151
|
Khanna AK, Motamedi V, Bouldin B, Harwood T, Pajewski NM, Saha AK, Segal S. Automated Electronic Frailty Index-Identified Frailty Status and Associated Postsurgical Adverse Events. JAMA Netw Open 2023; 6:e2341915. [PMID: 37930697 PMCID: PMC10628731 DOI: 10.1001/jamanetworkopen.2023.41915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Importance Electronic frailty index (eFI) is an automated electronic health record (EHR)-based tool that uses a combination of clinical encounters, diagnosis codes, laboratory workups, medications, and Medicare annual wellness visit data as markers of frailty status. The association of eFI with postanesthesia adverse outcomes has not been evaluated. Objective To examine the association of frailty, calculated as eFI at the time of the surgical procedure and categorized as fit, prefrail, or frail, with adverse events after elective noncardiac surgery. Design, Setting, and Participants This cohort study was conducted at a tertiary care academic medical center in Winston-Salem, North Carolina. The cohort included patients 55 years or older who underwent noncardiac surgery of at least 1 hour in duration between October 1, 2017, and June 30, 2021. Exposure Frailty calculated by the eFI tool. Preoperative eFI scores were calculated based on available data 1 day prior to the procedure and categorized as fit (eFI score: ≤0.10), prefrail (eFI score: >0.10 to ≤0.21), or frail (eFI score: >0.21). Main Outcomes and Measures The primary outcome was a composite of the following 8 adverse component events: 90-item Patient Safety Indicators (PSI 90) score, hospital-acquired conditions, in-hospital mortality, 30-day mortality, 30-day readmission, 30-day emergency department visit after surgery, transfer to a skilled nursing facility after surgery, or unexpected intensive care unit admission after surgery. Secondary outcomes were each of the component events of the composite. Results Of the 33 449 patients (median [IQR] age, 67 [61-74] years; 17 618 females [52.7%]) included, 11 563 (34.6%) were classified as fit, 15 928 (47.6%) as prefrail, and 5958 (17.8%) as frail. Using logistic regression models that were adjusted for age, sex, race and ethnicity, and comorbidity burden, patients with prefrail (odds ratio [OR], 1.24; 95% CI, 1.18-1.30; P < .001) and frail (OR, 1.71; 95% CI, 1.58-1.82; P < .001) statuses were more likely to experience postoperative adverse events compared with patients with a fit status. Subsequent adjustment for all other potential confounders or covariates did not alter this association. For every increase in eFI of 0.03 units, the odds of a composite of postoperative adverse events increased by 1.06 (95% CI, 1.03-1.13; P < .001). Conclusions and Relevance This cohort study found that frailty, as measured by an automatically calculated index integrated within the EHR, was associated with increased risk of adverse events after noncardiac surgery. Deployment of eFI tools may support screening and possible risk modification, especially in patients who undergo high-risk surgery.
Collapse
Affiliation(s)
- Ashish K. Khanna
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Vida Motamedi
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bethany Bouldin
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Timothy Harwood
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amit K. Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
| | - Scott Segal
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
| |
Collapse
|
152
|
Weidner A, Brazelton T, Altman W. The Challenges of External Letters for Promotion: Academic Family Medicine's Attempts to Address the Issue. Ann Fam Med 2023; 21:559-560. [PMID: 38012043 PMCID: PMC10681690 DOI: 10.1370/afm.3061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
|
153
|
McCormick C, Ahluwalia S, Segon A. Effect of a Performance Feedback Dashboard on Hospitalist Laboratory Test Utilization. Am J Med Qual 2023; 38:273-278. [PMID: 37908029 DOI: 10.1097/jmq.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Healthcare spending continues to be an area of improvement across all forms of medicine. Overtreatment or low-value care, including overutilization of laboratory testing, has an estimated annual cost of waste of $75.7-$101.2 billion annually. Providing performance feedback to hospitalists has been shown to be an effective way to encourage the practice of quality-improvement-focused medicine. There remains limited data regarding the implementation of performance feedback and direct results on hospital laboratory testing spending in the short term. OBJECTIVE The objective of this project was to identify whether performance-based feedback on laboratory utilization between both hospitalists and resident teams results in more conservative utilization of laboratory testing. DESIGN, SETTING, PARTICIPANTS This quality improvement project was conducted at a tertiary academic medical center, including both direct-care and house-staff teams. INTERVENTION OR EXPOSURE A weekly performance feedback report was generated and distributed to providers detailing laboratory test utilization by all hospitalists in a ranked system, normalized by the census of patients, for 3 months. MAIN OUTCOMES AND MEASURES The outcome measure was cumulative laboratory utilization during the intervention period compared to baseline utilization during the corresponding 3 months in the year prior and the weekly trend in laboratory utilization over 52 weeks. The aggregate laboratory utilization rate during intervention and control time periods was defined as the total number of laboratory tests ordered divided by the total number of patient encounters. Additionally, the cost difference was averaged per quarter and reported. The week-by-week trend in laboratory utilization was evaluated using a statistical process control (SPC) chart. RESULTS We found that following intervention during January-March 2020, the cumulative complete blood count utilization rate decreased from 5.54 to 4.83 per patient encounter and the basic metabolic panels/CMP utilization rate decreased from 6.65 to 6.11 per patient encounter compared with January-March 2019. This equated to cost savings of ~$42,700 in total for the quarter. Nonrandom variation was seen on SPC charts in weekly laboratory utilization rates for common laboratory tests during the intervention period. CONCLUSIONS We found that our intervention did result in a decrease in laboratory test utilization rates across direct-care and house-staff teams. This study lays promising groundwork for one tool that can be used to eliminate a source of hospital waste and improve the quality and efficiency of patient care.
