The impact of a rapid molecular identification test on positive blood cultures from critically ill with bacteremia: A pre-post intervention study

ObjectiveMeasuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.Design and settingPre–post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state.ParticipantsWe included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017.InterventionsEstablishment of an interdisciplinary walk-in clinic in the reception centre (02/2016).Main outcome measuresInternational lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission.ResultsThe prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876).ConclusionsA walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.

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The impact of a pharmacist-managed dosage form conversion service on ciprofloxacin usage at a major Canadian teaching hospital: a pre- and post-intervention study

BMC Health Services Research ◽

10.1186/1472-6963-5-48 ◽

2005 ◽

Vol 5 (1) ◽

Cited By ~ 17

Author(s):

Bradley P Ho ◽

Tim TY Lau ◽

Robert M Balen ◽

Terryn L Naumann ◽

Peter J Jewesson

Keyword(s):

Teaching Hospital ◽

Dosage Form ◽

Intervention Study ◽

Post Intervention ◽

The Impact

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Impact of Health Education on Mothers' Knowledge of Preventive Health Practices

Tropical Doctor ◽

10.1177/004947559702700405 ◽

1997 ◽

Vol 27 (4) ◽

pp. 199-202 ◽

Cited By ~ 5

Author(s):

Mubina Agboatwalla ◽

Dure Samin Akram

Keyword(s):

Health Education ◽

Breast Feeding ◽

Intervention Study ◽

Intervention Group ◽

Preventive Health ◽

Slum Area ◽

Post Intervention ◽

Community Based ◽

Significant Difference ◽

The Impact

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).

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Impact of Electronic Prescription on Prescribing Errors

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32a31733 ◽

2021 ◽

pp. 212-220

Author(s):

Ameen M. Almohammadi ◽

Huda M. Al-Dhahri ◽

Shroug H. Al-Harbi

Keyword(s):

Study Design ◽

Intervention Study ◽

Dosage Forms ◽

Electronic Prescribing ◽

Prescribing Errors ◽

Post Intervention ◽

Electronic Prescription ◽

Prescription Errors ◽

Trade Names ◽

The Impact

Aims: There are series of medical errors that can be prevented by taking precautions. Therefore, the study evaluates the impact of the electronic prescribing system on prescription errors. Study Design: A pre-post study design was conducted. Place and Duration of Study: The study was conducted at outpatient pharmacy services of a teaching hospital in Jeddah city. Methodology: Prescriptions were evaluated for the presence of the essential prescription elements such as patient information, drug name, dose, frequency, strength, and other prescription completeness parameters. Results: In the pre-intervention study, 1182 handwritten prescriptions were evaluated, and 6627 errors were detected from these prescriptions. The length of the pre-and post-intervention period was two weeks each. The most prevalent prescribing errors were that of medications written without defined dosage forms were recorded 1653 (55.90%) time followed by prescriptions written by trade names 1493 (22.5%), without route of administration 1266 (19.1%), and without specified duration 1009 (15.2%). However, 1512 prescriptions were evaluated in the post-intervention study, among which 339 errors were detected. The errors included prescriptions written without diagnosis (5.09%), or without doctor’s name or stamp (1.52%), written by trade names (4.49%), without defined dosage forms (4.29%), and without specified duration (2.84%). Conclusion: The study concluded that E-prescribing eliminated prescription errors that resulted from handwritten prescriptions.

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The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

Southern African Journal of Anaesthesia and Analgesia ◽

10.36303/sajaa.2020.26.3.2343 ◽

2020 ◽

pp. 139-148

Author(s):

L Geldenhuys ◽

R Wise ◽

R Rodseth

Keyword(s):

