Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Introduction. Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods. In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results. Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). Conclusion. When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.

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Abstract TP366: Significant Reduction in Readmission Using Transitions Nurse

Stroke ◽

10.1161/str.51.suppl_1.tp366 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kiersten Espaillat ◽

Paula Buckner

Keyword(s):

Hospital Discharge ◽

Transitional Care ◽

Medical Center ◽

Hospital Readmissions ◽

Primary Diagnosis ◽

Adult Patients ◽

Care Coordinator ◽

Readmission Rates ◽

Before And After

In an effort to reduce early hospital readmissions, Vanderbilt University Medical Center (VUMC) implemented a transitional care coordinator (TCC) to provide careful coordinated follow up care for stroke patients after hospital discharge. The aim of this study is to compare all cause thirty- day readmission rates of adult patients with a primary diagnosis of stroke before and after the implementation of a stroke services TCC. All adult patients admitted to VUMC with a primary diagnosis of stroke; ischemic, hemorrhagic, and TIA; and readmitted within the first thirty days following hospital discharge between January-June of 2015, 2016, 2017, & 2018 were analyzed. Readmission data from 2015 & 2016, prior to the implementation of the TCC was compared to readmission data from 2017 & 2018, after the TCC was implemented. A total of 1911 charts were reviewed for the timeframe January-June of 2015-2018. In 2015 there were 369 stroke admissions and 120 (33%) were readmitted and in 2016 there were 474 stroke admissions and 112 (24%) readmissions, before the TCC role was implemented. In 2017 there were 540 stroke admissions and 62 (11%) were readmitted and in 2018 there were 528 stroke admissions and 74 (14%) readmissions, after the TCC role was implemented. Hospital readmissions were reduced significantly after implementing a TCC.

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Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽

10.1161/str.46.suppl_1.tp168 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Josephine F Huang ◽

Jennifer E Fugate ◽

Alejandro A Rabinstein

Keyword(s):

Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Treatment ◽

Good Outcome ◽

Time Period ◽

Academic Medical ◽

Younger Age ◽

Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

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Loop diuretic use following fluid resuscitation in the critically ill

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab372 ◽

2021 ◽

Author(s):

Mashael A Alaskar ◽

Joshua D Brown ◽

Stacy A Voils ◽

Scott M Vouri

Keyword(s):

Hospital Discharge ◽

Fluid Resuscitation ◽

Loop Diuretic ◽

Medical Center ◽

Academic Medical Center ◽

Loop Diuretics ◽

Intravenous Fluid ◽

Factors Associated ◽

Icu Stay ◽

Potential Factors

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To identify the incidence of continuation of newly initiated loop diuretics upon intensive care unit (ICU) and hospital discharge and identify factors associated with continuation. Methods This was a single-center retrospective study using electronic health records in the setting of adult ICUs at a quaternary care academic medical center. It involved patients with sepsis admitted to the ICU from January 1, 2014, to June 30, 2019, who received intravenous fluid resuscitation. The endpoints of interest were (1) the incidence of loop diuretic use during an ICU stay following fluid resuscitation, (2) continuation of loop diuretics following transition of care, and (3) potential factors associated with loop diuretic continuation after transition from the ICU. Results Of 3,591 patients who received intravenous fluid resuscitation for sepsis, 39.4% (n = 1,415) were newly started on loop diuretics during their ICU stay. Among patients who transitioned to the hospital ward from the ICU, loop diuretics were continued in 33% (388/1,193) of patients. At hospital discharge, 13.4% (52/388) of these patients were prescribed a loop diuretic to be used in the outpatient setting. History of liver disease, development of acute kidney injury, being on vasopressors while in the ICU, receiving blood products, and receiving greater than 90 mL/kg of bolus fluids were significant potential factors associated with loop diuretic continuation after transition from the ICU. Conclusion New initiation of loop diuretics following intravenous fluid resuscitation in patients with sepsis during an ICU stay is a common occurrence. Studies are needed to assess the effect of this practice on patient outcomes and resource utilization.

