electronic order
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Author(s):  
Eleanor D Sadler ◽  
Edina Avdic ◽  
Sara E Cosgrove ◽  
Dawn Hohl ◽  
Michael Grimes ◽  
...  

Abstract Purpose To identify barriers to safe and effective completion of outpatient parenteral antimicrobial therapy (OPAT) in patients discharged from an academic medical center and to develop targeted solutions to potentially resolve or improve the identified barriers. Summary A failure modes and effects analysis (FMEA) was conducted by a multidisciplinary OPAT task force to evaluate the processes for patients discharged on OPAT to 2 postdischarge dispositions: (1) home and (2) a skilled nursing facility (SNF). The task force created 2 process maps and identified potential failure modes, or barriers, to the successful completion of each step. Thirteen and 10 barriers were identified in the home and SNF process maps, respectively. Task force members created 5 subgroups, each developing solutions for a group of related barriers. The 5 areas of focus included (1) the OPAT electronic order set, (2) critical tasks to be performed before patient discharge, (3) patient education, (4) patient follow-up and laboratory monitoring, and (5) SNF communication. Interventions involved working with information technology to update the electronic order set, bridging communication and ensuring completion of critical tasks by creating an inpatient electronic discharge checklist, developing patient education resources, planning a central OPAT outpatient database within the electronic medical record, and creating a pharmacist on-call pager for SNFs. Conclusion The FMEA approach was helpful in identifying perceived barriers to successful transitions of care in patients discharged on OPAT and in developing targeted interventions. Healthcare organizations may reproduce this strategy when completing quality improvement planning for this high-risk process.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S117-S118
Author(s):  
Henry B Huson ◽  
Herbert Phelan ◽  
David G’Sell ◽  
Sydney Smith ◽  
Jeffrey E Carter

Abstract Introduction Burn care (BC) remains a highly specialized and resource intensive specialty with only 2% of hospitals featuring a burn center and less than 1% of graduating general surgery and plastic surgery residents pursing a burn fellowship each year. Access to specialized care is further complicated by burn wound assessment (BWA) which is commonly performed visually without adjunctive devices. To help clinicians make more accurate assessments and potentially reduce delays in transfer or treatment, a new non-invasive imaging device for BWA is being developed using visible and non-visible wavelengths of light with machine learning algorithms. Our goal was to assess the potential reduced treatment delay (RTD) and associated financial savings by implementing such a device using our burn center’s historical data. Methods The study was an IRB-approved, retrospective review of admissions from 07/01/2018 through 06/30/2019. Inclusion criteria: thermal, chemical, contact, or electrical mechanism of injury, >15 years of age requiring excision, and length of stay >72 hours. Inclusion data included: presence/absence of concomitant trauma, day of surgery, day of admission, day of electronic order entry for case request, and length of stay per percent total body surface area (LOS%TBSA). RTD was defined starting >48 hours after injury daily until electronic order entry for surgical case request. Reduced costs were calculated per day from prior studies ranging $3,000 to $5,100/day. Results A total of 109 patients were included. 29 patients had case requests placed within 48 hours of admission. Of the remaining 80 patients, a potential of 398 days would have been saved had a novel BWA adjunctive imaging devices aided surgeon to requests earlier surgical intervention. Overall savings from reduced length of stay range from $1,194,000 to $2,029,800 dollars. Conclusions Our study demonstrates that should a BWA technology with accuracy 48 hours after injury be developed, even burn centers with 24-hour access to operating rooms can reduce treatment delays. The study does not look at additional cost savings offered by reduced emergent transfers or admissions which offer additional intrigue and promise.


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Kunliang Bu ◽  
Wenhao Zhang ◽  
Ying Fei ◽  
Yuan Zheng ◽  
Fangzhou Ai ◽  
...  

AbstractMultiple ordered states have been observed in unconventional superconductors. Here, we apply scanning tunneling microscopy to probe the intrinsic ordered states in FeSe, the structurally simplest iron-based superconductor. Besides the well-known nematic order along [100] direction, we observe a checkerboard charge order in the iron lattice, which we name a [110] electronic order in FeSe. The [110] electronic order is robust at 77 K, accompanied with the rather weak [100] nematic order. At 4.5 K, The [100] nematic order is enhanced, while the [110] electronic order forms domains with reduced correlation length. In addition, the collective [110] order is gaped around [−40, 40] meV at 4.5 K. The observation of this exotic electronic order may shed new light on the origin of the ordered states in FeSe.


2020 ◽  
Vol 1 (6) ◽  
Author(s):  
Daniel Pedersen ◽  
Angelina Rodriguez ◽  
Olu Oyesanmi ◽  
Heather Schramm ◽  
Michael R. King

2020 ◽  
Vol 125 (26) ◽  
Author(s):  
L. X. Yang ◽  
G. Rohde ◽  
K. Hanff ◽  
A. Stange ◽  
R. Xiong ◽  
...  
Keyword(s):  

CJC Open ◽  
2020 ◽  
Vol 2 (6) ◽  
pp. 497-505
Author(s):  
Robert J.H. Miller ◽  
Alexandra Bell ◽  
Sandeep Aggarwal ◽  
James Eisner ◽  
Jonathan G. Howlett

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