scholarly journals The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study (Preprint)

2021 ◽  
Author(s):  
Reem Halabi ◽  
Geoffrey Smith ◽  
Marc Sylwestrzak ◽  
Brian Clay ◽  
Christopher A Longhurst ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Medical Center ◽  
Academic Medical Center ◽  
Working Environment ◽  
Teaching Hospitals ◽  
Protective Equipment ◽  
Cross Sectional ◽  
Academic Medical ◽  
Telemedicine Technology ◽  
The Impact

UNSTRUCTURED With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine.

scholarly journals Characterization of community-based donation of personal protective equipment to an academic health center during the COVID-19 pandemic

2021 ◽  
Vol 9 (6) ◽  
pp. 33
Author(s):  
Ronda S. Farah ◽  
James T. Pathoulas ◽  
Nathan Rubin ◽  
Lisa M. Hursin ◽  
Molly A. Wyman ◽  
...  
Keyword(s):  
Social Media ◽  
Personal Protective Equipment ◽  
Small Businesses ◽  
Medical Center ◽  
Academic Medical Center ◽  
Protective Equipment ◽  
Academic Medical ◽  
Personal Use ◽  
Building Community ◽  
Novel Coronavirus

Objective: The novel coronavirus 2019 (COVID-19) pandemic led to a shortage of personal protective equipment (PPE) early in the pandemic. Healthcare systems asked for public donations of PPE and established community drop-off sites. Herein, we aim to profile community PPE donors at one large academic medical center including evaluation of donor industry, public messaging, and psychosocial aspects of donation.Methods: A survey was created and distributed to donors at two urban PPE drop-off sites between March and April 2020. Targeted donors and drop-off sites were located in the Twin Cities metropolitan area (approximate population of 3.5 million people).Results: A total of 486 surveys were completed. Nearly half (47.3%) of PPE donated was initially intended for personal use. Donors primarily learned of PPE collection efforts through word of mouth (23.2%) and social media (22.7%). The most frequently reported barrier to donation included distance between donors and drop off sites or location (27.8%). Donors rated the severity of the PPE shortage in the state as a 7.8 ± 1.7 out of 10. There was a slight correlation between donors assessment of COVID-19 severity and feeling that their donation was a meaningful contribution against COVID-19 (r = 0.21, p = .00).Conclusions: Future community collection campaigns during widespread disasters should prioritize mobilizing privately held goods from individuals rather than small businesses. Public messaging around donation should utilize simple narratives that are easily shareable via social media and evoke donation as a means of building community.

scholarly journals Characterization of community-based donation of personal protective equipment to an academic health center during the COVID-19 pandemic

2021 ◽  
Vol 9 (6) ◽  
pp. 34
Author(s):  
Alexandra N. Fuher ◽  
James T. Pathoulas ◽  
Nathan Rubin ◽  
Lisa M. Hursin ◽  
Molly A. Wyman ◽  
...  
Keyword(s):  
Social Media ◽  
Personal Protective Equipment ◽  
Small Businesses ◽  
Medical Center ◽  
Academic Medical Center ◽  
Protective Equipment ◽  
Academic Medical ◽  
Personal Use ◽  
Building Community ◽  
Novel Coronavirus

Objective: The novel coronavirus 2019 (COVID-19) pandemic led to a shortage of personal protective equipment (PPE) early in the pandemic. Healthcare systems asked for public donations of PPE and established community drop-off sites. Herein, we aim to profile community PPE donors at one large academic medical center including evaluation of donor industry, public messaging, and psychosocial aspects of donation.Methods: A survey was created and distributed to donors at two urban PPE drop-off sites between March and April 2020. Targeted donors and drop-off sites were located in the Twin Cities metropolitan area (approximate population of 3.5 million people).Results: A total of 486 surveys were completed. Nearly half (47.3%) of PPE donated was initially intended for personal use. Donors primarily learned of PPE collection efforts through word of mouth (23.2%) and social media (22.7%). The most frequently reported barrier to donation included distance between donors and drop off sites or location (27.8%). Donors rated the severity of the PPE shortage in the state as a 7.8 ± 1.7 out of 10. There was a slight correlation between donors assessment of COVID-19 severity and feeling that their donation was a meaningful contribution against COVID-19 (r = 0.21, p = .00).Conclusions: Future community collection campaigns during widespread disasters should prioritize mobilizing privately held goods from individuals rather than small businesses. Public messaging around donation should utilize simple narratives that are easily shareable via social media and evoke donation as a means of building community.

