Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 262-262
Author(s):  
Ronak Patel ◽  
Victor Chiu ◽  
Darcy V. Spicer
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Post Intervention ◽  
Safety Net Hospital ◽  
The Mean ◽  
Chemotherapy Initiation ◽  
Mean Time

262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.

Identifying Actionable Causes of Potentially Avoidable Readmissions to an Oncology Service at a Safety Net Hospital

2020 ◽  
pp. OP.20.00593
Author(s):  
Vishal K. Gupta ◽  
Michael Dennis ◽  
Emily Mann ◽  
Joseph O. Jacobson ◽  
Naomi Y. Ko
Keyword(s):  
Pleural Fluid ◽  
Cancer Progression ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Oncology Service ◽  
Safety Net Hospital ◽  
Avoidable Readmissions

PURPOSE: Hospital readmissions occur commonly in those receiving cancer care and result in impaired quality of life and increased costs. Causes of readmission in safety net hospitals that serve vulnerable populations are not well understood. The primary goal of this project was to identify potentially avoidable and intervenable causes of readmissions to an urban safety net hospital. METHODS: A retrospective chart review was performed on patients who were readmitted within 30 days of discharge from the hematology and oncology service at Boston Medical Center over the 6-month period between October 2018 and March 2019. Charts were reviewed by three internal medicine residents and discussed under the supervision of an attending oncologist. RESULTS: Two hundred ninety-one patient encounters involving 203 unique patients were identified in the 6-month study period. Of these 291 encounters, 80 encounters (27.5%) were followed by a readmission within 30 days and occurred in 61 (30.0%) unique patients. Nineteen (31.1%) of these 61 patients experienced two readmissions within 30 days of discharge. Twenty-five readmissions (31.3%) were classified as potentially avoidable, with the most common cause of potentially avoidable readmissions attributed to ascitic or pleural fluid reaccumulation (8, 32%). The majority of presumed nonpreventable readmissions were due to expected complications of cancer progression and treatment-related side effects. DISCUSSION: In conclusion, readmissions were common, and a modifiable reason for 30-day readmissions was identified. Addressing recurrent ascitic and pleural fluid reaccumulation in the outpatient setting could help to reduce inpatient hospital readmission on an inpatient oncology service.

scholarly journals Impact of a Multi-disciplinary C. difficile Action Team

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S397
Author(s):  
Emily Heil ◽  
Bharathi Sivasailam ◽  
SoEun Park ◽  
Jose Diaz ◽  
Erik Von Rosenvinge ◽  
...  
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Disciplinary Action ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Post Intervention ◽  
Fecal Microbiota Transplant ◽  
Action Team

Abstract Background Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. Methods A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. Results We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. Conclusion Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. Disclosures All authors: No reported disclosures.

Abstract 17076: Empowering Telemetry Technicians to Call Code Blue

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Cody McCoy ◽  
Neil Keshvani ◽  
Maryam Warsi ◽  
Eugene Chu ◽  
Anita Hegde
Keyword(s):  
Clinical Status ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Post Intervention ◽  
Neurologic Outcomes ◽  
Code Blue ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Life Threatening ◽  
The Impact

Background: Delays in treatment of in-hospital cardiac arrest (IHCA) events are associated with lower survival and poor neurologic outcomes. With centralized telemetry, telemetry technicians need to notify nursing staff of life-threatening arrhythmias immediately for nursing to verify a patient's clinical status and determine whether code blue activation is necessary. Delays in this verification lead to delays in code activation, which can in turn lead to increased morbidity and mortality. Objective: We sought to assess the impact of empowering telemetry technicians to activate code blues on IHCA code survival, survival to discharge, time to cardiopulmonary resuscitation (CPR), and inappropriate code activation. Methods: We implemented a quality improvement protocol September 1, 2016 at Parkland Memorial Hospital, a 900-bed, urban, safety-net hospital, in Dallas, Texas to empower telemetry technicians to call code blue directly for the following life-threatening arrhythmias: ventricular fibrillation, sustained ventricular tachycardia of greater than 30 seconds, asystole, or bradycardia less than 30 beats/minute. We performed a retrospective chart review of all IHCA in patients on centralized telemetry at Parkland for one year prior to the intervention and three years post intervention to look at code survival and survival to discharge. Secondary outcomes were time to CPR and inappropriate code activation. Results: The pre intervention code survival was 12/20 (60.0%) and the post intervention code survival was 46/55 (83.6%) (p=0.03). The pre intervention survival to discharge was 3/20 (15.0%) and the post intervention survival to discharge was 21/55 (38.2%), (p=0.0585). The time to CPR, in seconds, was 180 versus 120 (p=0.58) for pre and post intervention non-PEA codes. There were 0 inappropriate code activations post intervention. Conclusions: Empowering telemetry technicians to activate code blue for general ward patients on centralized telemetry showed a significant improvement in code survival and a trend in survival to discharge. Importantly, there were no inappropriate code activations by telemetry technicians, highlighting the safety of this intervention.

