scholarly journals Utilization and Diagnostic Yield of Neurogenetic Testing at a Tertiary Care Facility

2007 ◽  
Vol 53 (6) ◽  
pp. 1016-1022 ◽  
Author(s):  
Kerstin L Edlefsen ◽  
Jonathan F Tait ◽  
Mark H Wener ◽  
Michael Astion
Keyword(s):  
Positive Result ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Molecular Genetic ◽  
Tertiary Care ◽  
Care Facility ◽  
Utilization Review ◽  
Tertiary Care Facility

Abstract Background: Institutions face increasing charges related to molecular genetic testing for neurological diseases. The literature contains little information on the utilization and performance of these tests. Methods: A retrospective utilization review was performed to determine the diagnostic yield of neurogenetic tests ordered during calendar year 2005 at a large academic medical center in the western United States. Results: Overall, a relevant mutation was identified in 30.2% of the 162 patients tested and in 21.5% of the 121 probands, defined as patients for whom no mutation has been previously identified in a family member. Patients with muscle weakness (n = 65) had a mutation detected in 26.2% of all patients and 23.5% of probands (n = 51), with an estimated testing cost per positive result of $3190. Patients tested for neuropathy (n = 36) had a mutation detected in 27.8% of patients and 22.6% of probands (n = 31), with an estimated cost per positive result of $5955. Patients with chorea (n = 25) had a positive result obtained in 68% of patients and 71.4% of probands (n = 7); the estimated cost per positive test was $440. Other diagnostic categories evaluated include ataxias (n = 18; yield, 11.1%; $7620 per positive), familial stroke or dementia syndromes (n = 8; yield, 12.5%; $6760 per positive), and multisystem mitochondrial disorders (n = 10; yield, 20%; $6485 per positive). Conclusions: Expert clinicians at a tertiary care center who ordered neurogenetic tests obtained a positive result in 21.5% of patients without previously identified familial mutations. These results can be used for comparison and to help establish utilization guidelines for neurogenetic testing.

scholarly journals 1064. Antimicrobial Stewardship Program at a Large Academic Medical Center, Impact Over 12 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S376-S377
Author(s):  
Susan E Kline ◽  
Kimberly Boeser ◽  
Jeana Houseman ◽  
Samantha Saunders ◽  
Shawnda Johnson ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Downward Trend ◽  
Full Time ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Hospital Acquired

Abstract Background The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 12 years. Methods The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians. Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made. Results There was a downward trend in Hospital-acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient-days (pt day). Rates appear stable from 2014 to 2019 with adjustment for change to NHSN lab-based CDI surveillance (Figure 1). From 2009 to 2019 a decrease was seen in VRE hospital-acquired infections (HAI) from 0.53 to 0.21/1,000 patient-days and in MRSA HAIs from 0.2 to 0.14/1,000 patient-days. Newly acquired ESBL HAIs have remained relatively stable from 2009 to 2019 at 0.09 to 0.05/1,000 patient-days. CRE HAIs are low but stable rates at 0.02/1,000 patient-days (Figure 2). We track antimicrobial utilization for internal and national reporting (starting in July 2017). A SAAR for all Antibacterial agents (ICUs, wards, and oncology units) of 1.33 in 2018. Our top four agents average DOT; piperacillin/tazobactam (66.81), cefepime (34.40), oral levofloxacin (23.56) and intravenous meropenem (21.49). We demonstrate lower average DOT for our restricted antimicrobials (206.21) as compared with our nonrestricted antimicrobials (236.74) (Figure 3). Cost savings continued from year to year. After adjusting for inflation annually, our expected costs ($84.08) compared with actual costs ($40.12 ytd 2019), demonstrates effective cost management of antimicrobial agents. (Figure 4) Conclusion We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. This downward trend has continued. ESBL HAIs remain relatively stable and CRE are stable at low rates but remain emerging HAIs of concern. We are now focusing efforts on limiting unneeded fluoroquinolone and carbapenem use. We continue to analyze our SAAR data and internal DOT data to identify areas of opportunity to improve antimicrobial use. The ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic. Disclosures All authors: No reported disclosures.

scholarly journals The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

2017 ◽  
Vol 35 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Elise C. Carey ◽  
Ann M. Dose ◽  
Katherine M. Humeniuk ◽  
Yichen C. Kuan ◽  
Ashley D. Hicks ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Hospital Death ◽  
Personal Care ◽  
Predominately White ◽  
Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

scholarly journals Yield of biliary stent cytology: Is it time to think lean?

