Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18654-e18654
Author(s):  
Reid Christian Bowers ◽  
Sandra Tomany Korman ◽  
Michael A. Thompson ◽  
Sherjeel Sana ◽  
Manish Krishna Pant ◽  
...  
Keyword(s):  
Best Practices ◽  
Blood Product ◽  
Healthcare Providers ◽  
Nutrient Deficiency ◽  
Hematologic Malignancies ◽  
Nutrient Deficiencies ◽  
Hospital Discharges ◽  
Chi Square ◽  
Access To Treatment ◽  
Subsequent Addition

e18654 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were <13 g/dL in men and <12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2020, 181 were referred to the Anemia Clinic and 259 were not. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (52.5% vs. 43.6% Chi-Square p=0.07). Of preoperatively anemic Pts who were transfused in 2020, an average of 1.49 PRBCs were used in the referred group vs. an average of 2.12 PRBCs in those in the not referred group (Poisson Means p=0.0009). Length of stay (LOS) which was a median 9d ( P25=6d, P75=16d) in the referred group vs a median 10d ( P25=6d, P75=16d) in the non-referred group was not statistically different between groups (Smirnov p=0.99). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2020 through Nov. the referred group had an O/E = 0.89 (observed LOS μgeo = 9.97 days, expected LOS μgeo = 11.17 days, N=159). The not referred group had an O/E = 0.94 (observed LOS μgeo = 10.14 days, expected LOS μgeo = 10.83 days, N=232). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year. Subsequent addition of Anemia Clinic services did not decrease PRBC use further at first but appears to have contributed to this past year’s decrease. There is a trend toward shorter LOS for patients referred to Anemia Clinic but it is not statistically significant. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies.[Table: see text]

Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14142-e14142
Author(s):  
Reid Christian Bowers ◽  
Michael A. Thompson ◽  
Sandra Tomany Korman ◽  
Sherjeel Sana ◽  
Manish Krishna Pant ◽  
...  
Keyword(s):  
Best Practices ◽  
Blood Product ◽  
Healthcare Providers ◽  
Nutrient Deficiency ◽  
Hematologic Malignancies ◽  
Nutrient Deficiencies ◽  
Hospital Discharges ◽  
Chi Square ◽  
Access To Treatment ◽  
Subsequent Addition

e14142 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2019, 180 were referred to the Anemia Clinic and 301 were not. Anemia Clinic identified iron (N = 114), vitamin B12 (N = 24), and folate (N = 18) deficiencies. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (65.6% vs. 61.8% Chi-Square p = 0.44). Of preoperatively anemic Pts who were transfused in 2019, an average of 2.34 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (Poisson Means p = 0.46). Length of stay (LOS) which was a median 10d ( P25= 7d, P75 =17d) in the referred group vs a median 12d ( P25= 7d, P75 =19d) in the non-referred group was not statistically different between groups (Smirnov p = 0.39). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2019 through Nov. the referred group had an O/E = 1.03 (observed LOS μgeo = 11.58 days, expected LOS μgeo = 11.21 days, N = 167). The not referred group had an O/E = 1.06 (observed LOS μgeo = 12.24 days, expected LOS μgeo = 11.58 days, N = 272). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year. Subsequent addition of Anemia Clinic services has not decreased PRBC use further. There is a trend toward shorter LOS for patients referred to Anemia Clinic but it is not statistically significant. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]

Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital: Focus on cardiovascular patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18014-e18014
Author(s):  
Reid Christian Bowers ◽  
Sandra Tomany Korman ◽  
Michael A. Thompson ◽  
Manish Krishna Pant ◽  
Sherjeel Sana ◽  
...  
Keyword(s):  
Best Practices ◽  
Blood Product ◽  
Medical Center ◽  
Healthcare Providers ◽  
Nutrient Deficiency ◽  
Hematologic Malignancies ◽  
Hospital Discharges ◽  
Chi Square ◽  
Cardiovascular Patients ◽  
To Receive

