scholarly journals In-Person Interpreter Use and Hospital Length of Stay among Infants with Low Birth Weight

2018 ◽  
Vol 15 (8) ◽  
pp. 1570 ◽  
Author(s):  
Monica Eneriz-Wiemer ◽  
Lee Sanders ◽  
Mary McIntyre ◽  
Fernando Mendoza ◽  
D. Do ◽  
...  
Keyword(s):  
Birth Weight ◽  
Length Of Stay ◽  
Low Birth Weight ◽  
Healthcare Providers ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Interpreter Use ◽  
Adjusted Incidence Rate ◽  
Hospital Days ◽  
Adjusted Incidence

To ensure timely appropriate care for low-birth-weight (LBW) infants, healthcare providers must communicate effectively with parents, even when language barriers exist. We sought to evaluate whether non-English primary language (NEPL) and professional in-person interpreter use were associated with differential hospital length of stay for LBW infants, who may incur high healthcare costs. We analyzed data for 2047 infants born between 1 January 2008 and 30 April 2013 with weight <2500 g at one hospital with high NEPL prevalence. We evaluated relationships of NEPL and in-person interpreter use on length of stay, adjusting for medical severity. Overall, 396 (19%) had NEPL parents. Fifty-three percent of NEPL parents had documented interpreter use. Length of stay ranged from 1 to 195 days (median 11). Infants of NEPL parents with no interpreter use had a 49% shorter length of stay (adjusted incidence rate ratio (IRR) 0.51, 95% confidence interval (CI) 0.43–0.61) compared to English-speakers. Infants of parents with NEPL and low interpreter use (<25% of hospital days) had a 26% longer length of stay (adjusted IRR 1.26, 95% CI 1.06–1.51). NEPL and high interpreter use (>25% of hospital days) showed a trend for an even longer length of stay. Unmeasured clinical and social/cultural factors may contribute to differences in length of stay.

scholarly journals 56. Ertapenem Utilization: “CRE”ating Solutions for Improving Hospital Stay and Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S49-S49
Author(s):  
Debra M Willner ◽  
Victoria Bengualid ◽  
Bismarck Bisono-Garcia ◽  
Judith Berger
Keyword(s):  
Length Of Stay ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Acinetobacter Baumanii ◽  
Carbapenem Resistant ◽  
Days Of Therapy ◽  
Future Direction ◽  
Hospital Days

Abstract Background Ertapenem, a carbapenem offers advantages over other carbapenems. It is administered daily and can therefore facilitate home infusion discharges, it has a narrower spectrum of activity which could reduce resistance, and is more cost effective than meropenem. Our objectives were to determine whether ertapenem utilization decreased hospital length of stay and whether use had an impact on future meropenem resistance. Methods This was a retrospective chart review of ertapenem over 2 years for the following infections: urinary tract, skin and soft tissue (SSTI), and osteomyelitis. Evaluated pathogens, duration of inpatient therapy, discharged antimicrobials, length of discharged therapy, and positive cultures up to 90 days post treatment. Analyzed length of stay, and calculated the hospital days that were saved by discharging patients on ertapenem. Results 70 patients were analyzed, with indications and pathogens listed in Figure 1. Patients were initially placed on empiric therapies pending culture results. On average, patients received 2.9 days of empiric meropenem. Once cultures finalized, patients were switched to ertapenem. On average, patients received 6 days of inpatient ertapenem prior to discharge. 37 patients were discharged with ertapenem, totaling 937 days of discharged therapy. Of the 36 patients readmitted within 90 days, 20 had pathogens identified, of which 4 were meropenem-resistant (Figure 2). Infections, Pathogens, and Treatment Duration Conclusion In this pilot stewardship initiative, switching to and discharging patients on ertapenem saved 937 hospital days over the 2 years evaluated, with the greatest days of therapy saved in osteomyelitis and SSTIs. There were a total of 422 days of inpatient ertapenem, mostly in the SSTI and cystitis indications. Of the 20 pathogens identified on readmission, 4 (20%) were meropenem-resistant. All were Acinetobacter baumanii-often carbapenem-resistant; none of the cultures were the same pathogen as the originally identified, but this warrants further investigation. The indication associated with least days of therapy saved and the highest days of inpatient ertapenem was cystitis. 53% of the patients were discharged with ertapenem; future direction involved identifying barriers for speedy discharge across all indications. Disclosures All Authors: No reported disclosures

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

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