Communication about opioid versus nonopioid analgesics in the emergency department

2015 ◽  
Vol 11 (3) ◽  
pp. 229 ◽  
Author(s):  
Danielle M. McCarthy, MD, MS ◽  
Kenzie A. Cameron, PhD, MPH ◽  
D. Mark Courtney, MD, MS ◽  
James G. Adams, MD ◽  
Kirsten G. Engel, MD
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Academic Medical ◽  
Frequency Of Use ◽  
Nonopioid Analgesics ◽  
Attending Physicians

Objective: The Medication Communication Index (MCI) was used to compare counseling about opioids to nonopioid analgesics in the Emergency Department (ED) setting.Design: Secondary analysis of prospectively collected audio recordings of ED patient visits.Setting: Urban, academic medical center (>85,000 annual patient visits). Participants: Patient participants aged >18 years with one of four low acuity diagnoses: ankle sprain, back pain, head injury, and laceration. ED clinician participants included resident and attending physicians, nursing staff, and ED technicians.Main outcome measures: The MCI is a five-point index that assigns points for communicating the following: medication name (1), purpose (1), duration (1), adverse effects (1), number of tablets (0.5), and frequency of use (0.5). Recording transcripts were scored with the MCI, and total scores were compared between drug classes.Results: The 41 patients received 56 prescriptions (27 nonopioids, 29 opioids). Nonopioid median MCI score was 3 and opioid score was 4.5 (p = 0.0008). Patients were counseled equally about name (nonopioid 100 percent, opioid 96.6 percent, p = 0.34) and purpose (88.9 percent, 89.7 percent, p = 0.93). However, patients receiving opioids were counseled more frequently about duration of use (nonopioid 40.7 percent, opioid 69.0 percent, p = 0.03) and adverse effects (18.5 percent, 93.1 percent, p < 0.001). In multivariable analysis, opioids (β = 0.54, p = 0.04), number of medications prescribed (β = −0.49, p = 0.05), and time spent in the ED (β = 0.007, p = 0.006) were all predictors of total MCI score.Conclusions: The extent of counseling about analgesic medications in the ED differs by drug class. When counseling patients about all analgesic medications, providers should address not only medication name and purpose but also the less frequently covered topics of medication dosing, timing, and adverse effects.

scholarly journals Using design and innovation principles to reduce avoidable emergency department visits among employees of a large academic medical center

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 100514
Author(s):  
Krisda H. Chaiyachati ◽  
Katy Mahraj ◽  
Carolina Garzon Mrad ◽  
Christina J. O'Malley ◽  
Marguerite Balasta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Emergency Department Visits ◽  
Academic Medical

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p &lt; 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p &lt; 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

Clinicians Are From Mars and Pathologists Are From Venus

2000 ◽  
Vol 124 (7) ◽  
pp. 1040-1046 ◽  
Author(s):  
Seth M. Powsner ◽  
José Costa ◽  
Robert J. Homer
Keyword(s):  
Medical Errors ◽  
Medical Information ◽  
Potential Problem ◽  
Medical Center ◽  
Academic Medical Center ◽  
Open Book ◽  
Surgical Experience ◽  
Academic Medical ◽  
Pathology Reports ◽  
Attending Physicians

Abstract Context.—Text reports convey critical medical information from pathologists, radiologists, and subspecialty consultants. These reports must be clear and comprehensible to avoid medical errors. Pathologists have paid much attention to report completeness but have ignored the corresponding issue of report comprehension. This situation presents an increasingly serious potential problem. As laboratories are consolidated and as reports are disseminated in new ways (eg, via the World Wide Web), the target audience becomes more diverse and less likely to have any contact with pathologists beyond the written reports themselves. Objective.—To compare clinician comprehension with pathologist intent in written pathology reports. Methods.—Typical surgical pathology reports relevant to surgeons and covering a range of specimen complexity were taken from our hospital files. Questionnaires based on these cases were administered open-book-examination style to surgical attending physicians and trainees during surgical conferences at an academic medical center. Main Outcome Measures.—Scores from questionnaires. Results.—Surgeons misunderstood pathologists' reports 30% of the time. Surgical experience reduced but did not eliminate the problem. Streamlined report formatting exacerbated the problem. Conclusions.—A communication gap exists between pathologists and surgeons. Familiarity with report format and clinical experience help reduce this gap. Paradoxically, stylistic improvements to report formatting can interfere with comprehension and increase the number of misunderstandings. Further investigation is required to reduce the number of misunderstandings and, thus, medical errors.