e18014 Background: As part of a system wide implementation of Patient Blood Management (PBM), an Anemia Clinic program was implemented at St. Luke’s Medical Center, Advocate Aurora Health in Milwaukee, WI. Methods: September 2016 the Anemia Clinic started accepting referrals for management of non-cancer anemia, predominantly pre-operative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiency received appropriate supplementation. Pts with CKD or chronic disease were eligible to receive erythropoiesis stimulating agents. Results: PBM implementation 2015-2018 resulted in a drop in packed red blood cell (PRBC) usage during a surgical episode (Table). Of 508 CVS Pts pre-operatively anemic in 2018, 155 were referred to the Anemia Clinic and 353 were not. There was not a statistical difference between the referred and the non-referred for percentage of Pts who received PRBCs (65.4% vs. 70.3% Chi-Square p = 0.31). Of preoperatively anemic Pts who were transfused in 2018 an average of 2.23 PRBCs were used in the referred group vs. an average of 2.35 PRBCs in those in the not referred group (Poisson Means p = 0.49). Length of stay (LOS) in the referred group was a median 10d ( P25= 7d, P75 =15d) vs LOS in the non-referred group was a median 11d ( P25= 7d, P75 =20d). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges.. For 2018 through Nov. the referred group was observed to have LOS mgeo = 10.19 days vs LOS mgeo = 11.72 days (N = 141, O/E 0.87). The not referred group was observed to have a LOS mgeo = 12.45 days vs. an LOS mgeo = 10.65 days (N = 311, O/E 1.17). Conclusions: Referral to the Anemia Clinic as part of a broader program of PBM was associated with shorter LOS and a decrease in PRBC use. Implementation of PBM at our institution decreased PRBC use even in patients not referred to anemia clinic due to systematization of best practices. Implementation of our methods as the initial approach to general anemia referrals may increase access and efficiencies in the systemization and treatment of hematologic malignancies. [Table: see text]

Identification of Current Best Practices for Short-term Medical Mission Trips and Adherence to Current Common Principles and Guidelines

2020 ◽  
Vol 7 (2) ◽  
pp. 67-82
Author(s):  
Susan Andrews
Keyword(s):  
Best Practices ◽  
Global Health ◽  
Language Proficiency ◽  
Survey Methodology ◽  
Healthcare Providers ◽  
Final Analysis ◽  
Short Term ◽  
Convenience Sample ◽  
Operational Practices ◽  
Descriptive Survey

Background:  Recent reviews of published guidelines for conducting short-term medical missions (STMM) identify significant concerns about the lack of adherence and of formal regulations concurrent with the increasing number of individuals and organizations participating in STMM. Method: A descriptive survey methodology was used. A 44-item survey that identifies current practices utilized by healthcare providers (HCP) who have participated in STMM was used based on the literature and prior research, and distributed electronically to HCP participating in STTM to identify current best practices and compare findings with the most recent recommendations for short-term global health activities. A focus on current operational practices was surveyed and analyzed to develop operational recommendations for the ethical and safe care provided during STMM. Results: Eighty-seven surveys were included in the final analysis, with 33% (N=29) serving as coordinators for the trip. The majority of the respondents were female (67%) and the primary roles represented were: MD (N=17; 20%), nurse practitioner (N=20; 23%), and registered nurse (N=18; 21%). A majority (N=48; 67%) traveled to South America or Latin America, with 38% (N=33) having participated in four or more STMM. Language proficiency was reported as deficient (N=35; 40%) along with little or no knowledge of the basic culture (N=39; 45%). Additional data were collected on trip preparation, clinic operations, and outcomes follow up. Conclusions: Using a convenience sample, the results of the survey provide information on the current best practices utilized by HCP who have participated in STMM and compare the findings to assess for adherence with the most recent recommendations for short-term global health activities. There was variation in the degree to which HCP were knowledgeable about specific aspects related to knowledge of local culture, language proficiency, and adherence to recommended practices for STMM. Additional research on STMM is needed, along with further exploration of how evidence based practices for STMM can be implemented to improve access and safety to the care provided while in the host country.

scholarly journals Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Multidisciplinary Care ◽  
The United States ◽  
Comprehensive Care ◽  
Patient Support ◽  
Patient Support Group ◽  
Patient Advocates

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

scholarly journals Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽  
2016 ◽  
Vol 6 (4) ◽  
pp. 215824401667774 ◽  
Author(s):  
Benjamin Woodward ◽  
Reba Umberger
Keyword(s):  
Best Practices ◽  
Healthcare Providers ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mandatory Reporting ◽  
Future Research ◽  
Common Source ◽  
Healthcare Associated Infection ◽  
Extrinsic Factors ◽  
The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

