scholarly journals Emergency Medicine Matters: Epidemiology of Medical Pathology and Changes in Patient Outcomes after Implementation of a Post-graduate Training Program at a Tertiary Teaching Hospital in Kigali, Rwanda

2020 ◽  
Author(s):  
Katelyn Moretti ◽  
Doris Lorette Uwamahoro ◽  
Sonya Naganathan ◽  
Chantal Uwamahoro ◽  
Naz Karim ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Patient Outcomes ◽  
Teaching Hospital ◽  
Emergency Care ◽  
Medical Conditions ◽  
Time Period ◽  
Medical Emergencies ◽  
Time Periods ◽  
The Impact

Abstract Background: Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda.Methods: A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013 - September 2013 versus September 2015 - June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results: A random sample of 1,704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included: gastrointestinal, infectious disease and neurologic pathology. Differences by time period in EC management included: antibiotic use (37.2% vs. 42.2%, p=0.04), vasopressor use (1.9% vs. 0.5%, p=0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p=0.001) and mean IVF administration (2,057 ml vs. 2,526 ml, p<0.001). EC specific mortality fell from 10.0% to 1.4% (p<0.0001) across time periods.Conclusions: Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

scholarly journals Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Katelyn Moretti ◽  
Doris Lorette Uwamahoro ◽  
Sonya Naganathan ◽  
Chantal Uwamahoro ◽  
Naz Karim ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Patient Outcomes ◽  
Teaching Hospital ◽  
Emergency Care ◽  
Medical Conditions ◽  
Time Period ◽  
Medical Emergencies ◽  
Time Periods ◽  
The Impact

Abstract Background Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda. Methods A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results A random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods. Conclusions Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.

scholarly journals Implementation of a Breast/Reconstruction Surgery Coordinator to Reduce Preoperative Delays for Patients Undergoing Mastectomy With Immediate Reconstruction

2016 ◽  
Vol 12 (3) ◽  
pp. e338-e343 ◽  
Author(s):  
Mehra Golshan ◽  
Katya Losk ◽  
Melissa A. Mallory ◽  
Kristen Camuso ◽  
Linda Cutone ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Cancer Center ◽  
Immediate Reconstruction ◽  
Reconstruction Surgery ◽  
Surgical Services ◽  
Breast Surgeon ◽  
Time Period ◽  
Surgical Teams ◽  
The Impact ◽  
Surgical Clinic

Purpose: Mastectomy with immediate reconstruction (MIR) requires coordination between breast and reconstructive surgical teams, leading to increased preoperative delays that may adversely impact patient outcomes and satisfaction. Our cancer center established a target of 28 days from initial consultation with the breast surgeon to MIR. We sought to determine if a centralized breast/reconstructive surgical coordinator (BRC) could reduce care delays. Methods: A 60-day pilot to evaluate the impact of a BRC on timeliness of care was initiated at our cancer center. All reconstructive surgery candidates were referred to the BRC, who had access to surgical clinic and operating room schedules. The BRC worked with both surgical services to identify the earliest surgery dates and facilitated operative bookings. The median time to MIR and the proportion of MIR cases that met the time-to-treatment goal was determined. These results were compared with a baseline cohort of patients undergoing MIR during the same time period (January to March) in 2013 and 2014. Results: A total of 99 patients were referred to the BRC (62% cancer, 21% neoadjuvant, 17% prophylactic) during the pilot period. Focusing exclusively on patients with a cancer diagnosis, an 18.5% increase in the percentage of cases meeting the target (P = .04) and a 7-day reduction to MIR (P = .02) were observed. Conclusion: A significant reduction in time to MIR was achieved through the implementation of the BRC. Further research is warranted to validate these findings and assess the impact the BRC has on operational efficiency and workflows.

Merging Two Hospitals: The Effects on Pediatric Extracorporeal Cardiopulmonary Resuscitation Outcomes

2020 ◽  
Author(s):  
Rebecca Anderson de la Llana ◽  
Renate Le Marsney ◽  
Kristen Gibbons ◽  
Benjamin Anderson ◽  
Emma Haisz ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Initial Time ◽  
Nonsignificant Trend ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Time Period ◽  
Neurocognitive Outcomes ◽  
Time Periods ◽  
The Impact

AbstractA retrospective study was performed to describe the impact of merging two pediatric intensive care units on the overall and neurocognitive outcomes of children who required extracorporeal cardiopulmonary resuscitation (ECPR). Results from three cohorts were compared: 2008 to 2014: premerge, 2014 to 2017: initial time period postmerge, and 2018 to 2019: established merge. Survival to hospital discharge (and with good neurological outcome) was of 68% (61%), 46% (36%), and 79% (71%), respectively, for the three time periods. Merging two hospitals resulted in a nonsignificant trend toward temporary worse outcomes in pediatric patients requiring ECPR.

scholarly journals 1344. Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S683-S683
Author(s):  
Julia Sapozhnikov ◽  
Marisol Fernandez
Keyword(s):  
Pediatric Hospital ◽  
Antimicrobial Utilization ◽  
Time Period ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Central Texas ◽  
Successful Approach ◽  
Time Periods ◽  
The Impact ◽  
Physician Team

