scholarly journals S266 Reducing the Inappropriate Use of Fecal Immunochemical Testing (FIT) in the Hospital Setting

2021 ◽  
Vol 116 (1) ◽  
pp. S118-S118
Author(s):  
Archish Kataria ◽  
James Gnecco ◽  
Eugene Stolow ◽  
Allison Harrington ◽  
Brenda Briones ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Fecal Immunochemical Testing ◽  
Inappropriate Use

12: THE OVERUSE OF STRESS ULCER PROPHYLAXIS ON ADMISSION AND DISCHARGE AT A TERTIARY CARE TEACHING HOSPITAL: AN OBSERVATIONAL STUDY

2016 ◽  
Vol 64 (3) ◽  
pp. 804.1-804 ◽  
Author(s):  
J Jackson ◽  
JM Okun ◽  
N Paddu
Keyword(s):  
New York ◽  
Teaching Hospital ◽  
Stress Ulcer ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Stress Ulcer Prophylaxis ◽  
High Rate ◽  
Clinical Indication ◽  
Inappropriate Use ◽  
Ulcer Prophylaxis

Purpose of StudyStudies have linked the use of anti-secretory agents to nosocomial complications including Clostridium difficile–induced pseudomembranous colitis and hospital acquired pneumonia. Although there are comprehensive evidence-based guidelines for the initiation of stress ulcer prophylaxis, there are no universally accepted approaches. This has caused nationwide disorganization in current practice, which has led to their overuse. While many studies have shown the pervasiveness of stress ulcer prophylaxis overuse in the hospital setting, none have demonstrated its effect on the community through the improper discharge of patients on these medications.Methods UsedA retrospective review of patient data at a major teaching hospital in New York City was performed. During a 2 month study period, adult non-intensive care patients were randomly selected to determine the incidence of inappropriate initiation of stress ulcer prophylaxis on admission, as compared to the incidence of appropriate use. A follow-up assessment was then completed to determine the incidence of patients that were inappropriately discharged on these medications.Summary of ResultsA total of 100 randomly selected patients throughout the inpatient medicine service were analyzed. The results showed a high rate of inappropriate initiation and discharge of patients on anti-secretory agents. The study showed a 50% (n=50) incidence of overall stress ulcer prophylaxis use. Of the patients on stress ulcer prophylaxis, a 76% (n=38) incidence of inappropriate use was found. Of the patients inappropriately on stress ulcer prophylaxis, there was a 53% (n=19) incidence of inappropriate discharge home on these medications.ConclusionsThis study highlights the continued inappropriate initiation and discharge of patients on anti-secretory agents, despite mounting evidence and advisories against this practice. The use of an electronic medical record could provide an additional resource to improve quality of care. Electronic prescriptions allow for prompts that ask for a clinical indication during the prescription process. The advent of this technology may yield even more promising improvements in clinical practice, and its implementation is the current focus of a continuing study.

scholarly journals Use of the Emergency Ambulance Service to an Inner City Accident and Emergency Department – a Comparison of General Practitioner and ‘999’ Calls

1991 ◽  
Vol 84 (12) ◽  
pp. 726-727 ◽  
Author(s):  
A G Pennycook ◽  
R M Makower ◽  
W G Morrison
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Hospital Setting ◽  
Ambulance Service ◽  
Inappropriate Use ◽  
Accident And Emergency ◽  
Emergency Ambulance ◽  
Accident And Emergency Department ◽  
A Prospective Study ◽  
Effective Use

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a ‘999’ call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.

scholarly journals Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults

Viruses ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1885
Author(s):  
Giovanni Battista Biserni ◽  
Sara Scarpini ◽  
Arianna Dondi ◽  
Carlotta Biagi ◽  
Luca Pierantoni ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Clinical Presentation ◽  
Inflammatory Responses ◽  
Early Recognition ◽  
Hospital Setting ◽  
Diagnostic Tools ◽  
Inappropriate Use ◽  
Airway Infections ◽  
Lymphocyte Cultures ◽  
Children And Young Adults

Human Adenoviruses (HAdV) are known to be potentially associated with strong inflammatory responses and morbidity in pediatric patients. Although most of the primary infections are self-limiting, the severity of clinical presentation, the elevation of the white blood cell count and inflammatory markers often mimic a bacterial infection and lead to an inappropriate use of antibiotics. In infections caused by HAdV, rapid antigen detection kits are advisable but not employed routinely; costs and feasibility of rapid syndromic molecular diagnosis may limit its use in the in-hospital setting; lymphocyte cultures and two-sampled serology are time consuming and impractical when considering the use of antibiotics. In this review, we aim to describe the principal diagnostic tools and the immune response in HAdV infections and evaluate whether markers based on the response of the host may help early recognition of HAdV and avoid inappropriate antimicrobial prescriptions in acute airway infections.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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