Human Factors Considerations for Patients: A Cursory Review of Telehealth Guidelines

2021 ◽  
Vol 65 (1) ◽  
pp. 943-947
Author(s):  
Sarah A. Powers ◽  
Kimberly N. Perry ◽  
Amanda J. Ashdown ◽  
Matthew Pacailler ◽  
Mark W. Scerbo
Keyword(s):  
Best Practices ◽  
Human Factors ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Environmental Requirements ◽  
Laws And Policies

During the COVID-19 pandemic, changes to telehealth laws and policies enabled more patients to meet with their healthcare providers remotely. The rapid implementation of telehealth has resulted in providers and patients interacting remotely with few existing standards or guidelines. Additionally, a cursory search of telehealth guidelines for patients revealed overly broad recommendations related to technology, security, and environmental requirements. Although researchers have recommended some human factors considerations for guidelines, these recommendations were rarely implemented in the guidelines we reviewed. Therefore, human factors professionals can contribute further by implementing best practices for telehealth appointments to create evidence-based standardized guidelines. Some initial areas to focus on include accessibility for patients, overcoming typical telehealth barriers, and addressing a wider diversity of patients.

scholarly journals A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Mihaela C. Munteanu ◽  
Julie Choi Jordan
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
Medical Professional ◽  
Physician Attitudes ◽  
Negative Consequences ◽  
Access To Treatment ◽  
Medical Specialties ◽  
And Behavior

Medical professional societies each develop specific clinical practice guidelines (CPGs). Based on the best available evidence, CPGs are intended to control variability and optimize quality of care in clinical practice. Yet, healthcare providers often do not accept or adhere to guidelines, but their reasons are not fully understood. When providers opt to choose not to follow CPGs, unfavorable patient outcomes including unequal access to treatment become negative consequences. In this small qualitative study, we will explore what causes non-adherence to CPGs and what changes have been made to CPGs from when physicians completed their medical residencies to the present. We interviewed physicians from a variety of medical specialties to assess how these changes may influence guideline adherence as well as the consequences of not following them. We found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. In some specialties, physicians can develop a poor reputation if they do not adhere to the CPGs, and managed care agencies may deny reimbursement for care they provided. To best serve the physician and the patient, we need to find ways to improve CPG adherence. Tactics such as improving the methodology of CPG formation, using information technology, and creating ways to change physician attitudes and behavior are all viable options.

scholarly journals A Study of Factors Influencing Plant Growth by WSN Approach and Plant Nutrient Deficiency Classification in Tomato Using SVM

2021 ◽  
Vol 23 (06) ◽  
pp. 36-46
Author(s):  
Vrunda Kusanur ◽  
◽  
Veena S Chakravarthi ◽  
Keyword(s):  
Machine Learning ◽  
Plant Growth ◽  
Nutrient Deficiency ◽  
Learning Model ◽  
Plant Nutrients ◽  
Polynomial Kernel ◽  
Second Phase ◽  
Nutrient Deficiencies ◽  
Deficiency Symptoms ◽  
Machine Learning Model

Soil temperature and humidity straight away influence plant growth and the availability of plant nutrients. In this work, we carried out experiments to identify the relationship between climatic parameters and plant nutrients. When the relative humidity was very high, deficiency symptoms were shown on plant leaves and fruits. But, recognizing and managing these plant nutrients manually would become difficult. However, no much research has been done in this field. The main objective of this research was to propose a machine learning model to manage nutrient deficiencies in the plant. There were two main phases in the proposed research. In the first phase, the humidity, temperature, and soil moisture in the greenhouse environment were collected using WSN and the influence of these parameters on the growth of plants was studied. During experimentation, it was investigated that the transpiration rate decreased significantly and the macronutrient contents in the plant leave decreased when the humidity was 95%. In the second phase, a machine learning model was developed to identify and classify nutrient deficiency symptoms in a tomato plant. A total of 880 images were collected from Bingo images to form a dataset. Among all these images, 80% (704 images) of the dataset were used to train the machine learning model and 20% (176 images) of the dataset were used for testing the model performance. In this study, we selected K-means Clustering for key points detection and SVM for classification and prediction of nutrient stress in the plant. SVM using linear kernel performed better with the accuracy rates of 89.77 % as compared to SVM using a polynomial kernel.

