Impact on physician workload and revenue following the creation of a specialty vein clinic within an academic vascular practice

2007 ◽  
Vol 22 (4) ◽  
pp. 164-170 ◽  
Author(s):  
M A Passman ◽  
J B Dattilo ◽  
R J Guzman ◽  
T C Naslund
Keyword(s):  
Vascular Surgery ◽  
Rapid Expansion ◽  
Time Period ◽  
Relative Value ◽  
Increasing Trend ◽  
Procedure Volume ◽  
Time Periods ◽  
The Impact ◽  
Academic Vascular Surgery ◽  
Physician Workload

Objective: To evaluate the impact of creating a new specialty vein clinic within an academic-based vascular practice on clinical volume, physician workload and financial parameters. Methods: All patients evaluated and treated for varicose vein related problems within an academic vascular surgery practice were identified from institutional billing databases. Data were stratified according to the time period prior to establishing a vein clinic (PRE-VC) (1999–2001) and after creation of a vein clinic (POST-VC) (2002–2004). Clinical volume, physician workload and financial parameters were evaluated. Comparisons were made between vein (VEIN) and overall vascular (VASC) practice trends. Results: Comparison of clinical volume, physician workload and financial parameters in both the clinic and operative settings showed larger and more rapid expansion of the VEIN practice than VASC practice between PRE-VC and POST-VC time periods (VEIN vs. VASC growth, respectively: new patient clinic volume +162 vs. +18%; clinic relative value units (RVUs) +131 vs. +1%, clinic revenue +201 vs. +44%; procedure volume +348 vs. +19%; procedure RVUs +129 vs. +11%; procedure revenue +93 vs. +10%). Comparing the beginning of PRE-VC to the end of POST-VC time periods, an increasing trend was also present for the percentage of VEIN practice accounting for the total VASC practice (%VEIN PRE-VC to POST-VC, respectively: new patient clinic volume 11.6–30.2%; clinic RVUs 3.2–48.2%; clinic revenue 17.6–31.2%; procedure volume 3.1–14.3%; procedure RVUs 2.8–9.8%; procedure revenue 3.3–11.7%). Conclusion: Establishing a specialty vein clinic within an academic vascular practice can lead to a rapid expansion of clinical volume with associated increase in physician workload and reimbursement at a rate greater than that for the overall vascular practice.

Merging Two Hospitals: The Effects on Pediatric Extracorporeal Cardiopulmonary Resuscitation Outcomes

2020 ◽  
Author(s):  
Rebecca Anderson de la Llana ◽  
Renate Le Marsney ◽  
Kristen Gibbons ◽  
Benjamin Anderson ◽  
Emma Haisz ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Initial Time ◽  
Nonsignificant Trend ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Time Period ◽  
Neurocognitive Outcomes ◽  
Time Periods ◽  
The Impact

AbstractA retrospective study was performed to describe the impact of merging two pediatric intensive care units on the overall and neurocognitive outcomes of children who required extracorporeal cardiopulmonary resuscitation (ECPR). Results from three cohorts were compared: 2008 to 2014: premerge, 2014 to 2017: initial time period postmerge, and 2018 to 2019: established merge. Survival to hospital discharge (and with good neurological outcome) was of 68% (61%), 46% (36%), and 79% (71%), respectively, for the three time periods. Merging two hospitals resulted in a nonsignificant trend toward temporary worse outcomes in pediatric patients requiring ECPR.

scholarly journals 1344. Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S683-S683
Author(s):  
Julia Sapozhnikov ◽  
Marisol Fernandez
Keyword(s):  
Pediatric Hospital ◽  
Antimicrobial Utilization ◽  
Time Period ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Central Texas ◽  
Successful Approach ◽  
Time Periods ◽  
The Impact ◽  
Physician Team

Abstract Background “Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD). Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure Results Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P< 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P< 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D]. Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days Conclusion Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion. Disclosures All Authors: No reported disclosures

scholarly journals Delayed Leidenfrost phenomenon during impact of elastic fluid droplets

