Implementation of a Pediatric Pharmacy Education Program at a Community Regional Medical Center

OBJECTIVES This study aimed to implement a web-based pediatric education program designed for pharmacists who participate in neonatal and pediatric order verification at a community-based health system and to evaluate the success through measuring outcomes related to both comfort and competence of pharmacists in pediatric and neonatal pharmacotherapy. METHODS This prospective quality improvement study assessed changes in confidence and competence from before to after education. Eight educational modules were designed to provide education based on the needs of this institution. All pharmacists who participate in neonatal and pediatric order verification were eligible for inclusion throughout the health system. Time in the verification queue for pediatric and neonatal medication orders was compared for before to after education as an objective surrogate marker for comfort and competence. A provider survey was conducted before and after education to assess the providers' perspective of the quality and necessity of pharmacist-provider interactions. RESULTS All confidence scores showed statistical improvement from before to after education (p < 0.001). Before to after education competency scores significantly improved (median 77% [IQR, 69%–85%] to 100% [IQR, 92%–100%]; p < 0.01). The module with the lowest mean score (87%) was module 4 (Antibiotics Part 1), and the one with highest number of retakes (24 retakes from 16 different pharmacists) was module 5 (Antibiotics Part 2). CONCLUSIONS Targeted web-based education effectively improved both confidence and competence among health-system pharmacists to provide pediatric and neonatal care in a community hospital.

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The Use of Smartphone-Based Triage to Reduce the Rate of Outpatient Error Registration: Cross-Sectional Study

JMIR mhealth and uhealth ◽

10.2196/15313 ◽

2019 ◽

Vol 7 (11) ◽

pp. e15313 ◽

Cited By ~ 2

Author(s):

Wanhua Xie ◽

Xiaojun Cao ◽

Hongwei Dong ◽

Yu Liu

Keyword(s):

Patient Satisfaction ◽

Medical Center ◽

Cross Sectional Study ◽

Sectional Study ◽

Outpatient Services ◽

Cross Sectional ◽

Web Based ◽

Outpatient Visits ◽

Registration Rate ◽

Before And After

Background In many clinics, patients now have the option to make Web-based appointments but doing so according to their own judgment may lead to wrong registration and delayed medical services. We hypothesized that smartphone-based triage in outpatient services is superior to Web-based self-appointment registration guided by the medical staff. Objective This study aimed to investigate smartphone-based triage in outpatient services compared with Web-based self-appointment registration and to provide a reference for improving outpatient care under appointment registration. Methods The following parameters in Guangzhou Women and Children’s Medical Center were analyzed: wrong registration rate, the degree of patient satisfaction, outpatient visits 6 months before and after smartphone-based triage, queries after smartphone-based triage, number of successful registrations, inquiry content, and top 10 recommended diseases and top 10 recommended departments after queries. Results Smartphone-based triage showed significant effects on average daily queries, which accounted for 16.15% (1956/12,112) to 29.46% (3643/12,366) of daily outpatient visits. The average daily successful registration after queries accounted for 56.14% (1101/1961) to 60.92% (1437/2359) of daily queries and 9.33% (1130/12,112) to 16.83% (2081/12,366) of daily outpatient visits. The wrong registration rate after smartphone-based triage was reduced from 0.68% (12,810/1,895,829) to 0.12% (2379/2,017,921) (P<.001), and the degree of patient satisfaction was improved. Monthly outpatient visits were increased by 0.98% (3192/325,710) to 13.09% (42,939/328,032) compared with the same period the preceding year (P=.02). Conclusions Smartphone-based triage significantly reduces the wrong registration rate caused by patient Web-based appointment registration and improves the degree of patient satisfaction. Thus, it is worth promoting.

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Results of a Web-based Patient Education Program in a Multi-Center University Health System

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.07.152 ◽

2014 ◽

Vol 219 (3) ◽

pp. S65-S66

Author(s):

Nicole E. Lopez ◽

Cristina R. Harnsberger ◽

Kathrin M. Troppmann ◽

Emily V. Finlayson ◽

Alessio Pigazzi ◽

...

Keyword(s):

Patient Education ◽

Health System ◽

Education Program ◽

Web Based ◽

Patient Education Program

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Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

Applied Clinical Informatics ◽

10.1055/s-0039-1698465 ◽

2019 ◽

Vol 10 (05) ◽

pp. 849-858

Author(s):

Benjamin R. Kummer ◽

Joshua Z. Willey ◽

Michael J. Zelenetz ◽

Yiping Hu ◽

Soumitra Sengupta ◽

...

Keyword(s):

Electronic Health Record ◽

Medical Center ◽

Academic Medical Center ◽

Turnaround Time ◽

Health Record ◽

Web Based ◽

Patient Chart ◽

Academic Medical ◽

Before And After ◽

The Difference

Abstract Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.

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Storage and Distribution of Pathology Digital Images Using Integrated Web-Based Viewing Systems

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0533-sadopd ◽

2002 ◽

Vol 126 (5) ◽

pp. 533-539 ◽

Cited By ~ 1

Author(s):

Alberto M. Marchevsky ◽

Ronda Dulbandzhyan ◽

Kevin Seely ◽

Steve Carey ◽

Raymond G. Duncan

Keyword(s):