Adverse Events ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Hospital ◽

Composite Outcome ◽

Post Intervention ◽

Hospital System ◽

Metropolitan Hospital ◽

Event Rates ◽

The Impact

Background: Intrahospital transfer (IHT) of critically ill patients is associated with a high incidence of adverse events (AEs). This study aimed to determine whether the introduction of an intervention bundle could decrease AEs during, and immediately after IHT to the intensive care unit (ICU), as compared to event rates prior to the bundle’s introduction. Methods: This was a prospective, pre- and post-intervention trial, conducted in both a regional and tertiary hospital in Pietermaritzburg, South Africa. The intervention bundle consisted of an IHT protocol, a transport backpack, emergency drug container and simulation training. Primary outcomes were: 1) composite outcome of serious AEs, and 2) composite outcome of AEs contributing directly to morbidity or mortality. Secondary outcomes were miscellaneous complications, equipment-related AEs, total number of AEs, total number of IHTs complicated by AEs and the subjective measure of IHTs needing intervention within the first 30 minutes after arrival in ICU. Results: There were 381 pre-intervention IHTs and 264 post-intervention IHTs with one documented serious AE. Adverse events directly contributing to morbidity or mortality showed a reduction from 58.3% (CI 0.53–0.63) pre-intervention, to 56.1% (CI 0.50–0.62) post-intervention (p = 0.6). Miscellaneous complications yielded a reduction of 12.9% (CI 10.3–14.7%) pre-intervention to 9.5% (CI 8.3–11.1%) post-intervention (p = 0.2). Equipment-related AE reduced from 5.2% (CI 3.4–8%) to 1.9% (CI 0.8–4.5%) (p = 0.03). The total number of AEs reduced from 5% (CI 3.6–7.4%) to 4.1% (CI 2.4–6.8%) (p = 0.03), while the total number of transfers complicated by AEs reduced from 63.3% (CI 61.9–65.1%) to 60.6% (CI 58.8–63.1%) (p = 0.5). There was a reduction in IHTs requiring intervention within the first 30 minutes of arrival in ICU (34.6% to 22.7%; p = 0.001). Conclusion: These results support the use of an intervention bundle to decrease the incidence of AEs during IHT.

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Treatment Bundle Improves Outcomes in the Management of Candidemia at Large Urban Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.050 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S89-S89 ◽

Cited By ~ 1

Author(s):

Gregory Cook ◽

Shreena Advani ◽

Saira Rab ◽

Sheetal Kandiah ◽

Manish Patel ◽

...

Keyword(s):

Patient Outcomes ◽

Best Practice ◽

Medical Center ◽

Academic Medical Center ◽

Blood Cultures ◽

Source Control ◽

Post Intervention ◽

The Impact ◽

Early Source ◽

Order Set

Abstract Background A candidemia treatment bundle (CTB) may increase adherence to guideline recommended candidemia management and improve patient outcomes. The purpose of this study was to evaluate the impact of a best practice alert (BPA) and order-set on optimizing compliance with all CTB components and patient outcomes. Methods A single center, pre-/post-intervention study was completed at Grady Health System from August 2015 to August 2017. Post-CTB intervention began August 2016. The CTB included a BPA that fires for blood cultures positive for any Candida species to treatment clinicians upon opening the patient’s electronic health record. The BPA included a linked order-set based on treatment recommendations including: infectious diseases (ID) and ophthalmology consultation, repeat blood cultures, empiric echinocandin therapy, early source control, antifungal de-escalation, intravenous to oral (IV to PO) switch, and duration of therapy. The primary outcome of the study was total adherence to the CTB. The secondary outcomes include adherence with the individual components of the CTB, 30-day mortality, and infection-related length of stay (LOS). Results Forty-five patients in the pre-group and 24 patients in the CTB group with candidemia were identified. Twenty-seven patients in the pre-group and 19 patients in the CTB group met inclusion criteria. Total adherence with the CTB occurred in one patient in the pre-group and threepatients in the CTB group (4% vs. 16%, P = 0.29). ID was consulted in 15 patients in the pre-group and 17 patients in the CTB group (56% vs. 89%, P = 0.02). Source control occurred in three and 11 patients, respectively (11% vs. 58% P < 0.01). The bundle components of empiric echinocandin use (81% vs. 100%, P = 0.07), ophthalmology consultation (81% vs. 95%, P = 0.37), and IV to PO switch (22% vs. 32%, P = 0.5) also improved in the CTB group. Repeat cultures and antifungal de-escalation were similar among groups. Thirty-day mortality decreased in the CTB group by 10% (26% vs. 16%, P = 0.48). Median iLOS decreased from 30 days in the pre-group to 17 days in the CTB group (P = 0.05). Conclusion The CTB, with a BPA and linked order-set, improved guideline recommended management of candidemia specifically increasing the rates of ID consultation and early source control. There were quantitative improvements in mortality and iLOS. Disclosures All authors: No reported disclosures.

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Evaluating the impact of a quality management intervention on post-abortion contraceptive uptake in private sector clinics in western Kenya: a pre- and post-intervention study

Reproductive Health ◽

10.1186/s12978-018-0452-4 ◽

2018 ◽

Vol 15 (1) ◽

Cited By ~ 2

Author(s):

Susy Wendot ◽

Rachel H. Scott ◽

Inviolata Nafula ◽

Isaac Theuri ◽

Edward Ikiugu ◽

...