2020 ◽  
Vol 476 (2243) ◽  
pp. 20200556
Author(s):  
Purbarun Dhar ◽  
Soumya Ranjan Mishra ◽  
Ajay Gairola ◽  
Devranjan Samanta
Keyword(s):  
Weber Number ◽  
Polymer Concentration ◽  
Time Period ◽  
Increasing Trend ◽  
Viscoelastic Effects ◽  
Critical Weber Number ◽  
Leidenfrost Temperature ◽  
Elastic Fluids ◽  
The Impact

This article highlights the role of non-Newtonian (elastic) effects on the droplet impact phenomenon at temperatures considerably higher than the boiling point, especially at or above the Leidenfrost regime. The Leidenfrost point (LFP) was found to decrease with an increase in the impact Weber number (based on the velocity just before the impact) for fixed polymer (polyacrylamide) concentrations. Water droplets fragmented at very low Weber numbers (approx. 22), whereas the polymer droplets resisted fragmentation at much higher Weber numbers (approx. 155). We also varied the polymer concentration and observed that, up to 1000 ppm, the LFP was higher than that for water. This signifies that the effect can be delayed by the use of elastic fluids. We have shown the possible role of elastic effects (manifested by the formation of long lasting filaments) during retraction in the increase of the LFP. However, for 1500 ppm, the LFP was lower than that for water, but had a similar residence time during the initial impact. In addition, we studied the role of the Weber number and viscoelastic effects on the rebound behaviour at 405°C. We observed that the critical Weber number up to the point at which the droplet resisted fragmentation at 405°C increased with the polymer concentration. In addition, for a fixed Weber number, the droplet rebound height and the hovering time period increased up to 500 ppm, and then decreased. Similarly, for fixed polymer concentrations like 1000 and 1500 ppm, the rebound height showed an increasing trend up to certain a certain Weber number and then decreased. This non-monotonic behaviour of rebound heights was attributed to the observed diversion of the rebound kinetic energy to rotational energy during the hovering phase. Finally, a relationship between the non-dimensional Leidenfrost temperature and the associated Weber and Weissenberg numbers is developed, and a scaling relation is proposed.

scholarly journals 1339. Impact of COVID-19 Pandemic on Activity of Other Respiratory Viral Pathogen and Norovirus

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S757-S757
Author(s):  
Lauren DiBiase ◽  
Emily Sickbert-Bennett ◽  
David J Weber ◽  
David J Weber ◽  
Melissa B Miller
Keyword(s):  
Significant Decline ◽  
Influenza B ◽  
Research Support ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Molecular Tests ◽  
Time Period ◽  
Percent Positivity ◽  
Time Periods ◽  
The Impact

Abstract Background The COVID-19 pandemic led to the implementation of several strategies (e.g., masking, physical distancing, daycare/school and business closures, hand hygiene, surface disinfection) intended to mitigate the spread of disease in the community. Our objective was to evaluate the impact of these strategies on the activity of respiratory viral pathogens (other than SARS-CoV-2) and norovirus. Methods At University of North Carolina (UNC) Hospitals, we compared the percent positivity for respiratory viral pathogens and norovirus by calendar year for 2014-2019 and the first three months of 2020 to the percent positivity in the subsequent months of 2020 and the first quarter of 2021. Patients were included in the study if they had a positive specimen obtained in a clinic, ED or as an inpatient. Three molecular tests were used to detect these viruses: adenoviruses, endemic coronaviruses (OC43, 229E, NL63, HKU1), influenza A (subtypes H3, H1, H1N1pdm), influenza B, metapneumovirus (MPV), parainfluenza viruses 1-4 (PIV), rhinovirus and/or enterovirus (RhV/EV), and respiratory syncytial virus (RSV). Two molecular tests were used to detect norovirus. We calculated point prevalence rates with 95% confidence intervals to assess statistical differences in percent positivity. Results There was a statistically significant decline in percent positivity for endemic coronaviruses, influenza, MPV, PIV, RSV and norovirus during the time-periods after March 2020 when compared to all other time-periods (Figure). RhV/EV, followed by adenovirus were the most prevalent types of respiratory viruses circulating during height of COVID-19. There was a statistically significant decline seen in RhV/EV in April-Dec 2020, but activity increased in 2021. There was no difference seen in adenovirus activity across time-periods. Percent Positivity of Respiratory Viral Pathogens and Norovirus by Time Period Conclusion Our study demonstrated statistically significant decreases in the percent positivity of several respiratory viral pathogens, as well as norovirus, during the time-period of high community prevalence of SARS-CoV-2. Strategies put in place to mitigate SARS-CoV-2 transmission likely contributed to these differences. Non-enveloped viruses like rhinovirus and adenoviruses may have been less impacted by these strategies since they are more resistant to disinfection. Disclosures David J. Weber, MD, MPH, PDI (Consultant) Melissa B. Miller, PhD, D(ABMM), F(AAM), Abbott Molecular (Grant/Research Support)Agena Bioscience (Consultant)ArcBio (Grant/Research Support)Cepheid (Consultant)Luminex Molecular Diagnostics (Consultant)QIAGEN (Consultant)Sherlock Biosciences (Consultant)Talis Biomedical (Consultant)Werfen (Consultant)