scholarly journals Associations Between Structural and Social Determinants of Health With COVID Infection Rates at a Safety Net Hospital.

2021 ◽  
Author(s):  
Dotun Ogunyemi ◽  
Rolando Mantilla ◽  
Abhinav Markus ◽  
Aubrey Reeves ◽  
Suyee Win ◽  
...  
Keyword(s):  
Predictive Value ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Positive Association ◽  
Safety Net ◽  
Individual Risk ◽  
Infection Rates ◽  
Significant Positive Association ◽  
Increased Risk ◽  
Safety Net Hospital

Abstract Background: The reported disproportionate impact of COVID-19 infections on minority populations may be due to living in disinvested communities with high level of poverty, pollution, inadequate unsafe employment, and overcrowded housing.Objective: To determine the association of county, city, and individual risk factors with COVID-19 infection ratesMethods: Retrospective chart review on COVID-19 tests performed from March through July 2020 at Arrowhead Regional Medical Center, Colton­, California. Results: A total of 7104 tests were performed with 69% in the drive-through testing center. The mean duration of test-to-results time was 2.36 (+0.02) days. COVID-19 positive tests occurred in 1095 (15.4%). At least one symptom occurred in 414 (33%) with sensitivity of 37.8, specificity of 86.02, positive predictive value of 33.01, and negative predictive value of 72.76. Individual factors significantly associated with testing positive for COVID-19 were diabetes, Hispanic ethnicity, and male gender. Younger age was significantly associated with testing COVID positive with the highest risk in children <10 years. COVID-19 positive persons significantly resided in cities with higher population density, household members, poverty, non-English speaking homes, disability, lower median household income, lack of health insurance and decreased access to a computer and WIFI services. County health rankings showed significant positive association between testing positive for COVID-19 with increased smoking, air pollution, violent crimes, physical inactivity, decreased education and access to exercise. Conclusion: Adverse county health rankings; socially and economically disadvantaged cities are associated with an increased risk of testing positive for COVD-19. This information can be used in strategic planning and invention mitigation.

scholarly journals Improving Delays in Obtaining Lenalidomide at a Large Safety Net Hospital

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1925-1925
Author(s):  
Jonathan S. Pai ◽  
Ronak Patel ◽  
Sandra Algaze ◽  
Leslie Martinez ◽  
Caroline I. Piatek
Keyword(s):  
Research Funding ◽  
Medical Center ◽  
Safety Net ◽  
Patient Survey ◽  
Patient Support ◽  
Step Process ◽  
Clinic Staff ◽  
Safety Net Hospital ◽  
Specialty Pharmacy ◽  
Mean Time