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Abstract 204: Echocardiographic Evidence for Systemic Atherosclerosis, Atrial Fibrillation, and Long-Term Prognosis in Stroke Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.204 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Justin Pieper ◽

Michael Ashamalla ◽

Neil Yager ◽

Daniel Sedhom ◽

Khetan Gate ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hemorrhagic Stroke ◽

Normal Sinus Rhythm ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Patients ◽

Long Term Prognosis ◽

Echocardiographic Evidence

Background: Echocardiography is routinely performed for evaluation of cardiac embolic causes in stroke patients. We sought to examine the association of echocardiographic evidence of atherosclerosis with atrial fibrillation and long-term outcomes. Materials and methods: Retrospective chart review was performed in 756 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Transthoracic echocardiograms were reviewed for presence of mitral annular calcifications, aortic valve sclerosis, or aortic atherosclerosis. Admission ECG and telemetry recordings were evaluated for documented dysrhythmias. Mean follow up length was 46+/- 20 months. Results: A significant number (57.7%) of patients with non-hemorrhagic stroke diagnosed with atrial fibrillation had evidence of cardiac and systemic atherosclerosis on transthoracic echocardiogram, which was less likely in patients with normal sinus rhythm (35.4%) or non-sinus non-atrial fibrillation rhythms (37.1%, p<0.05). Findings of cardiac and systemic atherosclerosis were more common in older patients (75+/- 11 vs 60+/- 16 years old, p<.001), with lower BMI (27.4+/- 6.0 vs. 29+/- 6.5, p<.001), and hypertension (71.9% vs. 59.2 %, p=.002). Patients with findings of cardiac and systemic atherosclerosis were more likely to die during follow-up (56.1% vs. 43.9%, p<.001). Conclusion: In patients with non-hemorrhagic stroke, cardiac and systemic evidence of atherosclerosis was strongly associated with atrial fibrillation and portended poor long-term prognosis. In stroke patients with cardiac and systemic evidence of atherosclerosis and rhythms other than atrial fibrillation, extended ECG monitoring may be warranted.

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Abstract NS5: Use of a Multidisciplinary Approach to Successfully Improve Inpatient Diabetes Self-Management Education and Diabetes Medication Reconciliation at Discharge for Persons With Diabetes and Stroke at a Major Academic Medical Center

Stroke ◽

10.1161/str.51.suppl_1.ns5 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Suzanne Stone ◽

Nancy Drobycki ◽

Mark Johnson

Keyword(s):

Medication Reconciliation ◽

Medical Center ◽

Diabetes Education ◽

Academic Medical Center ◽

Blood Pressure Reduction ◽

Diabetes Medication ◽

Effective Discharge ◽

Inpatient Diabetes ◽

Patients With Diabetes

Background: Persons with diabetes are 1.5 times more likely to have a stroke. Research shows that there is a correlation between increasing diabetes and stroke. Education for stroke patients, however, continues to focus on medication management and blood pressure reduction. American Diabetes Association indicates, “There should be a structured discharge plan tailored to the individual patient with diabetes.” Transitioning from the acute care is risky for diabetics, recommendations now include individualized education for diabetics with stroke. 40% of the stroke population at our institution showed risk factors for diabetes, yet 11% received diabetes education, and only 59% had diabetes medication pre-prescribed at discharge. The stroke team initiated an inpatient diabetes education to increase patient awareness and medication adherence. Purpose: The purpose of this project was to identify and address barriers related to the provision of individualized inpatient diabetes education and outpatient diabetes medication reconciliation for persons with diabetes and stroke. Method: The Endocrinology team was consulted for patients with diabetes and stroke with an A1c level of 7%. These team worked collaboratively to establish a consult process. Endocrinology APPs provided diabetic education and advised the Neurology team on the appropriate discharge medication regimen and follow-up. The stroke coordinator provided reminders during rounds to assure that consults were ordered for patients with diabetes having A1c 7% or greater. Results: Inpatient diabetes education improved from 11% in 2017 to 96% in 2019. Diabetes medication reconciliation, with listing of diabetes medications on the after visit summary at discharge increased from 59% in 2017 to 93% in 2019. Conclusions: Both metrics reflect improvement over a 2-year period, showing that collaboration between the Endocrinology and Neurology teams is key to effective discharge planning, diabetes medication reconciliation and outpatient follow-up.

