scholarly journals Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

2021 ◽  
Vol 12 (2) ◽  
pp. 13
Author(s):  
Melanie Berry ◽  
Amy Gustafson ◽  
Maya Wai ◽  
Alex J. Luli
Keyword(s):  
Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Acceptance Rate ◽  
Demographic Information ◽  
Consult Service ◽  
Descriptive Data ◽  
Academic Medical ◽  
Patient Demographic Information

Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service.  Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.

Evaluation of Patient Experience from Telemedicine Use for an Anesthesiology Pain Division: Time, Cost, and Patient Satisfaction Analysis (Preprint)

2021 ◽  
Author(s):  
Laleh Jalilian ◽  
Irene Wu ◽  
Jakun Ing ◽  
Xuezhi Dong ◽  
George Pan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Travel Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Travel Distance ◽  
Patient Cost ◽  
Academic Medical ◽  
Pain Patients

BACKGROUND An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, healthcare providers have utilized telemedicine for pain management of both interventional and chronic pain patients. OBJECTIVE This study describes telemedicine implementation for pain management at an academic pain division in a large metropolitan area. The study estimates patient cost savings from telemedicine, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction with telemedicine for pain management care. METHODS This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1,398 patients and conducted 2,948 video visits for remote pain management care. We utilize publicly available IRS Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimate median travel time, travel distance, direct cost of travel, and time-based opportunity savings and report patient satisfaction scores. RESULTS Telemedicine patients avoided an estimated median roundtrip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within sample, the median hourly earnings was $28/hr. Patients saved a median of $22 on gas and parking and a total of $52 per telemedicine visit based on estimated hourly earnings and travel time. Patients evaluated serially with telemedicine for medication management saved a median of $156 over three visits. 91% of patients surveyed (n = 313) were satisfied with their telemedicine experience. CONCLUSIONS Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for pain patients. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings.

scholarly journals Conversion of Provider EMR Training from Instructor-Led Training to eLearning at an Academic Medical Center

2017 ◽  
Vol 08 (03) ◽  
pp. 754-762
Author(s):  
Karen Sharp ◽  
Michele Williams ◽  
Adrienne Bogacz ◽  
Sighle Denier ◽  
Ann McAlearney ◽  
...  
Keyword(s):  
Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
End User ◽  
Provider Training ◽  
Step Process ◽  
Training Tool ◽  
Academic Medical ◽  
Training Approach

SummaryThis case study overviews the conversion of provider training of the electronic medical record (EMR) from an instructor-led training (ILT) program to eLearning at an Academic Medical Center (AMC). This conversion provided us with both a useful training tool and the opportunity to maximize efficiency within both our training and optimization team and organization. eLearning Development Principles were created and served as a guide to assist us with designing an eLearning curriculum using a five step process. The result was a new training approach that allowed learners to complete training at their own pace, and even test out of sections based on demonstrated competency. The information we have leads us to believe that a substantial return on our investment can be obtained from the conversion with positive impacts that have served as the foundation for the future of end user EMR training at our AMC.Citation: Sharp K, Williams M, Aldrich A, Bogacz A, Denier S, McAlearney AS. Conversion of Provider EMR Training from Instructor Led Training to eLearning at an Academic Medical Center. Appl Clin Inform 2017; 8: 754–762 https://doi.org/10.4338/ACI-2017-03-CR-0040

Economic Evaluation of a Pharmacist-Led 5-Day Therapeutic Hold of IV Levothyroxine at an Academic Medical Center

2020 ◽  
pp. 001857872097045
Author(s):  
Blake T. Barlow ◽  
Russel J. Roberts ◽  
Kelly Newman ◽  
Sarah K. Harrison ◽  
Jonathan H. Sin
Keyword(s):  
Medical Center ◽  
Financial Burden ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Surgical Trauma ◽  
Implementation Phase ◽  
Academic Medical ◽  
Pharmacokinetic Properties ◽  
Utilization Data ◽  
Surgical Icu

