scholarly journals Reduced turnaround times through multi-sectoral community collaboration during the first surge of SARS-CoV-2 and associated effect on patient care and hospital operations

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257302
Author(s):  
Rebecca C. Christofferson ◽  
Hollis R. O’Neal ◽  
Tonya Jagneaux ◽  
Catherine O’Neal ◽  
Christine S. Walsh ◽  
...  
Keyword(s):  
Baton Rouge ◽  
Diagnostic Testing ◽  
Academic Research ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Molecular Diagnostic ◽  
East Baton Rouge Parish ◽  
Hospital Operations ◽  
State And Local ◽  
The Impact

Background In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was an overall shortage of diagnostic testing capability at that time, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses. Methods A multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources. Findings Our model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.

scholarly journals Reduced turnaround times through multi-sectoral collaboration during the first surge of SARS-CoV-2 in Louisiana, March-April 2020

2020 ◽  
Author(s):  
RC Christofferson ◽  
Hollis R. O’Neal ◽  
Tonya Jagneaux ◽  
Catherine O’Neal ◽  
Christine S. Walsh ◽  
...  
Keyword(s):  
Baton Rouge ◽  
Diagnostic Testing ◽  
Healthcare Providers ◽  
Academic Research ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Molecular Diagnostic ◽  
East Baton Rouge Parish ◽  
State And Local ◽  
The Impact

AbstractBackgroundIn March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was a shortage of diagnostic testing capability, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses.MethodsA multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources.FindingsOur model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.InterpretationOverall, we provide rationale for and demonstration of the utility of multisectoral partnerships when responding to public health emergencies.

Application of lean methodology to improve quality and efficiency of molecular diagnostic testing in non-small cell lung cancer (NSCLC).

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 220-220
Author(s):  
Lawrence David Wagman ◽  
John Maurice ◽  
Peggy Crabtree ◽  
Ruslan Horblyuk
Keyword(s):  
Diagnostic Testing ◽  
Molecular Diagnostic ◽  
Value Stream Mapping ◽  
Molecular Testing ◽  
Cancer Therapies ◽  
Tissue Quality ◽  
Multiple Tumor ◽  
Disease States ◽  
Tissue Acquisition ◽  
The Impact

220 Background: The advent of targeted cancer therapies has triggered an increase in the volume of molecular testing performed across multiple tumor types. This raises concern about the efficiency of associated operational and quality processes. This study’s objective was to apply lean methodology, using NSCLC as a pilot disease state, to evaluate current molecular testing processes, identify existing inefficiencies, design an improved process and assess scalability for application across other tumor sites at the pilot site. Methods: Modified Lean methodology was employed. Semi-structured 1:1 interviews with multidisciplinary team (MDT) stakeholders representing oncology, pathology, interventional radiology, pulmonology and administration were conducted. MDT-based value stream mapping workshops were carried out to describe the “current” and design the “future” state of molecular testing process in NSCLC. The goal was to identify existing inefficiencies and inform targeted process improvement efforts. Results: Interviews with 25 MDT stakeholders revealed substantial variability in the molecular diagnosis processes and a lack of coordinated communication across disciplinary silos. Specifically, the consensus-derived “current” state map identified appropriate biopsy tissue (quality and quantity) and inconsistent protocol utilization among the major inefficiencies resulting in repeat biopsies. Development and implementation of the MDT-based molecular testing protocol, including introduction of a tissue acquisition protocol, were identified as target areas for process variability improvement. Conclusions: Inefficiencies exist in molecular testing processes and need to be identified and minimized as the burden of molecular testing increases. This pilot successfully employed modified Lean methodology to identify areas of improvement in the molecular testing process in NSCLC and could be replicated in other relevant disease states. Program evaluation is underway to quantify the impact of this initiative on operational and patient care metrics.

scholarly journals The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES): Protocol (Preprint)

2021 ◽  
Author(s):  
Karen Lutrick ◽  
Katherine D. Ellingson ◽  
Zoe Baccam ◽  
Patrick Rivers ◽  
Shawn Beitel ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Emergency Response ◽  
Natural Infection ◽  
Diagnostic Testing ◽  
Vaccine Dose ◽  
Demographic Characteristics ◽  
Healthcare Personnel ◽  
Molecular Diagnostic ◽  
Vaccination History ◽  
Baseline Information

UNSTRUCTURED Background: The Arizona Healthcare, Emergency Response, and Other Essential workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Methods: Eligible participants include Arizona residents aged 18–85 years who work at least 20 hours per week in an occupation involving regular direct contact (within three feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% healthcare personnel, 30% first responders, and 30% other essential workers), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-19–like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics and by seropositivity status and infection and vaccination history. Discussion: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and prospectively following strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness.

scholarly journals Survey of protozoan vector-borne diseases in dogs from Atlantic Rainforest fragment around Billings Dam, São Paulo, Brazil