scholarly journals Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1349
Author(s):  
Yu-Ren Lin ◽  
Yen-Yue Lin ◽  
Chia-Peng Yu ◽  
Ya-Sung Yang ◽  
Chun-Gu Cheng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
Intensive Care Units ◽  
Enterococcus Faecium ◽  
Healthcare Providers ◽  
Incidence Density ◽  
Healthcare Associated Infections ◽  
Chi Square ◽  
Control Protocols ◽  
Healthcare Associated

Background: Healthcare-associated infections (HAIs) cause increases in length of stay, mortality, and healthcare costs. A previous study conducted in Taiwan obtained similar results to those reported in Korea and Japan in 2015. Changes in microorganisms have been noted in recent years. Understanding the recent condition of HAIs in intensive care units (ICUs) can enable healthcare providers to develop effective infection control protocols to reduce HAIs. Methods: We used the Taiwan Nosocomial Infection Surveillance System to evaluate the incidence densities of HAIs, the proportions of causative pathogens, and the proportions of antimicrobial resistance (AMR). The Poisson regression model was constructed to incidence density, and the chi-square test was used to assess proportion. Results: The incidence density of HAIs decreased 5.7 to 5.4 per 1000 person-days. However, the proportions of Klebsiella pneumoniae and Enterococcus faecium significantly increased. In addition, the proportions of carbapenem-resistant K. pneumoniae and vancomycin-resistant Enterococcus faecium significantly increased over time. Conclusion: Analysis of the microorganisms involved in HAIs in ICUs showed elevated proportions of K. pneumoniae and E. faecium with AMR. Infection control protocols have been implemented for several years and require improvements regarding environmental cleanliness and medical staff prevention.

Abstract 184: Unraveling Disparities: Stroke Literacy, Self-Efficacy, and Perceptions of Care Among Spanish-Speaking Stroke Survivors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Pamela Cheng ◽  
Barbara Vickrey ◽  
Frances Barry ◽  
Monica Ayala-Rivera ◽  
Eric Cheng ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Care Patient ◽  
Spanish Speakers ◽  
Stroke Survivors ◽  
Chi Square ◽  
Spanish Speaking ◽  
Perceptions Of Care

Background: Approximately 25 million people in the US are Limited English Proficient (LEP). LEP individuals are more likely to feel dissatisfied with the quality of healthcare when compared to the English proficient, but little is known about LEP stroke survivors. Objective: To evaluate differences in stroke literacy, self-efficacy, and perceptions of healthcare delivery in English and Spanish-speaking individuals enrolled in the Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) trial. Methods: SUCCEED participants were given the option of receiving the intervention in English or Spanish. Baseline differences in stroke literacy (Schneider et al), self-efficacy (General Self-Efficacy Scale), and perceptions of care (Patient Assessment of Chronic Illness Care and Consumer Assessment of Healthcare Providers and Systems) were compared using T-test, Chi Square, and Fisher Exact in individuals who chose Spanish vs. English. Results: Of 487 participants, 207 preferred English and 280 chose Spanish. Despite feeling more worried about having a stroke (77 % vs. 67%), and feeling at risk of having a stroke (63% vs. 45%), Spanish-speakers were less likely to identify 3 stroke risk factors (19% vs. 33%, all p<0.05). Half of Spanish-speakers had difficulty understanding what was being told to them (50% vs. 30%), and less than half felt confident filling out medical forms (40% vs. 70%, both p<0.05). Spanish-speakers responded favorably about the ease of hospital admission or accessing medical care (80% vs. 55% and 72% vs. 53%), but responded negatively about providers spending enough time with them or explaining things in a way that was easy to understand (56% vs. 24% and 52% vs. 28%, all p<0.05). Spanish-speakers were more likely to feel that providers did not listen or respect what they had to say (52% vs. 22% and 44% vs. 17%, both p<0.05). Conclusion: Among stroke survivors, Spanish-speakers were more likely to have low stroke literacy, low self-efficacy, and a negative perception of healthcare delivery despite feeling that healthcare was accessible. Recognizing language barriers as a contributor to healthcare disparities, and tailoring interventions to address these barriers are crucial.

Sign in / Sign up

Export Citation Format

Share Document