Abstract Introduction: Lenalidomide is an immunomodulatory agent used primarily in the management of multiple myeloma and non-Hodgkin's lymphomas. Owing to the risks of birth defects and fetal death, lenalidomide is only available under a restricted program through Celgene called Revlimid Risk Evaluation and Mitigation Strategy (REMS). The Revlimid REMS program includes various requirements for patients and providers aimed to avoid embryo-fetal exposure from lenalidomide. Prescribers and patients are required to complete periodic mandatory surveys attesting that the patient is aware of the risks. Once the surveys are completed, a unique and time-limited authorization number is generated by Celgene, which must be included on the prescription. Each prescription is restricted to a 4-week supply with no automatic refills and must be sent to certified specialty pharmacy. In addition, the patient may require insurance authorization or may need to enroll in financial assistance program. Given this multi-step process, patients from our safety net hospital, LAC+USC Medical Center, experience delays in receiving their lenalidomide prescriptions. Such delays may lead to interruptions in cancer treatment and additional clinic visits. Our aim was to assess the effectiveness of the following interventions: creation of a standardized process flowchart, training of clinic staff, and additional patient support from Celgene to reduce delays in the dispensing of lenalidomide prescriptions. Methods: This is a retrospective study of patients prescribed lenalidomide through the hematology clinic at LAC+USC Medical Center, Los Angeles, CA from June 1, 2020 to December 31, 2020. Patients were identified through the Celgene REMS database. The electronic medical record was reviewed for: patient demographics, insurance, and specialty pharmacy dispensing of lenalidomide. Each prescription was reviewed for the authorization number, days from prescription submission to dispensing, and days between each prescription dispensing. A delay was defined as &gt; 2 weeks from the time from prescription submission to pharmacy dispensing. The medical chart was reviewed to identify the reason for the delay. A standardized process was created between July 2020 and August 2020. This included the creation of a workflow flowchart and training of the clinic staff. Additionally, a patient access specialist from Celgene was assigned to support patients and providers through the multi-step process for each prescription. The percentage of pre-intervention delays (before Sept 2020) and post-intervention delays (after Sept 2020) was compared. Results: A total of 196 lenalidomide prescriptions were reviewed. Prior to the intervention, the median time from prescription sent to date of dispensing was 3 days (range: 0-27 days), with a mean time of 5.9 days. 14 of 128 prescriptions (10.9%) had a delay of &gt; 2 weeks. Causes for delay included: awaiting completion of patient survey, insurance issues (need for prior authorization, insurance changes), clinic visit missed or not in correct timeframe to submit new prescription, hospitalization, and medication hold due to toxicity. Following the intervention, 3 of 68 prescriptions (4.4%) were delayed. Median time from prescription sent to date dispensed was 2.5 days (range: 0-29 days) with a mean time of 4.2 days. One prescription was not sent to the correct specialty pharmacy and one was on hold in setting of disease progression. Conclusion: Given the multi-step process, on-time dispensing of the specialty drug lenalidomide is a challenge at our safety net hospital. We identified several delays in the dispensing of lenalidomide prescriptions, including the timeliness of patient survey completion, drug coverage/insurance issues, and coordination of clinic visits with the time that the patient was due for the refill. Formalizing the workflow, training the clinic staff, and having a Celgene patient support specialist led to an improvement in prescription dispensing delays. With the continual addition of specialty medications into hematology/oncology clinics, establishing a standardized workflow with engagement of the clinic staff and specialty pharmacies/drug companies may help reduce delays in the dispensing of specialty drugs. Figure 1 Figure 1. Disclosures Piatek: Rigel: Consultancy, Research Funding; Alexion: Consultancy, Research Funding; Apellis: Research Funding; Dova: Consultancy, Speakers Bureau.

scholarly journals OP0159 EFFICACY OF COMPREHENSIVE TECHNOLOGY-ASSISTED HOME-BASED EXERCISE IN ANKYLOSING SPONDYLITIS: A RANDOMIZED, CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  
Keyword(s):  
Exercise Intervention ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Program ◽  
Group Differences ◽  
Control Group ◽  
Home Based ◽  
The Mean

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared

scholarly journals The Effect of Positive Mental Imagery on Labor Pain Tolerance in Primiparous Women Referred to Atieh Teaching-Medical Center of Hamadan, Iran, 2018

2019 ◽  
Author(s):  
Caroline Yavari ◽  
Seyedeh Zahra Masoumi ◽  
Farideh Kazemi ◽  
Mansoureh Refaei ◽  
Abolghasem Yaghoobi
Keyword(s):  
Mental Imagery ◽  
Medical Center ◽  
Intervention Group ◽  
Pain Scale ◽  
Pain Tolerance ◽  
Labor Pain ◽  
Control Group ◽  
Behavioral Pain Scale ◽  
The Mean ◽  
Primiparous Women