Collapse
Affiliation(s)
| | | | - Ankur Segon
- Medicine, University of Texas Health Science Center, San Antonio, TX
| |
Collapse
|
154
|
McNeil JS, Calgi MP, Tsang S, Theodore D, Thames MR, Naik BI. Impact of body mass index on surgical case durations in an academic medical center. J Clin Anesth 2023; 90:111198. [PMID: 37441834 DOI: 10.1016/j.jclinane.2023.111198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
STUDY OBJECTIVE To investigate the association between patient body mass index (BMI) and operating room duration. DESIGN Retrospective cohort analysis. SETTING Demographic data and anesthesia/surgical times for adult surgical patients at University of Virginia Health between August 2017 and February 2019 were collected and analyzed. PATIENTS A total of 31,548 cases were included in the final analysis. 55% of patients were female, and 51% were classified as ASA Physical Status 2. The mean operating room (OR) duration was 144.2 min ± 112.7 (median = 118, IQR = 121). Orthopedic surgery (32%) was the most common surgery. MEASUREMENTS Linear mixed effects models were used to examine whether procedure intervals differed across three BMI categories (BMI < 30, 30 ≤ BMI < 40, BMI ≥ 40), considering within-surgeon correlations. Surgical times were log-transformed to correct for positive skewness. MAIN RESULTS The average time in the operating room was longer for patients with higher BMI (mean ± SD [median, IQR] = 139.5 ± 111.2 [113.0, IQR = 114], 150.2 ± 115.4 [125, IQR = 127], and 153.1 ± 111.1 [130, IQR = 134] for BMI < 30, 30 ≤ BMI < 40, and BMI ≥ 40), respectively. We found a 2% [95% CI = 1-3%] and 3% [95% CI = 1-5%] increase in OR time for 30 ≤ BMI < 40 and BMI ≥ 40, respectively, compared to BMI < 30, after controlling for within-surgeon correlations and covariates. The excess time was primarily determined by anesthesia times. CONCLUSION In an academic hospital, patients with BMI ≥ 30 required more time in the operating room than patients with BMI < 30, when controlling for confounders. This information can be incorporated into modern-day OR scheduling software, potentially resulting in more accurate case duration estimates that reduce waiting and improve OR efficiency.
Collapse
Affiliation(s)
- John S McNeil
- University of Virginia School of Medicine, Department of Anesthesiology, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA.
| | - Michael P Calgi
- University of Virginia School of Medicine, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Siny Tsang
- University of Virginia School of Medicine, Department of Anesthesiology, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Daniel Theodore
- University of Virginia School of Medicine, Department of Anesthesiology, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Matthew R Thames
- University of Virginia School of Medicine, Department of Anesthesiology, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Bhiken I Naik
- University of Virginia School of Medicine, Department of Anesthesiology, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| |
Collapse
|
155
|
Maggio LA, Byington CL, Toner ES, Kanter SL. A Chief Health Security Officer for Every Academic Health Center: Improving Readiness, Response, Recovery, and Resilience. Acad Med 2023; 98:1247-1250. [PMID: 37556815 DOI: 10.1097/acm.0000000000005435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Academic health centers (AHCs) require expertise to ensure readiness for health security events, such as cyberattacks, natural disasters, and pandemics, as well as the ability to respond to and recover from these events. However, most AHCs lack an individual to coordinate efforts at an enterprise level across academic and operational units during an emergency; elevate the coordination of individual AHCs with local and state public health entities; and through professional organizations, coordinate the work of AHCs across national and international public health entities. Informed by AHCs' responses to the COVID-19 pandemic and a series of focused meetings in 2021 of the Association of Academic Health Centers President's Council on Health Security, the authors propose creating a new C-suite role to meet these critical needs: the chief health security officer (CHSO). The CHSO would be responsible for the AHC's overall health security and would report to the AHC's chief executive officer or president. The authors describe the role of CHSO in relation to the preparation, response, and recovery phases of public health events necessary for health security. They also propose key duties for this position and encourage institutions to offer training and credentials to facilitate the creation and define the portfolios of CHSO positions at AHCs and beyond.
Collapse
Affiliation(s)
- Lauren A Maggio
- L.A. Maggio is professor of medicine and health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-2997-6133
| | - Carrie L Byington
- C.L. Byington is executive vice president, University of California Health, Oakland, California; ORCID: https://orcid.org/0000-0002-7350-9495
| | - Eric S Toner
- E.S. Toner is senior associate, Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5292-9450
| | - Steven L Kanter
- S.L. Kanter is special advisor to the president and CEO, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0002-0436-1503
| |
Collapse
|
156
|
Hecht EM, Robbins JB, Desser TS, Grist TM, Min RJ, Catanzano TM, Slanetz PJ. Defining the Roles and Responsibilities for the Vice Chair for Academic Affairs/Faculty Development in Radiology. Acad Radiol 2023; 30:2728-2733. [PMID: 37059613 DOI: 10.1016/j.acra.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/16/2023]
Abstract
RATIONALE AND OBJECTIVES To inform the development of a job description for Vice-Chairs for academic affairs (VCAA), members of the Alliance of Leaders in Academic Affairs in Radiology (ALAAR) were surveyed to better understand their current job responsibilities and how they would ideally allocate their professional time. MATERIALS AND METHODS Based on a survey of 33 university-affiliated radiology departments and discussion among ALAAR members, the authors developed a detailed job description for the VCAA. The 21-question survey was composed and validated by experts in the field. It was distributed to all members of ALAAR via email with an electronic link and was open for 5 months. Results of the survey were tabulated, and a job description was crafted to represent the foundational roles of academic affairs leaders in radiology. RESULTS The response rate for institutions represented in ALAAR was 73% (33/45). All participants reported that they practiced in a university-affiliated institution. Faculty size varied from ≤49 (30.3%, 10/33), 50-99 faculty (24.2%, 8/33), and ≥100 faculty members (45.5%, 15/33). Only 24% of survey respondents had a detailed job description at the time of hire. More than 40% attested to significant oversight over faculty development programs (45%), mentorship programs (42%, and promotions (45%). Respondents ideally want increased oversight (defined as >10%) over exit interviews, faculty awards, promotions, onboarding, recruitment and hiring, and wellness programming. CONCLUSION The aspirational mission of the VCAA is to oversee components of sequential stages in the professional lifecycle of faculty members but a common job description for this role is lacking.