Health System ◽

Health Care Providers ◽

Wireless Local Area Network ◽

Local Area Network ◽

Digital Images ◽

Medical Center ◽

Local Area ◽

Area Network ◽

Care Providers ◽

Web Based

Abstract Context.—Health care providers have expressed increasing interest in incorporating digital images of gross pathology specimens and photomicrographs in routine pathology reports. Objective.—To describe the multiple technical and logistical challenges involved in the integration of the various components needed for the development of a system for integrated Web-based viewing, storage, and distribution of digital images in a large health system. Design.—An Oracle version 8.1.6 database was developed to store, index, and deploy pathology digital photographs via our Intranet. The database allows for retrieval of images by patient demographics or by SNOMED code information. Setting.—The Intranet of a large health system accessible from multiple computers located within the medical center and at distant private physician offices. Results.—The images can be viewed using any of the workstations of the health system that have authorized access to our Intranet, using a standard browser or a browser configured with an external viewer or inexpensive plug-in software, such as Prizm 2.0. The images can be printed on paper or transferred to film using a digital film recorder. Digital images can also be displayed at pathology conferences by using wireless local area network (LAN) and secure remote technologies. Conclusions.—The standardization of technologies and the adoption of a Web interface for all our computer systems allows us to distribute digital images from a pathology database to a potentially large group of users distributed in multiple locations throughout a large medical center.

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2363. Implementation of a Multi-Step Diagnostic Algorithm for C. difficile Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2041 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S814-S814

Author(s):

Morgan Walker ◽

Miranda Mitchell ◽

Britney Mellor ◽

Suzanne Buras ◽

Monica Young ◽

...

Keyword(s):

Medical Center ◽

Diagnostic Algorithm ◽

Nucleic Acid Amplification ◽

Test Results ◽

Before And After ◽

Regional Medical ◽

Regional Medical Center ◽

Step Algorithm ◽

Testing Algorithm ◽

Test Result

Abstract Background The diagnosis of C. difficile infection (CDI) in the hospital is challenging asymptomatic colonization rates vary between 3% and 26%. Guidelines recommend multistep testing for CDI diagnosis. On July 1, 2018 a two-step testing algorithm was implemented at our institution. Positive nucleic acid amplification test (NAAT) results reflexed to a toxin enzyme immunoassay (EIA) test. The EIA test result was then used for NHSN reporting; however, both test results were visible to the clinician. Updated guidance on the interpretation of the test and treatment of CDI was released to the medical staff in July. We compared the incidence of CDI lab ID events per 1000 patient-days and the rate of C. difficile antibiotic starts before and after the implementation of the testing algorithm. Methods A retrospective observational study was performed at an 800 bed regional medical center. CDI lab ID events between January 1 and December 31, 2018 were reviewed. Antibiotic initiation of intravenous (IV) and oral (PO) metronidazole and PO vancomycin was collected for all hospitalized patients diagnosed with C. difficile. The incidence of hospital onset (HO) and community-onset (CO) lab ID events as well as the rate of antibiotic starts were compared before and after implementation of the algorithm using a two-sided z test for proportions with an alpha of 0.05. Results The incidence of HO and CO lab ID events per 1000 patient-days decreased significantly from 0.56 to 0.16 (P < 0.0001) and 1.18 to 0.3 (P < 0.0001) after implementation of the testing algorithm (Figure 1). The CDI SIR decreased from 0.729 to 0.322, (P = 0.0048). The rate of antibiotic starts per 1,000 patient-days for IV and PO Metronidazole decreased significantly from 1.1 to 0.45 (P < 0.0001) and 0.86 to 0.35 (P < 0.0001), respectively. PO Vancomycinstarts decreased from 1.51 to 1.23 (P = 0.11) (Table 1). Conclusion A two-step algorithm for diagnosing CDI decreases the overall number of HO and CO C. difficile lab ID events and decreases overall antimicrobial use for CDI. Disclosures All authors: No reported disclosures.

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The Use of Smartphone-Based Triage to Reduce the Rate of Outpatient Error Registration: Cross-Sectional Study (Preprint)

10.2196/preprints.15313 ◽

2019 ◽

Author(s):

Wanhua Xie ◽

Xiaojun Cao ◽

Hongwei Dong ◽

Yu Liu

Keyword(s):

Patient Satisfaction ◽

Medical Center ◽

Cross Sectional Study ◽

Sectional Study ◽

Outpatient Services ◽

Cross Sectional ◽

Web Based ◽

Outpatient Visits ◽

Registration Rate ◽

Before And After

BACKGROUND In many clinics, patients now have the option to make Web-based appointments but doing so according to their own judgment may lead to wrong registration and delayed medical services. We hypothesized that smartphone-based triage in outpatient services is superior to Web-based self-appointment registration guided by the medical staff. OBJECTIVE This study aimed to investigate smartphone-based triage in outpatient services compared with Web-based self-appointment registration and to provide a reference for improving outpatient care under appointment registration. METHODS The following parameters in Guangzhou Women and Children’s Medical Center were analyzed: wrong registration rate, the degree of patient satisfaction, outpatient visits 6 months before and after smartphone-based triage, queries after smartphone-based triage, number of successful registrations, inquiry content, and top 10 recommended diseases and top 10 recommended departments after queries. RESULTS Smartphone-based triage showed significant effects on average daily queries, which accounted for 16.15% (1956/12,112) to 29.46% (3643/12,366) of daily outpatient visits. The average daily successful registration after queries accounted for 56.14% (1101/1961) to 60.92% (1437/2359) of daily queries and 9.33% (1130/12,112) to 16.83% (2081/12,366) of daily outpatient visits. The wrong registration rate after smartphone-based triage was reduced from 0.68% (12,810/1,895,829) to 0.12% (2379/2,017,921) (<italic>P</italic><.001), and the degree of patient satisfaction was improved. Monthly outpatient visits were increased by 0.98% (3192/325,710) to 13.09% (42,939/328,032) compared with the same period the preceding year (<italic>P</italic>=.02). CONCLUSIONS Smartphone-based triage significantly reduces the wrong registration rate caused by patient Web-based appointment registration and improves the degree of patient satisfaction. Thus, it is worth promoting.

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