2019 ◽  
Vol 07 (04) ◽  
pp. E545-E550 ◽  
Author(s):  
Muthuraman Alagappan ◽  
Natasha Darras ◽  
Lauren Yang ◽  
Paul Vanderlaan ◽  
Meir Mizrahi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Fine Needle Biopsy ◽  
Biliary Stent ◽  
Fine Needle ◽  
Cytologic Analysis

Abstract Background and study aims During evaluation of pancreaticobiliary strictures, it is common practice to send biliary stents for cytologic analysis. However, in recent years, complementary tissue acquisition techniques ranging from cholangioscopy to fine-needle biopsy have improved the ability to acquire tissue and diagnose malignancy. Data are limited on the current diagnostic yield and cost effectiveness of biliary stent analysis. Patients and methods We performed a retrospective study of all pancreaticobiliary stents sent for analysis in a tertiary care academic medical center from June 2013 to September 2016. Patient demographics, stent information, and final diagnosis history were collected through chart review. Costs were determined using published reimbursement rates for Medicare. Results Two hundred thirty-one stents from 175 patients were sent for cytologic analysis during the study period. Of the 62 stents obtained from patients ultimately diagnosed with malignancy, only one (1.6 %) had positive cytology for malignant cells, while the others were acellular/non-diagnostic (2/62, 3.2 %), negative (48/62, 77.4 %), or atypical (11/62, 17.7 %). The sensitivity of stent cytology for diagnosis of malignancy was 1.6 % (1/62). No cases were identified in which stent cytology changed clinical management. From a payer perspective, the mean estimated cost for each stent cytologic analysis is greater than $ 70.00. Conclusions While stent cytologic analysis is a common clinical practice, the diagnostic yield and cost effectiveness of the practice must be reevaluated. With the rise of newer diagnostic technologies such as digital cholangioscopy and endoscopic ultrasound-guided fine-needle biopsy, it may be time to “think lean” and acknowledge a sunset for biliary stent cytology.

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care

2021 ◽  
pp. 000348942110457
Author(s):  
Mohamad Issa ◽  
Nadeem El-Kouri ◽  
Sara Mater ◽  
Jonathan Y. Lee ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
High Volume ◽  
Care Team ◽  
Consulting Services ◽  
Tertiary Care Facility

Introduction: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). Methods: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. Results: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. Conclusion: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

scholarly journals Characteristic of COVID-19 infection in pediatric patients: early findings from a tertiary care center, Nagercoil, Tamil Nadu, India

2020 ◽  
Vol 7 (10) ◽  
pp. 2048
Author(s):  
Babitha Rexlin G. ◽  
Suresh P. M.
Keyword(s):  
Tamil Nadu ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Family Welfare ◽  
P Value ◽  
Mild Disease ◽  
Tertiary Care Facility

