scholarly journals MON-118 Reducing Unnecessary Repeat HbA1c Testing in a Tertiary Academic Hospital

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Vamana Rajeswaran ◽  
Lisa Alexander ◽  
Raad Alwithenani ◽  
Diana Jaskolka ◽  
Shirine Usmani ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Surrogate Marker ◽  
Academic Hospital ◽  
Repeat Testing ◽  
Root Cause ◽  
Important Target ◽  
Large Tertiary Care ◽  
The Impact

Abstract Background Glycated hemoglobin (HbA1c) is a surrogate marker of glycemia over the preceding three months, where the last 30 days contributes to 50% of the value (1). Therefore guidelines often recommend repeating HbA1c only after 3 months in most situations (2), but repeat testing of HbA1c is often conducted earlier when not warranted (3). We aimed to conduct a Quality Improvement (QI) initiative to reduce unnecessary repeat testing of HbA1c at a large tertiary care academic hospital in Toronto, Ontario by 50% by May 2020. Methods: The Model for Improvement Quality Improvement (QI) framework was used in the design of the QI project to reduce repeat HbA1c. Problem characterization was conducted to understand root causes and iterative Plan-Do-Study-Act cycles were used to develop a change intervention. Unnecessary HbA1c tests were the primary outcome and defined as repeat HbA1c testing within 60 days; the top three specialities that ordered unnecessary HbA1c tests were targeted for education prior to implementation of the change intervention. Results: Baseline data on all HbA1c tests in 2018 revealed repeat testing in approximately 10% of 15,290 HbA1c tests, with estimated potential savings of more than $11,000 based on the provincial reimbursement rate. The top 3 ordering specialities targeted for education included Nephrology (n=410 repeat HbA1c tests), Cardiology (n=246 repeat HbA1c tests), and Endocrinology (n=136 repeat HbA1C tests). Root cause analysis revealed that providers often ordered repeat HbA1c tests due to being unaware of prior results and a knowledge gap of testing recommendations. A laboratory forced function will be implemented on December 1, 2019 to cancel any repeat HbA1c tests within 60 days and calls to the lab to add HbA1c testing will be tracked. Conclusions: Repeat HbA1c testing is frequent in hospital settings and can be an important target for QI efforts. A forced function to cancel processing of repeat HbA1c may be an appropriate QI intervention to reduce repeat testing to promote high-value care. Ongoing data analysis will be conducted to assess the impact of this intervention. References (1) Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM, Sacks DB. Tests of Glycemia in Diabetes. Diabetes Care 2004;27(7): 1761-1773. (2) Berard LD, Siemens R, Woo V. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Monitoring Glycemic Control. Can J Diabetes 2018;42(Suppl 1):S47-S53. (3) Chami N, Simons JE, Sweetman A, Don-Wauchope AC. Rates of inappropriate laboratory test utilization in Ontario. Clinical Biochemistry 2017;50: 822-827.

scholarly journals Diagnosis and treatment delay of head and neck cancers during COVID-19 era in a tertiary care academic hospital: what should we expect?

2021 ◽  
Author(s):  
Pietro De Luca ◽  
Antonella Bisogno ◽  
Vito Colacurcio ◽  
Pasquale Marra ◽  
Claudia Cassandro ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Retrospective Analysis ◽  
Tertiary Care ◽  
Diagnostic Delay ◽  
Treatment Delay ◽  
Head And Neck Cancers ◽  
Control Measures ◽  
Academic Hospital ◽  
The Impact

Abstract Background Since the spreading of SARS-CoV-2 from China, all deferrable medical activities have been suspended, to redirect resources for the management of COVID patients. The goal of this retrospective study was to investigate the impact of COVID-19 on head and neck cancers’ diagnosis in our Academic Hospital. Methods A retrospective analysis of patients treated for head and neck cancers between March 12 and November 1, 2020 was carried out, and we compared these data with the diagnoses of the same periods of the 5 previous years. Results 47 patients were included in this study. We observed a significative reduction in comparison with the same period of the previous 5 years. Conclusions Our findings suggest that the COVID-19 pandemic is associated with a decrease in the number of new H&N cancers diagnoses, and a substantial diagnostic delay can be attributable to COVID-19 control measures.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

Long-Term Hearing Outcomes From Gamma Knife Treatment for Vestibulocochlear Nerve Schwannomas in a Large, Tertiary Care, Academic Hospital

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Matthew Maksimoski ◽  
Amishi Bajaj ◽  
Sneha Giri ◽  
Laurin M. Sharpe ◽  
John Kalapurakal ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Tertiary Care ◽  
Academic Hospital ◽  
Vestibulocochlear Nerve ◽  
Large Tertiary Care ◽  
Hearing Outcomes

scholarly journals The Impact of Antimicrobial Resistance and Aging in VAP Outcomes: Experience from a Large Tertiary Care Center