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Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

Otolaryngology ◽

10.1177/0194599819841893 ◽

2019 ◽

Vol 161 (1) ◽

pp. 164-170 ◽

Cited By ~ 5

Author(s):

Lyndy J. Wilcox ◽

Claudia Schweiger ◽

Catherine K. Hart ◽

Alessandro de Alarcon ◽

Nithin S. Peddireddy ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Balloon Dilation ◽

Case Series ◽

Slide Tracheoplasty ◽

Time Period ◽

Academic Medical ◽

Operative Notes ◽

Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

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Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽

10.1093/neuros/nyz310_434 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Shayan Moosa ◽

Lindsay Bowerman ◽

Ellen Smith ◽

Mindy Bryant ◽

Natalie Krovetz ◽

...

Keyword(s):

High Risk ◽

Patient Population ◽

Medical Center ◽

Academic Medical Center ◽

Readmission Rates ◽

Academic Medical ◽

Neurosurgical Patient ◽

Neurosurgical Patients ◽

Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

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Depression Screening and Measurement-Based Care in Primary Care

Journal of Primary Care & Community Health ◽

10.1177/2150132720931261 ◽

2020 ◽

Vol 11 ◽

pp. 215013272093126

Author(s):

Kimberly A. Siniscalchi ◽

Marion E. Broome ◽

Jason Fish ◽

Joseph Ventimiglia ◽

Julie Thompson ◽

...

Keyword(s):

Primary Care ◽

Task Force ◽

Medical Center ◽

Academic Medical Center ◽

Unmet Need ◽

The United States ◽

Depression Screening ◽

Improvement Project ◽

Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

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Frequency of 6-week follow-up appointment scheduling after intrauterine device insertion

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2017-101791 ◽

2017 ◽

Vol 44 (1) ◽

pp. 33-36 ◽

Cited By ~ 3

Author(s):

Abigail Bernard ◽

Catherine L Satterwhite ◽

Madhuri Reddy

Keyword(s):

Medical Center ◽

Intrauterine Device ◽

Value Added ◽

University Of Kansas ◽

Patient Demographics ◽

The Usa ◽

Long Acting ◽

The University ◽

Record Review

IntroductionLong-acting reversible contraception (LARC) is widely recommended to reduce unintended pregnancy in the USA. As intrauterine device (IUD) use increases, evaluating the role of post-insertion follow-up is important.MethodsA retrospective patient record review was conducted to assess the follow-up experience of women who had an IUD placed at the University of Kansas Medical Center from 1 January to 30 June 2015. Data were collected on patient demographics, IUD placement, follow-up visit attendance, and outcomes in the 12 months following placement. The primary outcome of interest was the proportion of patients who attended a 6-week follow-up visit. Secondary outcomes included adverse events detected at the 6-week visit and IUD removal within a year of placement.ResultsAmong 380 women who had an IUD inserted, physician documentation of a recommended 6-week follow-up visit was present in 91.3% of patient medical records. Two-thirds (66.6%) of patients receiving a recommendation returned for a follow-up visit. Of the 380 women who had an IUD placed, 66 (17.4%) had their IUD removed within 1 year of placement. Of those, 50 women attended the 6-week follow-up visit and 16 did not (19.8% vs 12.6%, p=0.08). Of the IUD removals, 14 occurred at the 6-week visit. After excluding IUD removals which occurred at the 6-week visit, attending a 6-week follow-up visit was not associated with IUD removal or retention (p=0.52).ConclusionDespite recommendations to forgo the 6-week follow-up visit, visits were still common, with no demonstrated value added.

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