scholarly journals The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Saurabh Jamdar ◽  
Vishnu V. Chandrabalan ◽  
Rami Obeidallah ◽  
Panagiotis Stathakis ◽  
Ajith K. Siriwardena ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Operating Theatre ◽  
Index Admission ◽  
Biliary Disease ◽  
Time Period ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Time Periods ◽  
The Impact

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

scholarly journals Emergency Medicine Matters: Epidemiology of Medical Pathology and Changes in Patient Outcomes after Implementation of a Post-graduate Training Program at a Tertiary Teaching Hospital in Kigali, Rwanda

2020 ◽  
Author(s):  
Katelyn Moretti ◽  
Doris Lorette Uwamahoro ◽  
Sonya Naganathan ◽  
Chantal Uwamahoro ◽  
Naz Karim ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Patient Outcomes ◽  
Teaching Hospital ◽  
Emergency Care ◽  
Medical Conditions ◽  
Time Period ◽  
Medical Emergencies ◽  
Time Periods ◽  
The Impact

Abstract Background: Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.Methods: A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013 - September 2013 versus September 2015 - June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results: A random sample of 1,704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included: gastrointestinal, infectious disease and neurologic pathology. Differences by time period in EC management included: antibiotic use (37.2% vs. 42.2%, p=0.04), vasopressor use (1.9% vs. 0.5%, p=0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p=0.001) and mean IVF administration (2,057 ml vs. 2,526 ml, p<0.001). EC specific mortality fell from 10.0% to 1.4% (p<0.0001) across time periods.Conclusions: Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

scholarly journals 815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Nicholls ◽  
C Stewart ◽  
J Coulston
Keyword(s):  
Critical Care ◽  
Vascular Surgery ◽  
Time Period ◽  
Care Capacity ◽  
The Impact ◽  
Second Wave ◽  
Surgical Unit

Abstract Introduction The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit. Method Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database. Results 92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%). There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10). Conclusions The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.

scholarly journals A preliminary study into the effects of the COVID-19 pandemic on Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores of patients with obsessive compulsive disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S249-S250
Author(s):  
Claire Fischer ◽  
Hannah Gyekye-Mensah ◽  
Ilenia Pampaloni ◽  
Augusta Chandler ◽  
Anusha Govender ◽  
...  
Keyword(s):  
Social Contact ◽  
Initial Assessment ◽  
Contributing Factors ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Time Period ◽  
Long Time ◽  
Preliminary Study ◽  
Time Periods ◽  
The Impact