PLoS ONE ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. e89984 ◽  
Author(s):  
Marios Arvanitis ◽  
Theodora Anagnostou ◽  
Themistoklis K. Kourkoumpetis ◽  
Panayiotis D. Ziakas ◽  
Athanasios Desalermos ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Large Tertiary Care ◽  
The Impact

scholarly journals Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice

2020 ◽  
Author(s):  
Hermano Alexandre Lima Rocha ◽  
Antonia Célia de Castro Alcântara ◽  
Fernanda Colares de Borba Netto ◽  
Flavio Lucio Pontes Ibiapina ◽  
Livia Amaral Lopes ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Rapid Response Team ◽  
Lessons Learned ◽  
Rapid Response ◽  
Initial Assessment ◽  
Care Hospital ◽  
Large Tertiary Care ◽  
Response Team ◽  
Hospital Wards ◽  
The Impact

Abstract Quality problem or issue Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). Initial assessment An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. Choice of solution Adequacy of workforce sizing. Implementation The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. Evaluation After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. Lessons learned The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.

Treatment of Patients with a History of Penicillin Allergy in a Large Tertiary-Care Academic Hospital

2013 ◽  
Vol 1 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Matthieu Picard ◽  
Philippe Bégin ◽  
Hugues Bouchard ◽  
Jonathan Cloutier ◽  
Jonathan Lacombe-Barrios ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Penicillin Allergy ◽  
Academic Hospital ◽  
Large Tertiary Care ◽  
History Of

Contextual Failure Analysis Improves Reliability While Pushing the Envelope of Extended Reach Wells in a Giant Brown Field, UAE

2021 ◽  
Author(s):  
Elena Cantarelli ◽  
Khoa Le Pham Dang ◽  
Hernan Melgares Escalera
Keyword(s):  
Quality Improvement ◽  
Service Quality ◽  
Failure Analysis ◽  
Failure Modes ◽  
Action Plan ◽  
Comparative Approach ◽  
Risk Matrix ◽  
Priority List ◽  
Root Cause ◽  
The Impact

Abstract The current combination of increasingly complex wellbores and tightening budgets forces operators to do more with less and find new ways to expand the drilling envelop. Often this pushes the parameters to the limit in order to achieve faster penetration rates. Operating at the limit or beyond impacts equipment reliability and project cost. A thorough failure analysis of the root cause(s) of every incident can help identify and address areas that need improvement. Identifying a cause fosters improvement while it simultaneously pushes the boundaries so the profitability of mature assets can be maximized. Typical failure analysis attempts to determine the cause of a failure and establish corrective actions to prevent reoccurrence. In a large extended reach drilling project targeting a mature field, the approach to a single failure was expanded and projected in a proactive manner to anticipate the impact of current failure modes in future more challenging scenarios. This innovative method combines the classic failure analysis approach with a comparative approach designed to identify and classify each factor that contributed to the failure. This information is then compiled into a dynamic predictive risk matrix to improve the planning. This method, thanks to the contextualization of individual failures and the multi-facet comparative analysis, revealed a pattern between reliability trends and environmental challenges. The pattern was correlated with the increased drilling difficulty over the lifetime of the project, and suggested that the long-established practices had to be revised to overcome the new scenario. The analysis contributed to the delineation of a strong action plan that immediately revealed a consistent service quality improvement quarter on quarter and nearly a 50% decrease in failure rate. The enhanced reliability had a direct impact on the performance that registered a significant reduction of the drilling time, thus lowering the overall well construction cost. In today's economics where cost reduction, resource optimization and sustainability are at the top of the operator's priority list, failure analysis has become paramount to ensure continuous improvement. Effective analytic methods to identify and eliminate showstoppers are needed to minimize unplanned events and deliver within budget. By digging deep into the root cause of incidents, this new approach to failure analysis enabled an enhanced, broader and more effective quality improvement plan that tackled service quality from multiple angles. From refining bottomhole assembly (BHA) design and risk matrix to drafting field guidelines and roadmaps, this approach also provided extra guidance and risk awareness for future well planning improvement. This particularly applies to mature fields where wellbore complexity increases at the same time budgets decrease and it's necessary to improve operational excellence to assure profitability.

scholarly journals Readability of patient discharge instructions with and without the use of electronically available disease-specific templates

2015 ◽  
Vol 22 (4) ◽  
pp. 857-863 ◽  
Author(s):  
Stephanie K Mueller ◽  
Kyla Giannelli ◽  
Robert Boxer ◽  
Jeffrey L Schnipper
Keyword(s):  
Tertiary Care ◽  
Patient Discharge ◽  
Care Hospital ◽  
Discharge Diagnosis ◽  
Discharge Instructions ◽  
Flesch Reading Ease ◽  
Grade Levels ◽  
Large Tertiary Care ◽  
Specific Discharge ◽  
The Impact

Abstract Objective Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. Materials and Methods We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based “discharge module,” which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0–100 scale, with higher scores indicating greater readability) and the Flesch–Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). Results Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. Discussion The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient’s specific discharge diagnosis. Conclusions Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.

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