Abstract Background “Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD). Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure Results Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P&lt; 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P&lt; 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D]. Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days Conclusion Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion. Disclosures All Authors: No reported disclosures

scholarly journals Examining critical factors affecting graduate retention from an emergency medicine training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives

2017 ◽  
Vol 8 (2) ◽  
pp. e61-74
Author(s):  
Meredith Jane Kuipers ◽  
Amira Eapen ◽  
Joel Lockwood ◽  
Sara Berman ◽  
Samuel Vaillancourt ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Training Program ◽  
Emergency Care ◽  
Addis Ababa ◽  
National Context ◽  
Critical Factors ◽  
Factors Affecting ◽  
Occupational Environment ◽  
Individual Condition

Background: In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and consumable resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system. Methods: Qualitative interviews were conducted with current AAU EM residents and stakeholders in Ethiopian EM. Mixed-methods inductive thematic analysis was performed.Results: Resident and stakeholder participants identified critical factors in three domains: the individual condition, the occupational environment, and the national context. Within each domain, priority themes emerged from the responses, including the importance of career satisfaction over the career continuum (individual condition), the opportunity to be involved in the developing EM program and challenges associated with resource, economic, and employment constraints (occupational environment), and perceptions regarding the state of awareness of EM and the capacity for change at the societal level (national context). Conclusions: This work underscores the need to resolve multiple systemic and cultural issues within the Ethiopian health care landscape in order to address EM graduate retention. It also highlights the potential success of a retention strategy focused on the career ambitions of keen EM doctors.

scholarly journals Emergency medicine training in Canada

CJEM ◽  
1999 ◽  
Vol 1 (01) ◽  
pp. 51-53 ◽  
Author(s):  
Kieran Moore ◽  
Cindy-Ann Lucky
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Emergency Care ◽  
Critical Mass ◽  
Rural Practice ◽  
Emergency Physicians ◽  
Certification Process

SUMMARY: Canada is the only country with two colleges governing emergency medicine (EM) certification. Does this serve us well or does it divide us and our resources? If most CCFP(EM) graduates practise strictly EM, with no family or rural practice, then reform in the certification process may be necessary. At the same time, FRCPC residencies seem excessively long and lack the numbers to develop “critical mass.” Shortening the length of training would allow more residency positions to be created, thus advancing the goal of optimum emergency care for the Canadian public. Canadians deserve one standardized, certified, accredited EM training program that produces the highest quality emergency physicians.

scholarly journals 1339. Impact of COVID-19 Pandemic on Activity of Other Respiratory Viral Pathogen and Norovirus

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S757-S757
Author(s):  
Lauren DiBiase ◽  
Emily Sickbert-Bennett ◽  
David J Weber ◽  
David J Weber ◽  
Melissa B Miller
Keyword(s):  
Significant Decline ◽  
Influenza B ◽  
Research Support ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Molecular Tests ◽  
Time Period ◽  
Percent Positivity ◽  
Time Periods ◽  
The Impact

Abstract Background The COVID-19 pandemic led to the implementation of several strategies (e.g., masking, physical distancing, daycare/school and business closures, hand hygiene, surface disinfection) intended to mitigate the spread of disease in the community. Our objective was to evaluate the impact of these strategies on the activity of respiratory viral pathogens (other than SARS-CoV-2) and norovirus. Methods At University of North Carolina (UNC) Hospitals, we compared the percent positivity for respiratory viral pathogens and norovirus by calendar year for 2014-2019 and the first three months of 2020 to the percent positivity in the subsequent months of 2020 and the first quarter of 2021. Patients were included in the study if they had a positive specimen obtained in a clinic, ED or as an inpatient. Three molecular tests were used to detect these viruses: adenoviruses, endemic coronaviruses (OC43, 229E, NL63, HKU1), influenza A (subtypes H3, H1, H1N1pdm), influenza B, metapneumovirus (MPV), parainfluenza viruses 1-4 (PIV), rhinovirus and/or enterovirus (RhV/EV), and respiratory syncytial virus (RSV). Two molecular tests were used to detect norovirus. We calculated point prevalence rates with 95% confidence intervals to assess statistical differences in percent positivity. Results There was a statistically significant decline in percent positivity for endemic coronaviruses, influenza, MPV, PIV, RSV and norovirus during the time-periods after March 2020 when compared to all other time-periods (Figure). RhV/EV, followed by adenovirus were the most prevalent types of respiratory viruses circulating during height of COVID-19. There was a statistically significant decline seen in RhV/EV in April-Dec 2020, but activity increased in 2021. There was no difference seen in adenovirus activity across time-periods. Percent Positivity of Respiratory Viral Pathogens and Norovirus by Time Period Conclusion Our study demonstrated statistically significant decreases in the percent positivity of several respiratory viral pathogens, as well as norovirus, during the time-period of high community prevalence of SARS-CoV-2. Strategies put in place to mitigate SARS-CoV-2 transmission likely contributed to these differences. Non-enveloped viruses like rhinovirus and adenoviruses may have been less impacted by these strategies since they are more resistant to disinfection. Disclosures David J. Weber, MD, MPH, PDI (Consultant) Melissa B. Miller, PhD, D(ABMM), F(AAM), Abbott Molecular (Grant/Research Support)Agena Bioscience (Consultant)ArcBio (Grant/Research Support)Cepheid (Consultant)Luminex Molecular Diagnostics (Consultant)QIAGEN (Consultant)Sherlock Biosciences (Consultant)Talis Biomedical (Consultant)Werfen (Consultant)

scholarly journals Emergency Medicine Education at a Medical Institute in Nepal: Breaking the Frontiers