Abstract Background: Childbirth is an important experience in the woman's life; and its quality has short- and long-term effects on them. The present study aimed to determine the effect of positive mental imagery on the labor pain tolerance in primiparous women referred to Atieh teaching-medical center in Hamadan.Method: The present clinical trial study was conducted on 90 primiparous mothers referred to Atieh Hospital of Hamadan in interventional (n= 45) and control (n= 45) groups. Data collection tools included demographic information forms, Behavioral pain scale, Visual analogue scale (VAS), and the birth registration checklist that were responded by both groups through interviews and observation during labor. The intervention group participated in 4 weekly counseling sessions in groups of 5 to 7 participants, but the control group received only routine care. Finally, the obtained data from above questionnaires was analyzed using SPSS 21 and analysis of covariance (ANCOVA), Independent t-test and chi-square test and the significance level of tests was considered to be at the level of 5%.Results: The research results indicated that the mean age of control and intervention groups was 25.98±4.82 and 25.32± 4.85 respectively. The mean scores of Visual analogue scale (VAS) and the Behavioral Pain Scale significantly decreased compared to the control group (P <0.001). The mean scores of behavioral changes in the intervention group were 1.77 ± 0.68, 2.39± 0.54 and 3.09±0.60 in 4-5 cm, 6-7 cm and 8-10 cm dilatations respectively. That was statistically significant decrease compared to the control group (P=0.005). Conclusion: Positive mental imagery counseling reduced the visual analogue intensity and behavioral pain intensity in primiparous women. It seems that continuing education and counseling during pregnancy and empowering mothers to control themselves and learn mental imagery techniques and practice during pregnancy and childbirth can help mothers to more relax and alleviate the labor pain intensity.Trial registration: Trial Registration Clinical Trial Registry: IRCT20120215009014N242.Registered on 2017-09-10. https://en.irct.ir/trial/9621Sampling start date:2018-10-23

The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

2019 ◽  
Vol 13 (2) ◽  
pp. 123-131
Author(s):  
Simon E. Smith ◽  
Julie Miller
Keyword(s):  
Patient Satisfaction ◽  
Ulcer Healing ◽  
Case Series ◽  
Outpatient Setting ◽  
The Mean ◽  
Prospective Case Series ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Mean Time ◽  
Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

scholarly journals Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

2016 ◽  
Vol 37 (4) ◽  
pp. 448-454 ◽  
Author(s):  
Mohamed Sarg ◽  
Greer E. Waldrop ◽  
Mona A. Beier ◽  
Emily L. Heil ◽  
Kerri A. Thom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Icu Patients ◽  
Antimicrobial Utilization ◽  
Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

Tongue-tie division to treat breastfeeding difficulties: our experience

2015 ◽  
Vol 129 (10) ◽  
pp. 986-989 ◽  
Author(s):  
S D Sharma ◽  
S Jayaraj
Keyword(s):  
Standard Deviation ◽  
Surgical Complications ◽  
Assessment Tool ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Early Age ◽  
Post Intervention ◽  
The Mean ◽  
Surgical Group ◽  
Telephone Questionnaire

AbstractObjectives:To assess the benefits of frenotomy on breastfeeding in infants, and determine the influence of age.Methods:A telephone questionnaire of all patients diagnosed with tongue-tie over 12 months was conducted pre-intervention and 1-month post-intervention. The Infant Breastfeeding Assessment Tool was used to assess breastfeeding.Results:Of 54 infants diagnosed with tongue-tie, 78 per cent of mothers participated in the survey. Eighty-six per cent of patients underwent frenotomy, with no surgical complications. In the frenotomy group, 81 per cent of mothers reported improvement in breastfeeding, versus 17 per cent in the non-surgical group (p = 0.0074). In the frenotomy group, the mean (±standard deviation) Infant Breastfeeding Assessment Tool score was 3.33 ± 1.51 pre-intervention, versus 9.19 ± 2.44 post-intervention (p = 0.0001). In the non-surgical intervention group, the mean score (±standard deviation) was 4.17 ± 0.75 pre-intervention, versus 6.00 ± 1.73 post-intervention (p = 0.16). For infants who underwent frenotomy, there was a reported improvement in 94 per cent of those aged less than 30 days, versus 68 per cent in infants aged over 30 days (p = 0.092).Conclusion:Frenotomy is a safe, short procedure that improves breastfeeding outcomes, and is best performed at an early age.

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