scholarly journals Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s114-s115
Author(s):  
Alexandra Johnson ◽  
Bobby Warren ◽  
Deverick John Anderson ◽  
Melissa Johnson ◽  
Isabella Gamez ◽  
...  
Keyword(s):  
Real World ◽  
Medical Center ◽  
Academic Medical Center ◽  
Randomized Study ◽  
Healthcare Providers ◽  
Clinical Workflow ◽  
Provider Type ◽  
Academic Medical ◽  
Rn Students ◽  
The Impact

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but ~5 mL of the supernatant was discarded. Samples were plated on sheep’s blood agar and selective media for clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals A Study on Knowledge Towards Brain Death among Residents in Indonesia

2020 ◽  
Vol 56 (2) ◽  
pp. 140
Author(s):  
Asra Al Fauzi ◽  
Christrijogo Sumartono Waloejo ◽  
Abdulloh Machin ◽  
Muhammad Ja'far Shodiq
Keyword(s):  
Brain Death ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Research Subjects ◽  
Cross Sectional ◽  
Academic Medical ◽  
Center Hospital ◽  
Level 3 ◽  
Level 2

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

2021 ◽  
Author(s):  
Landon Arensberg ◽  
Jessica Kalender-Rich ◽  
Jaehoon Lee ◽  
Cheryl Gibson
Keyword(s):  
Medical Care ◽  
Baby Boomers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Online Reviews ◽  
Online Resources ◽  
Cross Sectional ◽  
Academic Medical ◽  
Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Merilyn S Varghese ◽  
Jordan B Strom ◽  
Sarah Fostello ◽  
Warren J Manning
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Hospital Systems ◽  
The Impact ◽  
At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

scholarly journals Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Sophia Jung ◽  
Mary Elizabeth Sexton ◽  
Sallie Owens ◽  
Nathan Spell ◽  
Scott Fridkin
Keyword(s):  
Antibiotic Prescription ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Multivariable Logistic Regression Analysis ◽  
Comorbid Condition ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Care Clinic ◽  
The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

scholarly journals Impact of enhanced personal protective equipment on the physical and mental well-being of healthcare workers during COVID-19

2020 ◽  
pp. postgradmedj-2020-139150 ◽  
Author(s):  
Ramanathan Swaminathan ◽  
Bimantha Perera Mukundadura ◽  
Shashi Prasad
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Negative Impact ◽  
Well Being ◽  
Cross Sectional Study ◽  
Protective Equipment ◽  
Cross Sectional ◽  
The Impact ◽  
Mental Well Being

BackgroundThe COVID-19 pandemic has necessitated the use of enhanced personal protective equipment (PPE) in healthcare workers in patient-facing roles. We describe the impact on the physical and mental well-being of healthcare professionals who use enhanced PPE consistently.MethodsWe conducted a single-centre, cross-sectional study among healthcare professionals who use enhanced PPE. A web-based questionnaire was disseminated to evaluate the effects on individuals’ physical and mental well-being. Physical and mental impact was assessed through a visual analogue scale.ResultsProspective analysis of the views of 72 respondents is reported. 63.9% were women and 36.1% were men. Physical impact included exhaustion, headache, skin changes, breathlessness and a negative impact on vision. Communication difficulties, somnolence, negative impact on overall performance and difficulties in using surgical instrumentation were reported.ConclusionOur study demonstrates the undeniable negative impact on the front-line healthcare workers using enhanced PPE and lays the ground for larger multicentric assessments given for it to potentially be the norm for the foreseeable future.

scholarly journals The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

2018 ◽  
Vol 10 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Matthew Gorgone ◽  
Brian McNichols ◽  
Valerie J. Lang ◽  
William Novak ◽  
Alec B. O'Connor
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medical Providers ◽  
Procedural Training ◽  
Academic Medical ◽  
Attending Physician ◽  
Attending Physicians ◽  
The Impact ◽  
Training Opportunities

ABSTRACT Background  Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective  We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods  We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results  Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions  The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

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