Keyword(s):

Quality Management ◽

Private Sector ◽

Intervention Study ◽

Post Intervention ◽

Western Kenya ◽

Management Intervention ◽

Post Abortion ◽

The Impact ◽

Contraceptive Uptake

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107. Impact of a Rapid Blood Culture Identification Panel at a Community Teaching Hospital: a Pre-Post Quasi-Experiment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.152 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S68-S69

Author(s):

Catherine Trinh ◽

Steven Richardson ◽

Benjamin Ereshefsky

Keyword(s):

Targeted Therapy ◽

Blood Culture ◽

Culture Collection ◽

Blood Cultures ◽

Gram Stain ◽

Post Intervention ◽

Gram Positive ◽

Days Of Therapy ◽

Culture Identification ◽

The Impact

Abstract Background Rapid diagnostic tests (RDT) for positive blood cultures can lead to quicker identification of organisms and key resistance elements. As a result time to targeted therapy may decrease, thus reducing the duration of broad, empiric antibiotic use. The purpose of this study was to determine the impact of implementing the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for gram-positive organisms on antimicrobial process measures and patient outcomes at an academic community hospital. Methods This was a single-center, pre-post intervention, quasi-experimental study evaluating hospitalized adult patients who had at least one positive blood culture with gram-positive organisms from June 1, 2018 to August 31, 2018 and June 1, 2019 to August 31, 2019. Patients in the pre-intervention group were randomized and post-intervention patients were matched by identified organism. The primary outcome was the time to targeted therapy from blood culture collection. Secondary outcomes included time to targeted therapy from positive Gram stain, vancomycin and anti-pseudomonal β-lactam length of therapy (LOT), institutional vancomycin days of therapy (DOT), length of stay (LOS), and estimated hospitalization costs. Results A total of 75 patients in each group were included. The time to targeted therapy from blood culture collection was significantly decreased after RDT implementation [32.9 (23.2–51.8) hours vs. 49.2 (37.1–76.3 hours, p < 0.001)], as was time to targeted therapy from Gram stain results [8.5 (0–25.2) hours vs. 30 (19.4–52.9) hours, p < 0.001]. No difference was found between the groups with respect to LOS or estimated hospitalization cost. Overall the vancomycin LOT [0.86 (0.09–2.38) days vs. 2.18 (1.37–4.34) days, p = 0.001] and anti-pseudomonal β-lactam LOT for MRSA, MSSA, Streptococcus, and Enterococcus subgroup [1.15 (0.06–2.07) vs. 1.78 (1.28–2.89) days, p = 0.026] were significantly decreased in the post-RDT group. Figure 1: Institutional Use of Vnacomycin Conclusion Implementation of a rapid diagnostic test on gram-positive blood cultures was associated with decreased time to targeted therapy from blood culture collection, time to targeted therapy from positive culture, and vancomycin LOT. Disclosures All Authors: No reported disclosures

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Impact of ‘HIV-related stigma-reduction workshops’ on knowledge and attitude of healthcare providers and students in Central India: a pre-test and post-test intervention study

BMJ Open ◽

10.1136/bmjopen-2019-033612 ◽

2020 ◽

Vol 10 (4) ◽

pp. e033612 ◽

Cited By ~ 1

Author(s):

Anna Machowska ◽

Babu Lal Bamboria ◽

Courtney Bercan ◽

Megha Sharma

Keyword(s):

Intervention Study ◽

Healthcare Providers ◽

Central India ◽

Post Intervention ◽

Stigma Reduction ◽

Knowledge And Attitudes ◽

Stigma And Discrimination ◽

Related Stigma ◽

Knowledge And Attitude ◽

The Impact

IntroductionPeople living with HIV and AIDS (PLWHA) experience stigma and discrimination throughout their life. The consequences of stigma and discrimination are severe when enacted by healthcare providers (HCPs), and result in a delay in or poor adherence to treatment. Studies have demonstrated the presence of stigmatising behaviours among HCPs, yet only a few have presented the impact of interventions on the knowledge and attitude of practising (clinicians and nurses) and future (students) HCPs.ObjectivesTo evaluate knowledge, attitudes and infection risk perceptions related to HIV/AIDS among practising and future HCPs in central India. In addition, the impact of the ‘HIV-related stigma-reduction workshop’ using a pre-intervention and post-intervention study design was evaluated.Settings and participantsThe study was conducted in 2016 at two tertiary-care hospitals and three healthcare colleges in central India. Overall, 650 HCPs (75 clinicians and 211 nurses) and students (205 medical, 123 nursing and 36 Diploma in Medical and Laboratory Technology (DMLT)) voluntarily participated in the study.InterventionThe educational intervention comprised of training in epidemiology, the transmission and treatment of the HIV infection, the rights of PLWHA, the duties of HCPs and the use of standard precautions.ResultsAt pre-intervention, DMLT students had the lowest and clinicians the highest knowledge scores (24% and 45%, respectively). The stigmatised attitude was reflected in all groups, the lowest among clinicians (21%) and the highest among DMLT students (34%). Improvement in the post-intervention knowledge scores was the highest in medical students (36%) and the lowest among clinicians (16%). The participants’ attitudes improved between 3% and 17% across all groups.ConclusionsSignificant post-intervention improvements were seen in both knowledge and attitudes in all groups. Students had a higher tendency to improve than HCPs. Further long-term studies are needed to evaluate the sustainability of the improvements in knowledge and attitudes of the participants.

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