt; 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. Conclusion: Implementing institution-specific, updated maximum surgical blood order schedule–directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.

scholarly journals The Hospital Experience Through the Patients’ Eyes

2019 ◽  
Vol 7 (3) ◽  
pp. 408-417 ◽  
Author(s):  
Haverly J Snyder ◽  
Kathlyn E Fletcher
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Hospital Environment ◽  
Quality Reporting ◽  
Hospital Experience ◽  
Academic Medical ◽  
Patient Tolerance ◽  
Qualitative Interview Study ◽  
Patients Experience

Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult. Design: Qualitative interview study using grounded theory methodology. Setting: Single-site academic medical center. Patients: Hospitalized general medicine patients. Measurements: Interviews using a semistructured interview guide. Results: We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction. Conclusions: This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.

scholarly journals COVID-19-RELATED COAGULOPATHY IN CRITICALLY ILL PATIENTS: EXPERIENCE FROM AN ACADEMIC MEDICAL CENTER

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1038-A1039
Author(s):  
Thejus Thayyil Jayakrishnan ◽  
Aaron Haag ◽  
Shane Mealy ◽  
Corbyn Minich ◽  
Abraham Attah ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Patients Experience

Anesthesia-Associated Carbon Monoxide Exposures Among Surgical Patients

2001 ◽  
Vol 22 (6) ◽  
pp. 352-356 ◽  
Author(s):  
Michele L. Pearson ◽  
William C. Levine ◽  
Robert J. Finton ◽  
Charles T. Ingram ◽  
Kathleen B. Gay ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
General Anesthesia ◽  
Chemical Interaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Anesthesia Machine ◽  
Early Postoperative Period ◽  
Surgical Patients ◽  
Academic Medical ◽  
Increased Risk

AbstractObjective:To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.Design:Matched case-control study to measure carboxyhemoglobin levels.Setting:Large academic medical center.Participants:45 surgical patients who underwent general anesthesia.Results:Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.Conclusions:Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.

Perioperative methadone prescribing and association with respiratory depression

2020 ◽  
Vol 16 (6) ◽  
pp. 443-449
Author(s):  
Sarah E. Bova, PharmD ◽  
Rachel M. Kruer, PharmD ◽  
Suzanne A. Nesbit, PharmD ◽  
Michael C. Grant, MD ◽  
Andrew S. Jarrell, PharmD
Keyword(s):  
Respiratory Depression ◽  
Medical Records ◽  
Medical Center ◽  
Operative Procedure ◽  
Academic Medical Center ◽  
Post Operative Pain ◽  
Academic Medical ◽  
Male Sex ◽  
Baseline Characteristics ◽  
Patients Experience

Objective: Over 80 percent of surgery patients experience acute post-operative pain and less than half feel their pain is adequately controlled. Patients receiving chronic opioids, including methadone, are at the highest risk of inadequate pain control. Guidelines do not provide specific recommendations for analgesia management in this population. The purpose of this study was to evaluate the association between post-operative methadone use and respiratory depression.Design: This study was a single center, retrospective, cohort study of adult patients.Setting: Patients included were admitted to a single academic medical center from July 2016 to September 2018.Participants: Medical records of adult inpatients with an operative procedure who received perioperative methadone were reviewed.Main outcome measures: Preoperative methadone use was evaluated for all patients. Post-operative methadone dosing was compared to preoperative methadone dosing. Post-operative respiratory depression was evaluated. Logistic regression was performed to identify risk factors for respiratory depression.Results: Two hundred ninety-eight patients were included in the study. Patients were divided into groups based on preoperative methadone use. Over 90 percent of patients were on preoperative methadone. There were no significant differences in baseline characteristics between groups. In the initial seven post-operative days, 14.8 percent of patients had documented respiratory depression. Respiratory depression was more common among patients who were newly initiated on methadone post-operatively. Factors associated with respiratory depression included male sex, increased age, and new post-operative methadone initiation.Conclusions: Most patients who were administered post-operative methadone were on preoperative methadone. New post-operative methadone initiation was a risk factor for respiratory depression. 

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