2020 ◽  
Vol 50 (9) ◽  
Author(s):  
Roberta Carvalho de Freitas e Azevedo ◽  
Giovanna Stefani Nosberto Castelli ◽  
Ryan Emiliano da Silva ◽  
Jaciara de Oliveira Jorge Costa ◽  
Renata Tonhosolo ◽  
...  
Keyword(s):  
Animal Health ◽  
Companion Animals ◽  
Sao Paulo ◽  
Control Measures ◽  
Molecular Diagnostic ◽  
São Paulo ◽  
Vector Borne Diseases ◽  
Babesia Vogeli ◽  
Vector Borne ◽  
The Impact

ABSTRACT: Vector-borne diseases are currently one of the biggest public health concerns worldwide. Dogs, being the closest companion animals to humans, are considered the main reservoir of some of these diseases in the urban environment. Therefore, the study of the disease behavior in dogs can help to understand the disease affecting human health. Serological and molecular diagnoses of Babesia vogeli, Rangelia vitalli, Leishmania infantum, and other trypanosomatids, were performed by immunochromatographic and PCR assays, respectively, on dogs in a dog shelter located in an Atlantic Forest fragment near the Billings Dam, São Bernardo do Campo, São Paulo-Brazil. Our molecular diagnostic results showed a high prevalence of Babesia vogeli, at 20.9% (17/81). No other protozoan was detected in any of the tests. Determining the prevalence of major vector-borne diseases is essential to establish preventive and control measures for zoonotic diseases in animals kept in shelters, in order to minimize the impact of vector-borne diseases on animal health.

scholarly journals Differential impact of the COVID-19 pandemic on laboratory reporting of norovirus and Campylobacter in England: A modelling approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256638
Author(s):  
Nikola Ondrikova ◽  
Helen E. Clough ◽  
Amy Douglas ◽  
Miren Iturriza-Gomara ◽  
Lesley Larkin ◽  
...  
Keyword(s):  
National Laboratory ◽  
Diagnostic Testing ◽  
Control Measures ◽  
Differential Impact ◽  
Laboratory Surveillance ◽  
Quasi Experimental ◽  
Experimental Approaches ◽  
And Control ◽  
The Impact ◽  
Multiple Pathogens

Background The COVID-19 pandemic has impacted surveillance activities for multiple pathogens. Since March 2020, there was a decline in the number of reports of norovirus and Campylobacter recorded by England’s national laboratory surveillance system. The aim is to estimate and compare the impact of the COVID-19 pandemic on norovirus and Campylobacter surveillance data in England. Methods We utilised two quasi-experimental approaches based on a generalised linear model for sequential count data. The first approach estimates overall impact and the second approach focuses on the impact of specific elements of the pandemic response (COVID-19 diagnostic testing and control measures). The following time series (27, 2015–43, 2020) were used: weekly laboratory-confirmed norovirus and Campylobacter reports, air temperature, conducted Sars-CoV-2 tests and Index of COVID-19 control measures stringency. Results The period of Sars-CoV-2 emergence and subsequent sustained transmission was associated with persistent reductions in norovirus laboratory reports (p = 0.001), whereas the reductions were more pronounced during pandemic emergence and later recovered for Campylobacter (p = 0.075). The total estimated reduction was 47% - 79% for norovirus (12–43, 2020). The total reduction varied by time for Campylobacter, e.g. 19% - 33% in April, 1% - 7% in August. Conclusion Laboratory reporting of norovirus was more adversely impacted than Campylobacter by the COVID-19 pandemic. This may be partially explained by a comparatively stronger effect of behavioural interventions on norovirus transmission and a relatively greater reduction in norovirus testing capacity. Our study underlines the differential impact a pandemic may have on surveillance of gastrointestinal infectious diseases.

The DOOR to Antibiotic Stewardship: Refining Assessments of Interventions With Desirability of Outcome Ranking

2021 ◽  
pp. 089719002098713
Author(s):  
Steven M. Smoke ◽  
Vishal V. Patel ◽  
Nicole I. Leonida
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Molecular Diagnostic ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
The Impact ◽  
Post Intervention Group

Background: Limited sample size and disparate outcome measures can hinder the ability of antimicrobial stewardship programs to assess the utility of their quality improvement interventions. Desirability of outcome ranking (DOOR) is a novel methodology that incorporates multiple outcomes into a single value to more comprehensively compare therapeutic strategies. The objective of this study was to apply DOOR to a single center antibiotic stewardship intervention. Methods: A pre- and post-interventional study was conducted evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Outcomes included the percentage of patients who were switched to appropriate therapy, the time to appropriate therapy, and the percentage of patients who had missed de-escalation opportunities. Results: A total of 19 and 29 patients were included in the final analysis. The percentage of patients reaching appropriate therapy was 84% (16/19) and 97% ([28/29], p = 0.16) in the pre-intervention and post-intervention groups respectively. Median time to appropriate therapy was 26 hours and 36 minutes (IQR 13:05-50:45) and 22:40 (IQR 3:42-48:23, p = 0.32), respectively. One missed de-escalation opportunity was identified in the post-intervention group (0% vs 3%, p = 1.00). DOOR analysis indicated that the probability of a better outcome for the post-intervention group than the pre-intervention group was 58% (95% CI 54-62). Conclusion: In this analysis, DOOR revealed a benefit that would not have been apparent with traditional outcomes assessments. Antimicrobial stewardship programs conducting quality improvement studies should consider incorporating DOOR into their methodology.

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