Collapse
Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medicine, New York, New York.
| | - Jessica B Robbins
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Terry S Desser
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert J Min
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Tara M Catanzano
- Department of Radiology, UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
157
|
Joffe S, Conti RM, Contreras JL, Largent EA, Lynch HF, Mitchell D, Sachs RE, Whelan AM, McCoy MS. Access to affordable medicines: obligations of universities and academic medical centers. Gene Ther 2023; 30:753-755. [PMID: 37935851 DOI: 10.1038/s41434-023-00393-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rena M Conti
- Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Boston, MA, USA
| | - Jorge L Contreras
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Matthew S McCoy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
158
|
Sabanayagam A, Qasim A. Launching a career as an academic medical educator. Heart 2023; 109:1722-1723. [PMID: 37536759 DOI: 10.1136/heartjnl-2022-322284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Aarthi Sabanayagam
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Atif Qasim
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
159
|
Sze J, Chan T, Dalpoas S, Kiruthi C, Harris CM, Gundareddy V, Parker MS, Jacob E. Implementation of a Pharmacist-Led, Multidisciplinary Naloxone Patient Education Program at an Academic Medical Center. J Pharm Pract 2023; 36:1201-1210. [PMID: 35484711 DOI: 10.1177/08971900221094268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Opioid related overdoses are a leading cause of death in the United States (U.S). National, state and local initiatives have been implemented to combat the opioid crisis. However, there is a paucity of initiatives that examine the role of comprehensive naloxone education interventions for hospitalized patients. Objective: The aim of this study was to design a multidisciplinary, pharmacist-driven, standardized, patient and product tailored, inpatient naloxone education program (NEP) at a U.S. academic medical center, targeting patients at high risk of opioid overdose, and to examine patients' retention of education. Methods: This prospective pilot study targeted hospitalized patients who were considered at high-risk for opioid overdose once discharged. Using daily screening methods and established inclusion criteria, we evaluated the impact of implementing a patient-tailored NEP. The primary outcome measures were patient knowledge and awareness of naloxone use. A paired t-test analysis was conducted to assess for improvement in patient naloxone awareness and knowledge. Results: Of ninety-five patients screened, forty-four patients met inclusion criteria and nineteen patients completed naloxone education along with pre- and post-assessments. Patients more accurately completed the assessment, indicating enhanced knowledge about naloxone use and administration, following the naloxone education (4.68 ± .13 vs 3.42 ± .31 out of 5 questions, mean ± SEM; P = .0016). Conclusion: This study found a positive impact on patient knowledge of naloxone use and administration following implementation of a robust and comprehensive NEP.
Collapse
Affiliation(s)
- Jennifer Sze
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Tsz Chan
- OptumRx, Customer Service, United Health Group, Overland Park, KS, USA
| | - Stacy Dalpoas
- Department of Pharmacy, Novant Health, Winston-Salem, NC
| | - Catherine Kiruthi
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Che Matthew Harris
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Venkat Gundareddy
- Department of General Internal Medicine, Division of Hospital Medicine, Johns Hopkins School of Medicine, and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Marlena S Parker
- Department of Pharmacy, University of Pittsburgh Medical Center, Harrisburg, PA, USA
| | - Elsen Jacob
- College of Pharmacy & Health Sciences, St. John's University, Queens, NY, USA
| |
Collapse
|
160
|
Blalock AE, Balmer DF. Thinking organizationally and longitudinally to understand gender disparities in academic medicine. Med Educ 2023; 57:892-895. [PMID: 37528609 DOI: 10.1111/medu.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Affiliation(s)
- A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
161
|
Huang KX, Chen CK, Pessegueiro AM, Dowling E, Dermenchyan A, Natarajan A, Krishnan D, Vangala SS, Simon WM. Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. J Hosp Med 2023; 18:888-895. [PMID: 37584618 DOI: 10.1002/jhm.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures. OBJECTIVE This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication. DESIGNS, SETTINGS AND PARTICIPANTS Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020. RESULTS There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01). CONCLUSIONS Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.
