Oncology rapid assessment clinic and effect on ED visits.

258 Background: The use of the Emergency Department (ED) by oncology patients for lower acuity issues is common. Oncology Rapid Assessment Clinics (ORAC) may play a key role in reducing ED visits among oncology patients. We analyzed whether the advent of ORAC was associated with lower ED utilization by patients receiving cancer care at University of Chicago Medical Center (UCMC). Methods: UCMC opened its ORAC in March 2019 to provide supportive care and symptom management to cancer patients who needed acute medical issues addressed. To identify active cancer patients, we identified those that had either a forward or reverse 9 month rolling count of greater than or equal to 2 Outpatient Clinic Visits (complete or future). Of all those patients, we identified any ED visit made within the time period considered Pre-ORAC (6/2018-2/2019) and Post-ORAC (6/2019-2/2020). To determine effect of ORAC on ED utilization, we performed t-test comparison of rates. Results: A total of 9,043 unique patients were seen in the Pre-ORAC period and 8,753 in the Post-ORAC period. Predominant cancers seen in both periods were Breast, Lung/Head & Neck, GI, Lymphoma/Leukemia, GU, and Multiple Myeloma. The ED visit rate was 0.252 (2279/9043) in Pre-ORAC period and 0.237 (2075/8753) in the Post-ORAC period (p = 0.02). Conclusions: There was a decrease in ED visit rates for oncology patients cared for by UCMC in the immediate period after the opening of the ORAC clinic. More substantial declines are expected in the future as the capacity and efficiency of the ORAC clinic grows and the concept is socialized among cancer providers.

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study (Preprint)

BACKGROUND Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives. OBJECTIVE This study aims to survey pediatric and adult medicine clinicians at the University of Chicago Medical Center to understand their telemedicine benefits and barriers, workflow impacts, and training and support needs. METHODS In July 2020, we conducted an observational cross-sectional study of University of Chicago Medical Center faculty and advanced practice providers in the Department of Medicine (DOM) and Department of Pediatrics (DOP). RESULTS The overall response rate was 39% (200/517; DOM: 135/325, 42%; DOP: 65/192, 34%); most respondents were physicians (DOM: 100/135, 74%; DOP: 51/65, 79%). One-third took longer to prepare for (65/200, 33%) and conduct (62/200, 32%) video visits compared to in-person visits. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (<i>P=</i>.02), with no differences in the number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (<i>P=</i>.02), with no difference in reported burnout. Female clinicians were “more overwhelmed” with video visits compared to males (41/130, 32% vs 12/64, 19%; <i>P=</i>.05). Clinicians 50 years or older were “less overwhelmed” than those younger than 50 years (30/85, 35% vs 23/113, 20%; <i>P=</i>.02). Those who received more video visit training modalities (eg, a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (<i>P=</i>.007) or burnt out (<i>P=</i>.009). In addition, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (<i>P=</i>.02) or burnt out (<i>P=</i>.001). The top telemedicine barriers were patient-related: lack of technology access, lack of skill, and reluctance. Training needs to be focused on integrating learners into workflows. Open-ended responses highlighted a need for increased support staff. Overall, more than half “enjoyed conducting video visits” (119/200, 60%) and wanted to continue using video visits in the future (150/200, 75%). CONCLUSIONS Despite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed. Further, clinicians need additional training on trainee education and integration into workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers, and enhance clinician training are needed to support telemedicine’s durability.

Retrospective chart evaluation of hypercalcemia management in oncology patients at the University of Chicago Medical Center

Introduction Due to the lack of formal guideline recommendations, available primary literature was used to develop a proposed protocol for management of hypercalcemia of malignancy at the University of Chicago Medical Center. Methods A retrospective, single center, observational study was performed including adult patients hospitalized with a diagnosis of hypercalcemia and active malignancy. Patients were retrospectively identified as treated in a manner aligned with the proposed protocol (“per protocol”) or not treated according to the proposed protocol (“off protocol”), and the outcomes were compared. The primary outcome for efficacy was normalization of corrected calcium within four and seven days of treatment. Results Normalization of corrected calcium was observed in 66% of patients managed per protocol compared to 65% of patients managed off protocol ( p = 1.00) at day four, and in 73% of per protocol patients compared to 65% of off protocol patients ( p = 0.44) at day seven. Areas identified where prospective implementation of the proposed protocol can improve management include: decreasing utilization of bisphosphonates in mild hypercalcemia, optimizing bisphosphonate dosing in renal impairment, decreasing intravenous phosphate repletion, and ensuring proper fluid management and calcitonin dosing. Conclusion Although a statistical difference was not detected in terms of normalization of corrected calcium levels, areas for optimization in management were identified. Therefore, implementation of the proposed protocol is expected to promote evidence-based management of hypercalcemia of malignancy management at University of Chicago Medical Center.

Pseudo-outbreak ofMycobacterium gordonaeFollowing the Opening of a Newly Constructed Hospital at a Chicago Medical Center

OBJECTIVETo identify the source of a pseudo-outbreak ofMycobacterium gordonaeDESIGNOutbreak investigation.SETTINGUniversity Hospital in Chicago, Ilinois.PATIENTSHospital patients withM. gordonae-positive clinical cultures.METHODSAn increase in isolation ofM. gordonaefrom clinical cultures was noted immediately following the opening of a newly constructed hospital in January 2012. We reviewed medical records of patients withM. gordonae-positive cultures collected between January and December 2012 and cultured potable water specimens in new and old hospitals quantitatively for mycobacteria.RESULTSOf 30 patients withM. gordonae-positive clinical cultures, 25 (83.3%) were housed in the new hospital; of 35 positive specimens (sputum, bronchoalveolar lavage, gastric aspirate), 32 (91.4%) had potential for water contamination.M. gordonaewas more common in water collected from the new vs. the old hospital [147 of 157 (93.6%) vs. 91 of 113 (80.5%),P=.001]. Median concentration ofM. gordonaewas higher in the samples from the new vs. the old hospital (208 vs. 48 colony-forming units (CFU)/mL;P<.001). Prevalence and concentration ofM. gordonaewere lower in water samples from ice and water dispensers [13 of 28 (46.4%) and 0 CFU/mL] compared with water samples from patient rooms and common areas [225 of 242 (93%) and 146 CFU/mL,P<.001].CONCLUSIONSM. gordonaewas common in potable water. The pseudo-outbreak ofM. gordonaewas likely due to increased concentrations ofM. gordonaein the potable water supply of the new hospital. A silver ion-impregnated 0.5-μm filter may have been responsible for lower concentrations ofM. gordonaeidentified in ice/water dispenser samples. Hospitals should anticipate that construction activities may amplify the presence of waterborne nontuberculous mycobacterial contaminants.Infect Control Hosp Epidemiol 2014;00(0): 1–6

Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008

Objective.The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.Design.Retrospective cohort study.Setting and Participants.Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.Methods.Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.Results.The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.Conclusions.The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.