Care Coordination

2018 ◽  
pp. 163-167
Keyword(s):  
Emergency Department ◽  
Care Coordination ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Ethnically Diverse ◽  
Medicine Service ◽  
Academic Medical ◽  
Diverse Patient Population ◽  
Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

scholarly journals 2424. Shedding of Viable Clostridiodes difficile in Patients Admitted to a Medical Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S837-S838
Author(s):  
Vincent B Young ◽  
Micah Keidan ◽  
Rachel D Yelin ◽  
Thelma E Dangana ◽  
Pamela B Bell ◽  
...  
Keyword(s):  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Analysis ◽  
Icu Patients ◽  
Specific Pcr ◽  
Patient Admissions ◽  
Academic Medical ◽  
Healthcare Associated ◽  
Record Review

Abstract Background Hospitalized patients are at risk of colonization with a range of healthcare-associated bacterial pathogens, including C. difficile. In patients admitted to intensive care units (ICUs), in whom C. difficile infection (CDI) is associated with increased morbidity and mortality. To understand the risk for acquisition of C. difficile and development of CDI, we monitored ICU patients daily for shedding of C. difficile by culture. Methods We conducted a secondary analysis of daily rectal/fecal swab samples collected from medical ICU patients of a 720-bed academic medical center in Chicago, IL. Selective culture for C. difficile was performed on swab samples from patients who had 2 or more samples obtained using selective media. Confirmation of putative C. difficile isolates was done by specific PCR assays for the 16S rRNA-encoding gene and the toxin genes tcdA, tcdB, cdtA and cdtB. Clinical testing for CDI was performed using the Xpert® C. difficile PCR assay (Cepheid). Clinical and demographic metadata were collected at bedside and by electronic medical record review. Results Culture was attempted on 2106 swab samples from 451 patients (486 ICU admissions) (Figure 1). A mean of 4.33 samples was obtained from each patient. C. difficile was isolated from 211 (10%) samples from 79 patients (Table 1). The first sample was positive by culture for 48 (9.9%) of patient admissions to the ICU. 31 (6.4%) patients who were initially negative by culture had a subsequent sample from which C. difficile was isolated. Persistence of culture-positivity varied from patient to patient (Figure 2). Of 80 patients who were tested for CDI based on physician suspicion, 12 patients had a positive Cepheid PCR test; 9 had diarrhea and were treated for CDI. Conclusion Surveillance for shedding of C. difficile by daily culture reveals that patients admitted to the ICU can shed the pathogen intermittently without attributable disease. This can be in the form patients who are admitted carrying the organism as well as those who appear to acquire the organism during their stay. It is unclear whether patient or microbiome factors underlie the differences seen in patterns of shedding. Furthermore, intermittent shedding may reflect multiple episodes of exposure to C. difficile spores and asymptomatic shedding without stable colonization. Disclosures All authors: No reported disclosures.

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.

scholarly journals Major Radiologic and Clinical Outcomes of Total Spine MRI Performed in the Emergency Department at a Major Academic Medical Center

2020 ◽  
Vol 41 (6) ◽  
pp. 1120-1125
Author(s):  
C.W.C. Huang ◽  
A. Ali ◽  
Y.-M. Chang ◽  
A.F. Bezuidenhout ◽  
D.B. Hackney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Spine Mri
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