Collapse
Affiliation(s)
- Kelly X Huang
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Caitlin K Chen
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Erin Dowling
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Anna Dermenchyan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Dhwani Krishnan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, UCLA Health, Los Angeles, California, USA
| | - Wendy M Simon
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| |
Collapse
|
162
|
Hajibonabi F, Khalid H, Duszak R, Balthazar P, Lirette ST, Hanna TN. Are Academic Emergency Radiologists Systematically Disadvantaged Compared With Diagnostic Radiology Subspecialty Counterparts When It Comes to Promotion? J Am Coll Radiol 2023; 20:1063-1071. [PMID: 37400045 DOI: 10.1016/j.jacr.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE The aim of this study was to assess academic rank differences between academic emergency and other subspecialty diagnostic radiologists. METHODS Academic radiology departments likely containing emergency radiology divisions were identified by inclusively merging three lists: Doximity's top 20 radiology programs, the top 20 National Institutes of Health-ranked radiology departments, and all departments offering emergency radiology fellowships. Within departments, emergency radiologists (ERs) were identified via website review. Each was then matched on career length and gender to a same-institutional nonemergency diagnostic radiologist. RESULTS Eleven of 36 institutions had no ERs or insufficient information for analysis. Among 283 emergency radiology faculty members from 25 institutions, 112 career length- and gender-matched pairs were included. Average career length was 16 years, and 23% were women. The mean h indices for ERs and non-ERs were 3.96 ± 5.60 and 12.81 ± 13.55, respectively (P < .0001). Non-ERs were twice as likely as ERs (0.21 versus 0.1) to be associate professors at h index < 5. Men had nearly 3 times the odds of advanced rank compared with women (odds ratio, 2.91; 95% confidence interval, 1.02-8.26; P = .045). Radiologists with at least one additional degree had nearly 3 times the odds of advancing rank (odds ratio, 2.75; 95% confidence interval, 1.02-7.40; P = .045). Each additional year of practice increased the odds of advancing rank by 14% (odds ratio, 1.14; 95% confidence interval, 1.08-1.21; P < .001). CONCLUSIONS Academic ERs are less likely to achieve advanced rank compared with career length- and gender-matched non-ERs, and this persists even after adjusting for h index, suggesting that academic ERs are disadvantaged in current promotions systems. Longer term implications for staffing and pipeline development merit further attention as do parallels to other nonstandard subspecialties such as community radiology.
Collapse
Affiliation(s)
- Farid Hajibonabi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | | | - Richard Duszak
- Chair, Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi; and Chancellor, American College of Radiology
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Tarek N Hanna
- Vice Chair for Diagnostic Imaging and Division Director of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
163
|
Louwagie V, Halasy M. Understanding academic rank among PAs practicing in academic medical centers. JAAPA 2023; 36:30-36. [PMID: 37751255 DOI: 10.1097/01.jaa.0000977688.11838.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To evaluate the attitudes and prevalence of academic/clinical rank among practicing physician associates/assistants (PAs) in different specialties and geographic locations. METHODS We surveyed PAs in clinical practice with a bias toward hospital/academic-based clinicians. The survey was a modified instrument to evaluate perceptions, attitudes, barriers, and prevalence of academic rank. RESULTS Overall, 65% of respondents indicated academic/clinical rank opportunities were of interest, but 60.8% noted that they were not eligible to hold rank in their institutions. Nearly 55% indicated a desire to hold rank, but 81.9% of respondents did not hold rank. The survey response rate was 22.9%. A lack of departmental emphasis was a common barrier to rank. CONCLUSIONS Clinically practicing PAs clearly have a desire or interest in academic/clinical rank, but barriers persist. Further development of opportunities to hold academic/clinical rank with mentorship may improve PA careers and propel professional advancement and parity.
Collapse
Affiliation(s)
- Victoria Louwagie
- Victoria Louwagie is an assistant professor of medicine at the Mayo Clinic College of Medicine and Science in Rochester, Minn., and practices in the Department of Gastroenterology and Hepatology at the Mayo Clinic Health System in Mankato, Minn. Michael Halasy is an assistant professor in healthcare administration and a health services researcher in the Spine Center at the Mayo Clinic College of Medicine and Science. The study was supported by an internal grant from the Office of Mayo Clinic Health System Research in Southern Minnesota and by a cooperative agreement grant (UL1TR002377) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
164
|
Ravi A, Arvisais-Anhalt S, Weia B, Khanna R, Adler-Milstein J, Auerbach A. Governance of Electronic Health Record Modification at U.S. Academic Medical Centers. Appl Clin Inform 2023; 14:843-854. [PMID: 37553071 PMCID: PMC10599807 DOI: 10.1055/a-2150-8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES A key aspect of electronic health record (EHR) governance involves the approach to EHR modification. We report a descriptive study to characterize EHR governance at academic medical centers (AMCs) across the United States. METHODS We conducted interviews with the Chief Medical Information Officers of 18 AMCs about the process of EHR modification for standard requests. Recordings of the interviews were analyzed to identify categories within prespecified domains. Responses were then assigned to categories for each domain. RESULTS At our AMCs, EHR requests were governed variably, with a similar number of sites using quantitative scoring systems (7, 38.9%), qualitative systems (5, 27.8%), or no scoring system (6, 33.3%). Two (11%) organizations formally review all requests for their impact on health equity. Although 14 (78%) organizations have trained physician builders/architects, their primary role was not for EHR build. Most commonly reported governance challenges included request volume (11, 61%), integrating diverse clinician input (3, 17%), and stakeholder buy-in (3, 17%). The slowest step in the process was clarifying end user requests (14, 78%). Few leaders had identified metrics for the success of EHR governance. CONCLUSION Governance approaches for managing EHR modification at AMCs are highly variable, which suggests ongoing efforts to balance EHR standardization and maintenance burden, while dealing with a high volume of requests. Developing metrics to capture the performance of governance and quantify problems may be a key step in identifying best practices.