Background: The planet faces a new challenge with COVID-19 disease caused by novel SARS-CoV2. Pediatric COVID-19 is considered to be mild. Methods: The study aim was to describe the clinical presentation, diagnostic findings and outcome of a cohort of paediatric patients according to Ministry of health and family welfare (MOHFW) criteria, at KKGMCH a tertiary care facility in Kanyakumari district. It’s a retrospective chart review including data of children aged 0 to 12 years with COVID-19 from 20 March to 19 July 2020. Results: Of the 137 children with COVID-19, 17 (12.45%) were infants, 65 (35%) were 1-5 years and 72 (52.55%) were 6-12 years. Age didn’t have influence on acquiring the illness as p value is 0.125. Age had no influence on severity too as p value is 0.28. 46.7% were female and 53.3% were male. There was an apparent male preponderance with (OR 1.63, 95% CI 1.00 to 2.21) but a non-significant p value of 0.54. of the 34 (24.8%) mild symptomatic, 22 (64.7%) were males and 12 (35.2%) were females. The p value is 0.086 stating gender non-influential on severity. 129 (94.1%) children had contact history. The contacts were parents or close relatives. No child with comorbidity presented during this period. Most common clinical features were fever (8.76%), cough (6.6%), rhinorrhoea (2.2%), vomiting (2.9%) and diarrhoea (1.5%). Children never progressed to severe respiratory illness requiring intensive care as per MOHFW criteria. 1 (0.7%) presented with focal consolidation in chest x-ray. All 137 (100%) children got cured.Conclusion: Study concludes pediatric COVID-19 is a mild disease without mortality at beginning of pandemic in Kanyakumari district. Factors like age and gender neither influenced the occurrence of the disease nor the severity.

A new regional center for child care

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 538-541
Author(s):  
Richard D. Wood
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Maintenance Organizations ◽  
Delaware Valley ◽  
Health Maintenance ◽  
Child Guidance ◽  
Regional Center ◽  
Tertiary Care Facility ◽  
Planning And Construction

The new Children's Hospital of Philadelphia, in conjunction with affiliated Philadelphia Child Guidance Clinic, opened in June of this year, after 15 years in planning and construction. Ground-breaking took place in September 1968, construction began February 1969, and the physical relocation began June 1974. The new children's medical center merits attention as a major example of a new tertiary care facility, serving a tristate region and a university complex, while also rendering primary care through expanded ambulatory and emergency facilities, new transient one-day surgical service, and growing affiliations with health maintenance organizations in the general neighborhood. Regionally, the Hospital serves as a major consultative resource and pediatric referral center for hundreds of Delaware Valley hospitals and physicians.

Emergency General Surgery Regionalization: Retrospective Cohort Study of Emergency General Surgery Patients at a Tertiary Care Center

2021 ◽  
pp. 000313482110385
Author(s):  
Sullivan A. Ayuso ◽  
Sharbel A. Elhage ◽  
Kyle W. Cunningham ◽  
A. Britton Christmas ◽  
Ronald F. Sing ◽  
...  
Keyword(s):  
General Surgery ◽  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographic Origin ◽  
Care Facility ◽  
Care Hospital ◽  
Emergency General Surgery ◽  
Tertiary Care Facility ◽  
Tertiary Care Hospitals

Background Emergency general surgery (EGS) patients presenting at tertiary care hospitals may bypass local hospitals with adequate resources. However, many tertiary care hospitals frequently operate at capacity. We hypothesized that understanding patient geographic origin could identify opportunities for enhanced system triage and optimization and be an important first step for EGS regionalization and care coordination that could potentially lead to improved utilization of resources. Methods We analyzed patient zip code and categorized EGS patients who were cared for at our tertiary care hospital as potentially divertible if the southern region hospital was geographically closer to their home, regional hospital admission (RHA) patients, or local admission (LA) patients if the tertiary care facility was closer. Baseline characteristics and outcomes were compared for RHA and LA patients. Results Of 14 714 EGS patients presenting to the tertiary care hospital, 30.2% were categorized as RHA patients. Overall, 1526 (10.4%) patients required an operation including 527 (34.5%) patients who were potentially divertible. Appendectomy and cholecystectomy comprised 66% of the operations for potentially divertible patients. Length of stay was not significantly different ( P = .06) for RHA patients, but they did have lower measured short-term and long-term mortality when compared to their LA counterparts ( P < .05). Conclusions EGS diagnoses and patient geocode analysis can identify opportunities to optimize regional operating room and bed utilization. Understanding where EGS patients are cared for and factors that influenced care facility will be critical for next steps in developing EGS regionalization within our system.