2020 ◽  
Vol 18 (1) ◽  
pp. 120-125
Author(s):  
Harish Chandra Neupane ◽  
Niki Shrestha ◽  
Daya Ram Lamsal
Keyword(s):  
Emergency Medicine ◽  
Training Program ◽  
Emergency Care ◽  
Medical Institute ◽  
International Emergency Medicine ◽  
Medical College ◽  
Emergency Care Systems ◽  
Care Systems ◽  
The Uk ◽  
Medical Leadership

Emergency medicine, globally, is a developing specialty. The President of International Federation for Emergency Medicine penned down in a 2007 editorial that emergency medicine is rapidly becoming a global specialty. There are an increasing number of countries which are exploring ways to further build emergency medicine. The Hybrid International Emergency Medicine Training Program is the first collaborative international Emergency Medicine training developed in the UK. A Memorandum of Understanding has been signed among Doncaster& Bassetlaw Teaching Hospital,, UK, International Centre for Emergency Medicine UK, International Academy of Medical Leadership, UK and Chitwan Medical College, Nepal.The HIEM program has been executed by CMC from November 15, 2018. As per the MOU, the International Training Registrars of HIEM Program will undergo 1st& 4rth Year of training at CMC, Nepal and the 2nd year and 3rd year of training at DBTH, UK. The HIEM Training Program is the first of its kind in the country; HIEM is the first post graduate emergency medicine program in Nepal which also has an international recognition and is unique in the sense that the programme is integrated with training in leadership and management.The HIEM Training Program is recognized by Royal College of Emergency Medicine, UK. CMC has committed to improving emergency care in Nepal by pioneering the HIEM Training Program. We are committed to fulfilling our moral and social responsibility to improve emergency care systems in the country through building up of a cadre of adequately trained Emergency Physicians.Keywords: Emergencies; emergency care; emergency medicine; Nepal

scholarly journals The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Saurabh Jamdar ◽  
Vishnu V. Chandrabalan ◽  
Rami Obeidallah ◽  
Panagiotis Stathakis ◽  
Ajith K. Siriwardena ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Operating Theatre ◽  
Index Admission ◽  
Biliary Disease ◽  
Time Period ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Time Periods ◽  
The Impact

Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P &lt; 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

Impact on physician workload and revenue following the creation of a specialty vein clinic within an academic vascular practice

2007 ◽  
Vol 22 (4) ◽  
pp. 164-170 ◽  
Author(s):  
M A Passman ◽  
J B Dattilo ◽  
R J Guzman ◽  
T C Naslund
Keyword(s):  
Vascular Surgery ◽  
Rapid Expansion ◽  
Time Period ◽  
Relative Value ◽  
Increasing Trend ◽  
Procedure Volume ◽  
Time Periods ◽  
The Impact ◽  
Academic Vascular Surgery ◽  
Physician Workload

Objective: To evaluate the impact of creating a new specialty vein clinic within an academic-based vascular practice on clinical volume, physician workload and financial parameters. Methods: All patients evaluated and treated for varicose vein related problems within an academic vascular surgery practice were identified from institutional billing databases. Data were stratified according to the time period prior to establishing a vein clinic (PRE-VC) (1999–2001) and after creation of a vein clinic (POST-VC) (2002–2004). Clinical volume, physician workload and financial parameters were evaluated. Comparisons were made between vein (VEIN) and overall vascular (VASC) practice trends. Results: Comparison of clinical volume, physician workload and financial parameters in both the clinic and operative settings showed larger and more rapid expansion of the VEIN practice than VASC practice between PRE-VC and POST-VC time periods (VEIN vs. VASC growth, respectively: new patient clinic volume +162 vs. +18%; clinic relative value units (RVUs) +131 vs. +1%, clinic revenue +201 vs. +44%; procedure volume +348 vs. +19%; procedure RVUs +129 vs. +11%; procedure revenue +93 vs. +10%). Comparing the beginning of PRE-VC to the end of POST-VC time periods, an increasing trend was also present for the percentage of VEIN practice accounting for the total VASC practice (%VEIN PRE-VC to POST-VC, respectively: new patient clinic volume 11.6–30.2%; clinic RVUs 3.2–48.2%; clinic revenue 17.6–31.2%; procedure volume 3.1–14.3%; procedure RVUs 2.8–9.8%; procedure revenue 3.3–11.7%). Conclusion: Establishing a specialty vein clinic within an academic vascular practice can lead to a rapid expansion of clinical volume with associated increase in physician workload and reimbursement at a rate greater than that for the overall vascular practice.

Sign in / Sign up

Export Citation Format

Share Document