Collapse
Affiliation(s)
- Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Simone Arvisais-Anhalt
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Benjamin Weia
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Raman Khanna
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Andrew Auerbach
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| |
Collapse
|
165
|
Jiang C, Wolf K, Kaakati R, Oh J, Yip AT, Jonklaas J, Bianco AC, Laiteerapong N, Ettleson MD. The Effects of Patient Characteristics on the Management of Subclinical Hypothyroidism: A Survey of Faculty and Trainees. Endocr Pract 2023; 29:787-793. [PMID: 37549880 PMCID: PMC10592164 DOI: 10.1016/j.eprac.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE There is no universal approach to the management of subclinical hypothyroidism (SCH). This study was designed to determine the impact of patient characteristics on management decisions in SCH amongst physician faculty members and trainees. METHODS An online survey was distributed to faculty members and medical trainees (ie, interns, residents, and fellows) at multiple academic medical centers. The survey included 9 clinical scenarios describing women with SCH with 5 management options sequenced from most "conservative" (no further treatment or monitoring) to most "aggressive" (treatment with levothyroxine). RESULTS Of the 194 survey respondents, 95 (49.0%) were faculty members and 99 (51.0%) were trainees. Faculty members were more likely to report being "confident" or "very confident" in making the diagnosis of SCH compared to trainees (95.8% vs 46.5%, P < .001). Faculty members were also more likely to consider patient preference for treatment (60.0% vs 32.3%, P < .001). Among all respondents, the clinical factors that resulted in the highest predicted probability of treatment were hypothyroid symptoms (predicted probability [PP] 68.8%, 95% CI [65.7%-71.9%]), thyroid stimulating hormone >10 mIU/L in a 31-year-old (PP 63.9%, 95% CI [60.3%-67.3%]), and the desire for fertility (PP 52.2%, 95% CI [48.6%-56.0%]). In general, faculty members favored more aggressive treatment across all clinical scenarios. CONCLUSION The presence of symptoms, thyroid stimulating hormone >10 mIU/L, and desire for fertility were most predictive of the decision to treat in SCH. In several clinical scenarios, both trainee and faculty decision-making demonstrated discordance with general SCH management principles.
Collapse
Affiliation(s)
- Cherry Jiang
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Katherine Wolf
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rayan Kaakati
- Division of Rheumatology, Allergy, and Immunology, Department of Pediatrics, Univeristy of North Carolina, Chapel Hill, North Carolina
| | - Jessica Oh
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allison T Yip
- Division of General Internal Medicine, University of California San Diego, San Diego, California
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, District of Columbia
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Matthew D Ettleson
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois.
| |
Collapse
|
166
|
Steitz BD, Padi-Adjirackor NA, Griffith KN, Reese TJ, Rosenbloom ST, Ancker JS. Impact of notification policy on patient-before-clinician review of immediately released test results. J Am Med Inform Assoc 2023; 30:1707-1710. [PMID: 37403329 PMCID: PMC10531100 DOI: 10.1093/jamia/ocad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center implemented 2 sequential policies: immediate notifications for all results, and notifications only to patients who opt in. We used over 2 years of data from Vanderbilt University Medical Center to measure the effect of these policies on rates of patient-before-clinician result review and patient-initiated messaging using interrupted time series analysis. When releasing test results with immediate notification, the proportion of patient-before-clinician review increased 4-fold and the proportion of patients who sent messages rose 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%. Replacing automated notifications with an opt-in policy provides patients flexibility to indicate their preferences but may not substantially alleviate clinicians' messaging workload.
Collapse
Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kevin N Griffith
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
167
|
Wainwright S, Caskey R, Rodriguez A, Holicky A, Wagner-Schuman M, Glassgow AE. Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center. BMC Pregnancy Childbirth 2023; 23:675. [PMID: 37726664 PMCID: PMC10508033 DOI: 10.1186/s12884-023-05966-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic. METHODS The pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers' permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS. RESULTS 29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19-48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician. CONCLUSIONS Participation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.
Collapse
Affiliation(s)
- Sam Wainwright
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA.
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Rachel Caskey
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Aida Rodriguez
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
| | - Abigail Holicky
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa Wagner-Schuman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
| | - Anne Elizabeth Glassgow
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
168
|
Bhatia HS, Hurst S, Desai P, Zhu W, Yeang C. Lipoprotein(a) Testing Trends in a Large Academic Health System in the United States. J Am Heart Assoc 2023; 12:e031255. [PMID: 37702041 PMCID: PMC10547299 DOI: 10.1161/jaha.123.031255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/14/2023] [Indexed: 09/14/2023]
Abstract
Background Despite its high prevalence and clinical significance, clinical measurement of lipoprotein(a) is rare but has not been systematically quantified. We assessed the prevalence of lipoprotein(a) testing overall, in those with various cardiovascular disease (CVD) conditions and in those undergoing cardiac testing across 6 academic medical centers associated with the University of California, in total and by year from 2012 to 2021. Methods and Results In this observational study, data from the University of California Health Data Warehouse on the number of individuals with unique lipoprotein(a) testing, unique CVD diagnoses (using International Classification of Diseases, Tenth Revision [ICD-10], codes), and other unique cardiac testing were collected. The proportion of total individuals, the proportion of individuals with a given CVD diagnosis, and the proportion of individuals with a given cardiac test and lipoprotein(a) testing any time during the study period were calculated. From 2012 to 2021, there were 5 553 654 unique adults evaluated in the University of California health system, of whom 18 972 (0.3%) had lipoprotein(a) testing. In general, those with lipoprotein(a) testing were more likely to be older, men, and White race, with a greater burden of CVD. Lipoprotein(a) testing was performed in 6469 individuals with ischemic heart disease (2.9%), 836 with aortic stenosis (3.1%), 4623 with family history of CVD (3.3%), 1202 with stroke (1.7%), and 612 with coronary artery calcification (6.1%). For most conditions, the prevalence of testing in the same year as the diagnosis of CVD was relatively stable, with a small upward trend over time. Lipoprotein(a) testing was performed in 10 753 individuals (1.8%) who had lipid panels, with higher rates with more specialized testing, including coronary computed tomography angiography (6.8%) and apolipoprotein B (63.0%). Conclusions Lipoprotein(a) testing persists at low rates, even among those with diagnosed CVD, and remained relatively stable over the study period.