scholarly journals 1705. Clinical Characteristics and Outcomes of Cryptococcosis in a Tertiary Care Center in Kentucky, 2005 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S624-S625
Author(s):  
Mahesh Bhatt ◽  
Julie A Ribes ◽  
Vaneet Arora ◽  
Thein Myint
Keyword(s):  
Liver Disease ◽  
Cryptococcal Meningitis ◽  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Positive Culture ◽  
Solid Organ ◽  
India Ink

Abstract Background Cryptococcosis is an invasive fungal infection that causes pneumonia and extrapulmonary infection. This study explores its presentations, diagnostic tests, and outcome in different groups over a 12-year period at an academic medical center. Methods This was a retrospective study of the patients treated at University of Kentucky HealthCare from October 16, 2005 to October 15, 2017. Inclusion criteria were positive cryptococcal antigen (Ag), positive culture, or presence of yeast morphologically consistent with Cryptococcus on cyto- or histopathology. Patients were divided into HIV-infected, solid-organ transplant (SOT) recipients, and non-HIV/non-transplant groups. Cryptococcal meningitis comprised of either positive CSF Ag, culture, cytology or histopathology. Results A total of 114 patients were identified; 23 HIV-infected, 11 SOT recipients and 80 non-HIV/non-transplant patients (Table 1). Cryptococcus neoformans was the most common yeast isolated (91.8%). Cryptococcal meningitis was seen in 56% of total patients whereas 27% had isolated cryptococcal pneumonia (P < 0.01). Blood cultures and serum Ag were positive in 34% and 70%, respectively. Only 8.7% of HIV-infected patients had isolated pulmonary cryptococcosis compared with 36.4% in SOT recipients (P < 0.01). In patients with cryptococcal meningitis, abnormal CSF cell count, protein, or glucose was noted in 85.3%; India ink was positive in 61.3% and CSF culture was positive in 73.4% (Table 2, Figure 1). CSF cryptococcal Ag was detected in 95.6% cases if CSF cultures were positive, whereas serum Ag was positive in only 85.1% of meningitis cases. Mortality was seen in 48.6% (17/35) of patients with cirrhosis/liver disease, compared with 21.5% (17/79) of non-cirrhosis/liver disease (P = 0.003). Transplant group had 54.5% mortality compared with 26.1% in HIV group (P = 0.016). Conclusion Cryptococcal meningitis was the most common presentation for cryptococcal disease in all three groups. Isolated pulmonary disease was least common in the HIV-infected group. Inpatient mortality rate was higher in patients with cirrhosis/liver disease and transplant group compared with those without cirrhosis/liver disease and HIV group, respectively. It is imperative to rule out meningitis in immunosuppressed patients with cryptococcal pneumonia. Disclosures All authors: No reported disclosures.

scholarly journals Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience

2021 ◽  
pp. 014556132110167
Author(s):  
Kevin P. Stavrides ◽  
Timothy L. Lindemann ◽  
Evan J. Harlor ◽  
Thorsen W. Haugen ◽  
Nicholas Purdy
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Time Estimation ◽  
Patient Characteristics ◽  
Endocrine Surgery ◽  
Time Averaging ◽  
Tertiary Care Facility ◽  
Mean Differences

Objective: To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. Methods: Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon’s previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. Results: A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging ( P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. Conclusion: As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.

Assessment of Tracheostomy and Laryngectomy Knowledge among Non-Otolaryngology Physicians

2019 ◽  
Vol 129 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Tsung-yen Hsieh ◽  
Leah Timbang ◽  
Maggie Kuhn ◽  
Hilary Brodie ◽  
Lane Squires
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Tertiary Institution ◽  
Cross Sectional ◽  
Basic Principles ◽  
Chi Squared ◽  
Knowledge Deficits ◽  
The Impact

Objective: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits. Methods: Study Design: Cross-sectional assessment. Setting: Academic medical center. Subjects and Methods: An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis. Results: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% ( P < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% ( P < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% ( P < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment. Discussion: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months. Conclusions: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.

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