Objective: Providers often admit patients with active outpatient prescriptions for levothyroxine. During an inpatient admission, providers may instruct critically ill patients to take nothing by mouth, or nil per os (NPO). Thus, they may prescribe the intravenous (IV) formulation of levothyroxine during this period. However, levothyroxine possesses a prolonged half-life of up to 7 days; therefore, immediate transition to IV levothyroxine may not be clinically necessary in the acute NPO setting. Intravenous levothyroxine is significantly more expensive than equivalent oral doses and may prove to be a financial burden for an institution. By understanding the pharmacokinetic properties of levothyroxine, we implemented a cost-saving initiative involving a 5-day therapeutic hold of IV levothyroxine. Methods: This was a retrospective evaluation in 2 intensive care units (ICU): a 20-bed surgical/trauma ICU and an 18-bed mixed medical/surgical ICU. Patient data, utilization data, and documented pharmacist interventions were collected for 6 months prior to implementation of the 5-day IV levothyroxine therapeutic hold and for 6 months post-implementation. All patients prescribed IV levothyroxine during these timeframes were included. Results: During the 6-month pre-implementation phase, 674 doses (691 vials) of IV levothyroxine for 77 unique patients were dispensed from the 2 ICUs. During the 6-month post-implementation phase, 168 doses (188 vials) of IV levothyroxine were dispensed for 44 unique patients. Of the 44 patients (48 orders) who still received IV levothyroxine, 22.9% of orders were deemed clinically necessary by the pharmacist and were not recommended to be held under the protocol, 64.6% were due to the verifying pharmacist being unaware of the protocol, 8.3% of orders were due to protocol non-compliance, and 4.2% were verified after the 5-day hold was complete as the patient remained NPO. This pharmacy-led initiative resulted in a 75% decrease in usage post-implementation and an estimated annualized savings of $80,000. Conclusion: A pharmacy-led initiative comprised of a 5-day therapeutic hold of IV levothyroxine was feasible and led to a 75% reduction in usage and cost over a 6-month period in 2 ICU’s. Future steps include additional staff education for improved protocol adherence and expanding the protocol institution-wide for an even greater cost-savings potential.

Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile

2019 ◽  
Vol 40 (6) ◽  
pp. 710-712 ◽  
Author(s):  
Michele S. Fleming ◽  
Olivia Hess ◽  
Heather L. Albert ◽  
Emily Styslinger ◽  
Michelle Doll ◽  
...  
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Critical Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clostridioides Difficile ◽  
Testing Frequency ◽  
Academic Medical ◽  
Support Matrix ◽  
The Impact

AbstractWe assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.

scholarly journals Identifying disincentives to ethics consultation requests among physicians, advance practice providers, and nurses: a quality improvement all staff survey at a tertiary academic medical center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lynette Cederquist ◽  
Jamie Nicole LaBuzetta ◽  
Edward Cachay ◽  
Lawrence Friedman ◽  
Cassia Yi ◽  
...  
Keyword(s):  
Online Survey ◽  
Medical Center ◽  
Academic Medical Center ◽  
Scale Up ◽  
Healthcare Providers ◽  
Ethics Consultation ◽  
Consult Service ◽  
Cross Sectional ◽  
Knowing How ◽  
Academic Medical

Abstract Background Ethics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization. Methods This was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR). Results From January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations. Conclusions Based on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs.

scholarly journals Building eConsult (Electronic Consults) Capability at an Academic Medical Center to Improve Efficiencies in Delivering Specialty Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110053
Author(s):  
Matthew A. Thompson ◽  
Anne L. Fuhlbrigge ◽  
Duane W. Pearson ◽  
David R. Saxon ◽  
Linda A. Oberst-Walsh ◽  
...  
Keyword(s):  
Delivery System ◽  
System Integration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Cost Savings ◽  
Models Of Care ◽  
Health Crisis ◽  
Academic Medical ◽  
The Face

As the COVID-19 health crisis continues to reshape healthcare, systems across the country face increasing pressure to adapt their models of care to expand access to care, while also improving efficiency and quality in the face of limited resources. Consequently, many have shown a growing interest and receptivity to the expansion of telehealth models to help meet these demands. Electronic consultations (eConsults) are a telehealth modality that allow for a non-face-to-face asynchronous consultation between a primary care provider (PCP) and a specialist aimed at facilitating specialist input without the need for a patient visit. The aim of this case study is to describe eConsults, how they differ from traditional in person models of care and other models of telemedicine and to review the evidence related to the effectiveness of eConsults by PCPs and clinicians from multiple specialties at the University of Colorado School of Medicine. We have worked to develop an infrastructure, delivery system integration, and care model adaptations that aim to improve delivery system performance by ensuring proper care in appropriate settings and lowering costs through reduced utilization. Lastly, we have increased care coordination, improved collaboration and better care transitions through strengthening of relationships between community-based PCPs and academic medical center-based specialists. This work has resulted in cost savings to patients and positive provider satisfaction.

scholarly journals Optimizing Inpatient Urine Culture Ordering Practices Using the Electronic Medical Record: A Pilot Study

2016 ◽  
Vol 38 (4) ◽  
pp. 486-488 ◽  
Author(s):  
Daniel Shirley ◽  
Harry Scholtz ◽  
Kurt Osterby ◽  
Jackson Musuuza ◽  
Barry Fox ◽  
...  
Keyword(s):  
Pilot Study ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Before And After ◽  
Quasi Experimental ◽  
Before And After Study

A prospective quasi-experimental before-and-after study of an electronic medical record–anchored intervention of embedded education on appropriate urine culture indications and indication selection reduced the number of urine cultures ordered for catheterized patients at an academic medical center. This intervention could be a component of CAUTI-reduction bundles.Infect Control Hosp Epidemiol 2017;38:486–488

Sign in / Sign up

Export Citation Format

Share Document