Collapse
Affiliation(s)
- Harpreet S. Bhatia
- Division of Cardiology, Department of MedicineUniversity of California San DiegoLa JollaCA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCA
| | - Paresh Desai
- Altman Clinical and Translational Research Institute, University of California San DiegoLa JollaCA
| | - Wenhong Zhu
- Altman Clinical and Translational Research Institute, University of California San DiegoLa JollaCA
| | - Calvin Yeang
- Division of Cardiology, Department of MedicineUniversity of California San DiegoLa JollaCA
| |
Collapse
|
169
|
Schönbeck N, Hussein Y, Haack A, Schmager A, Harney U, Trübe L, Ückert F, Gottfried K. Evaluating REDCap as the Central Data Collection Tool for the Hamburg City Health Study. Stud Health Technol Inform 2023; 307:51-59. [PMID: 37697837 DOI: 10.3233/shti230693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION The collection of examination data for large clinical studies is often done with proprietary systems, which are accompanied by several disadvantages such as high cost and low flexibility. With the use of open-source tools, these disadvantages can be overcome and thereby improve data collection as well as data quality. Here we exemplary use the data collection process of the Hamburg City Health Study (HCHS), carried out at the University Medical Center Hamburg-Eppendorf (UKE). We evaluated how the recording of the examination data can be converted from an established, proprietary electronic healthcare record (EHR) system to the free-to-use Research Electronic Data Capture (REDCap) software. METHODS For this purpose, a technical conversion of the EHR system is described first. Metafiles derived from the EHR system were used for REDCap electronic case report form (eCRF) building. The REDCap system was tested by HCHS study assistants via completion of self-developed tasks mimicking their everyday study life. Usability was quantitatively evaluated via the IBM Computer System Usability Questionnaire (CSUQ) and qualitatively assessed with a semi-structured interview. RESULTS With the IBM CSUQ, the study assistants rated the usage of the basic REDCap system for HCHS examination data collection with an overall score of 4.39, which represents a medium acceptance. The interview feedback was used to formulate user stories to subsequently increase the administrative sovereignty and to conceptualize a REDCap HCHS information technology (IT) infrastructure. CONCLUSION Our work aims to serve as a template for evaluating the feasibility of a conversion from a proprietary to a free-to-use data collection tool for large clinical studies such as the HCHS. REDCap has great potential, but extensions and an integration to the current IT infrastructure are required.
Collapse
Affiliation(s)
- Nils Schönbeck
- Applied Medical Informatics, University Medical Center Eppendorf, Hamburg, Germany
| | - Yassin Hussein
- Epidemiological study center, University Medical Center Eppendorf, Hamburg, Germany
| | - Alena Haack
- Epidemiological study center, University Medical Center Eppendorf, Hamburg, Germany
| | - Axel Schmager
- Epidemiological study center, University Medical Center Eppendorf, Hamburg, Germany
| | - Ulrike Harney
- Epidemiological study center, University Medical Center Eppendorf, Hamburg, Germany
| | - Leona Trübe
- Applied Medical Informatics, University Medical Center Eppendorf, Hamburg, Germany
| | - Frank Ückert
- Applied Medical Informatics, University Medical Center Eppendorf, Hamburg, Germany
| | - Karl Gottfried
- Applied Medical Informatics, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
170
|
Joosten SA, Smeets MJR, Arbous MS, Manniën J, Laverman S, Driessen MMG, Cannegieter SC, Roukens AHE. Daily disease severity in patients with COVID-19 admitted to the hospital: The SCODA (severity of coronavirus disease assessment) score. PLoS One 2023; 18:e0291212. [PMID: 37683031 PMCID: PMC10490882 DOI: 10.1371/journal.pone.0291212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND A multitude of diagnostic and predictive algorithms have been designed for COVID-19. However, currently no score can accurately quantify and track day-to-day disease severity in hospitalised patients with COVID-19. We aimed to design such a score to improve pathophysiological insight in COVID-19. METHODS Development of the Severity of COronavirus Disease Assessment (SCODA) score was based on the 4C Mortality score but patient demographic variables that remain constant during admission were excluded. Instead, parameters associated with breathing and oxygenation were added to reflect the daily condition. The SCODA score was subsequently applied to the BEAT-COVID cohort to describe COVID-19 severity over time and to determine the timing of clinical recovery for each patient, an important marker in pathophysiological studies. The BEAT-COVID study included patients with PCR confirmed COVID-19 who were hospitalized between April 2020 and March 2021 in the Leiden University Medical Center, The Netherlands. RESULTS The SCODA score consists of 6 clinical and 2 routine lab parameters. 191 patients participated in the BEAT-COVID study. Median age was 66, and 74.4% was male. The modal timepoint at which recovery was clinically initiated occurred on days 8 and 24 since symptom onset for non-ICU and ICU-patients, respectively. CONCLUSIONS We developed a daily score which can be used to track disease severity of patients admitted due to COVID-19. This score is useful for improving insight in COVID-19 pathophysiology, its clinical course and to evaluate interventions. In a future stage this score can also be used in other (emerging) infectious respiratory diseases.