AimsThe COVID-19 pandemic has presented a challenge for treating people with OCD and it could be postulated that those with OCD fearing contamination might be more affected in current circumstances. Although there have been some studies already published, results have been heterogeneous and conflicting; possibly because of different populations or geographical locations examined.In this preliminary study we aim to identify the impact of the pandemic on the severity of OCD, as measured by Y-BOCS scores. To our knowledge, it is the first UK study of this kind and the only study that examines change in Y-BOCS scores over such a long time period.MethodPatients were identified from national OCD unit referral databases at Springfield Hospital. Referrals from March 2019–March 2020 were examined and patients included if they had a diagnosis of OCD, were accepted by the service following initial assessment and sufficient data were available. This preliminary study focused only on Y-BOCS to assess clinician-rated severity of OCD. Y-BOCS scores were compared from different time periods correlating to the progression of COVID-19. ‘Pre-pandemic’ score was taken from Jan–Dec 2019 or, if not available, from Jan–23 March 2020 (prior to UK lockdown). ‘Pandemic’ score was taken as the most recent rating from April 2020 onwards.Result21 patients were included. All treated as outpatients (although 9 had undergone previous inpatient treatment during the time period above). 81% showed improvement in Y-BOCS score between pre-pandemic and pandemic time periods, with an overall mean decrease in Y-BOCS of 10.3.ConclusionOverall, this study indicates that severity of OCD decreased during the pandemic compared to pre-pandemic. It may be that patients found it easier to access remote appointments, or perhaps the pandemic environment of being encouraged to stay at home and limiting unnecessary contact may have allowed limited opportunity for exposure. It might be that the pandemic provided a reason for patients to be avoidant of potential contamination thereby leading to a perceived rather than real improvement in Y-BOCS scores.Identification of specific contributing factors is beyond the scope of this preliminary study, however it will be important to conduct further research with a larger sample size that incorporates post-lockdown and post-pandemic scores to ascertain whether trends seen here are in fact maintained when normal social contact resumes.

scholarly journals Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Katelyn Moretti ◽  
Doris Lorette Uwamahoro ◽  
Sonya Naganathan ◽  
Chantal Uwamahoro ◽  
Naz Karim ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Patient Outcomes ◽  
Teaching Hospital ◽  
Emergency Care ◽  
Medical Conditions ◽  
Time Period ◽  
Medical Emergencies ◽  
Time Periods ◽  
The Impact

Abstract Background Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda. Methods A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results A random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods. Conclusions Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

scholarly journals Does Length of Time Caregiving Affect Net Worth? Caregivers Approaching Retirement Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 30-30
Author(s):  
Shirley Porterfield ◽  
Linda Quinn ◽  
Patricia Stoddard Dare ◽  
LeaAnne DeRigne ◽  
Miyuki Fukushima Tedor ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Chronically Ill ◽  
Health Condition ◽  
Household Member ◽  
Net Worth ◽  
Time Period ◽  
Time Periods ◽  
Nationally Representative ◽  
The Impact ◽  
Over Time

Abstract Using a nationally representative sample of N=3,659 adults (mean age 55.6 in 2016) from the 2008, 2012, and 2016 rounds of the National Longitudinal Survey of Youth 1979, we examine the impact of work-limiting health conditions, caregiving, and the length of time spent in a caregiving role inside and outside the home on total family net worth. Repeated measures analysis finds having a chronically ill or disabled household member (CIOD), or caring for a household member with a CIOD inside the home was associated with reduced total family net worth (TFNW; -$146.7, p&lt;0.002), on average, across the three time periods. In-home caregiving across time periods does not have an additive effect, but rather appears to result in a one-time drop in TFNW. Respondents who provide care for out-of-home family or friends report higher TFNW on average over time ($73.3K, p&lt;0.001). Respondents with a work-limiting health condition report a lower mean TFNW over this time span (-$53.1K, p&lt;0.005). Caregiving inside the home has 2-3 times the impact on TFNW as having a work-limiting health condition, though in the overall model, the effect of the two variables together on TFNW is additive. An adult is at the greatest disadvantage with respect to financial preparedness for retirement if they are both a caregiver (or have a CIOD in their household) and have a work-limiting health condition than if they have only one of these characteristics or have neither characteristic. Even a single time period of caregiving reduces total family net worth over time.

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