Collapse
Affiliation(s)
- Simone A. Joosten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark J. R. Smeets
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M. Sesmu Arbous
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith Manniën
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Sander Laverman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Merijn M. G. Driessen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna H. E. Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
171
|
King CR, Gregory S, Fritz BA, Budelier TP, Ben Abdallah A, Kronzer A, Helsten DL, Torres B, McKinnon S, Goswami S, Mehta D, Higo O, Kerby P, Henrichs B, Wildes TS, Politi MC, Abraham J, Avidan MS, Kannampallil T. An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures: The ACTFAST-3 Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2332517. [PMID: 37738052 PMCID: PMC10517374 DOI: 10.1001/jamanetworkopen.2023.32517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023] Open
Abstract
Importance Telemedicine for clinical decision support has been adopted in many health care settings, but its utility in improving intraoperative care has not been assessed. Objective To pilot the implementation of a real-time intraoperative telemedicine decision support program and evaluate whether it reduces postoperative hypothermia and hyperglycemia as well as other quality of care measures. Design, Setting, and Participants This single-center pilot randomized clinical trial (Anesthesiology Control Tower-Feedback Alerts to Supplement Treatments [ACTFAST-3]) was conducted from April 3, 2017, to June 30, 2019, at a large academic medical center in the US. A total of 26 254 adult surgical patients were randomized to receive either usual intraoperative care (control group; n = 12 980) or usual care augmented by telemedicine decision support (intervention group; n = 13 274). Data were initially analyzed from April 22 to May 19, 2021, with updates in November 2022 and February 2023. Intervention Patients received either usual care (medical direction from the anesthesia care team) or intraoperative anesthesia care monitored and augmented by decision support from the Anesthesiology Control Tower (ACT), a real-time, live telemedicine intervention. The ACT incorporated remote monitoring of operating rooms by a team of anesthesia clinicians with customized analysis software. The ACT reviewed alerts and electronic health record data to inform recommendations to operating room clinicians. Main Outcomes and Measures The primary outcomes were avoidance of postoperative hypothermia (defined as the proportion of patients with a final recorded intraoperative core temperature >36 °C) and hyperglycemia (defined as the proportion of patients with diabetes who had a blood glucose level ≤180 mg/dL on arrival to the postanesthesia recovery area). Secondary outcomes included intraoperative hypotension, temperature monitoring, timely antibiotic redosing, intraoperative glucose evaluation and management, neuromuscular blockade documentation, ventilator management, and volatile anesthetic overuse. Results Among 26 254 participants, 13 393 (51.0%) were female and 20 169 (76.8%) were White, with a median (IQR) age of 60 (47-69) years. There was no treatment effect on avoidance of hyperglycemia (7445 of 8676 patients [85.8%] in the intervention group vs 7559 of 8815 [85.8%] in the control group; rate ratio [RR], 1.00; 95% CI, 0.99-1.01) or hypothermia (7602 of 11 447 patients [66.4%] in the intervention group vs 7783 of 11 672 [66.7.%] in the control group; RR, 1.00; 95% CI, 0.97-1.02). Intraoperative glucose measurement was more common among patients with diabetes in the intervention group (RR, 1.07; 95% CI, 1.01-1.15), but other secondary outcomes were not significantly different. Conclusions and Relevance In this randomized clinical trial, anesthesia care quality measures did not differ between groups, with high confidence in the findings. These results suggest that the intervention did not affect the targeted care practices. Further streamlining of clinical decision support and workflows may help the intraoperative telemedicine program achieve improvement in targeted clinical measures. Trial Registration ClinicalTrials.gov Identifier: NCT02830126.
Collapse
Affiliation(s)
- Christopher R. King
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Stephen Gregory
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bradley A. Fritz
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Thaddeus P. Budelier
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alex Kronzer
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Daniel L. Helsten
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Brian Torres
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Sherry McKinnon
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shreya Goswami
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Divya Mehta
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Omokhaye Higo
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Paul Kerby
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bernadette Henrichs
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Troy S. Wildes
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha
| | - Mary C. Politi
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
172
|
Braverman A, Lin T, Messmer S, Wollner K, Taylor R, Williams AA, Class QA. Survey of stigma across healthcare workers in an urban, academic medical center regarding perinatal patients using opioids. Am J Addict 2023; 32:510-514. [PMID: 37337748 DOI: 10.1111/ajad.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/01/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To examine healthcare workers' attitudes towards pregnant woman using opioids across provider type, specialty, and years of service. METHODS Cross-sectional, anonymous survey of healthcare workers at an urban, academic medical center regarding attitudes towards pregnant women using opioids. RESULTS One hundred and nineteen surveys were completed. Nurses were less likely to feel sympathetic towards pregnant women that use opioids (p = .016). DISCUSSION AND CONCLUSIONS Differences in attitudes towards pregnant women using opioids were found between clinicians and nurses. SCIENTIFIC SIGNIFICANCE Training and experience may contribute to attitude differences towards pregnant women using opioids.
Collapse
Affiliation(s)
- Alexis Braverman
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - Tiffany Lin
- Department of Occupational Therapy, Neuroscience Institute, Cleveland Clinic, London, UK
| | - Sarah Messmer
- Department of Academic Internal Medicine, University of Illinois, Chicago, Illinois, USA
| | - Kathy Wollner
- Department of Family and Community Medicine, University of Illinois, Chicago, Illinois, USA
| | - Renee Taylor
- Division of Occupational Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois, USA
| | - Adrienne A Williams
- Department of Family and Community Medicine, University of Illinois, Chicago, Illinois, USA
| | - Quetzal A Class
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| |
Collapse
|
173
|
Magudia K, Goins S, Bucknor MD, Canon CL, Jagsi R, Arleo EK. Career Trajectory Factors Affecting Gender Diversity in Academic Radiology Department Chairs: Results of a Survey of SCARD Members. AJR Am J Roentgenol 2023; 221:391-395. [PMID: 37073899 DOI: 10.2214/ajr.23.29233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Kirti Magudia
- Duke University School of Medicine, Durham, NC
- University of California, San Francisco, San Francisco, CA, , @KMagudia
| | - Stacy Goins
- Duke University School of Medicine, Durham, NC
| | | | | | | | | |
Collapse
|
174
|
Patel B, Blalock TW. Defining "Access to Care" for dermatology at academic medical institutions. J Am Acad Dermatol 2023; 89:627-628. [PMID: 36948298 DOI: 10.1016/j.jaad.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Bianca Patel
- Morehouse University School of Medicine, Atlanta, Georgia
| | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
175
|
Conway SJ, Kuye IO, Yeatts J, Jaffery J, Berkowitz SA. Transforming Health Care from Volume to Value: Moving the Needle Through Population Health. Am J Med 2023; 136:874-877. [PMID: 37160195 DOI: 10.1016/j.amjmed.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
United States health systems face unique challenges in transitioning from volume-based to value-based care, particularly for academic institutions. Providing complex specialty and tertiary care dependent on servicing large geographic areas, and concomitantly meeting education and research academic missions may limit the time and resources available for focusing on the care coordination needs of complex local populations. Despite these challenges, academic medicine is well situated to capitalize on the promise of value-based care and to lead broad improvements in both teaching and nonteaching hospitals. If properly executed, value-based care and complex specialty care can be complementary and synergistic. We postulate that the transition from volume to value in population health requires all health care organizations to advance and formalize infrastructure in 3 core areas: organizational capabilities; provider engagement; and engagement of the patient, family, and community. Although these apply to all organizations, for academic health systems, this transition must also be interwoven with the other domains of the tripartite mission.
Collapse
Affiliation(s)
- Sarah J Conway
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Ifedayo O Kuye
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - John Yeatts
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | | | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Office of Population Health, Johns Hopkins Medicine, Baltimore, Md
| |
Collapse
|
176
|
Naik H, Malbeuf M, Levin A. Expanding the Learning Health Care System Beyond the Academic Health Center. Acad Med 2023; 98:973. [PMID: 37797301 DOI: 10.1097/acm.0000000000005273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Hiten Naik
- Research fellow, Department of Medicine Clinician Investigator Program, University of British Columbia, and research fellow, Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; ; ORCID: https://orcid.org/0000-0002-5193-4618
| | - Michelle Malbeuf
- Program manager, Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Professor and head, Division of Nephrology, Department of Medicine, University of British Columbia, executive director, BC Renal, and director, Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| |
Collapse
|
177
|
Hennein L, Liu Y, Shuman EA, Kim JS, Moss HE, Keenan JD, Seitzman GD. Role of Sex in Participation During Virtual Grand Rounds in Ophthalmology. JAMA Ophthalmol 2023; 141:900-903. [PMID: 37471083 PMCID: PMC10360000 DOI: 10.1001/jamaophthalmol.2023.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023]
Abstract
Importance Sex disparities exist in academia. Female attendees consistently ask fewer questions in scientific meetings than male attendees, even when they constitute half of the audience. Objective To assess the role of sex in participation during virtual grand rounds (GR) at a major academic center. Design, Setting, and Participants In this prospective cohort study, attendees of the Department of Ophthalmology at the University of California, San Francisco, GR from April 2020 to April 2021 were included. All GR were held via a synchronous live video communication platform. During each GR session, a predesignated attendee collected the sex of all attendees, sex of the GR speaker, and sex of each individual who asked a question to the GR speaker in order of inquiry. The GR speakers and audience were unaware of the study. Data were analyzed from June 2021 to April 2023. Main Outcome and Measures The main analysis assessed the association between being female and asking one of the first 3 questions. Results A total of 31 virtual ophthalmology GR sessions were observed. The sex of the GR speaker was female in 13 of 31 sessions (42%). The mean (SD) percentage of audience sex at each of the GR sessions was 47% (0.05) female, 45% (0.06) male, and 8% (0.03) unknown. Male attendees were more likely to ask one of the first 3 questions compared with female attendees (prevalence ratio, 3.1; 95% CI, 2.1-4.5; P < .001). Conclusions and Relevance Male attendees were more likely to ask questions during virtual ophthalmology GR compared with female attendees at an academic medical center. Strategies to encourage equal participation of sex in academic discourse should be encouraged.
Collapse
Affiliation(s)
- Lauren Hennein
- Viterbi Family Department of Ophthalmology, University of California, San Diego
- Department of Ophthalmology, Rady Children’s Hospital—San Diego, San Diego, California
| | - Yingna Liu
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Elizabeth A. Shuman
- Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles
| | - Jessica S. Kim
- Department of Gynecology, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Boston, Massachusetts
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, California
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
| | - Jeremy D. Keenan
- Department of Ophthalmology, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Gerami D. Seitzman
- Department of Ophthalmology, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
| |
Collapse
|
178
|
Cohen TN, Kanji FF, Wang AS, Seferian EG, Sax HC, Gewertz BL. Understanding ultrarare adverse events - Lessons learned from a twelve-year review of intraoperative deaths at an academic medical center. Am J Surg 2023; 226:315-321. [PMID: 37202268 DOI: 10.1016/j.amjsurg.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Intraoperative death (ID) is rare, the incidence remains challenging to quantify and learning opportunities are limited. We aimed to better define the demographics of ID by reviewing the longest single-site series. METHODS Retrospective chart reviews, including a review of contemporaneous incident reports, were performed on all ID between March 2010 to August 2022 at an academic medical center. RESULTS Over 12 years, 154 IDs occurred (∼13/year, average age: 54.3 years, male: 60%). Most occurred during emergency procedures (n = 115, 74.7%), 39 (25.3%) during elective procedures. Incident reports were submitted in 129 cases (84%). 21 (16.3%) reports cited 28 contributing factors including challenges with coordination (n = 8, 28.6%), skill-based errors (n = 7, 25.0%), and environmental factors (n = 3, 10.7%). CONCLUSIONS Most deaths occurred in patients admitted from the ER with general surgical problems. Despite expectations for incident reporting, few provided actionable information on ergonomic factors which might help identify improvement opportunities.
Collapse
Affiliation(s)
- Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Falisha F Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Andrew S Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Edward G Seferian
- Department of Medical Affairs, Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Harry C Sax
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Bruce L Gewertz
- Department of Surgery, Interventional Services, Academic Affairs, Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| |
Collapse
|
179
|
Dams G, Knapen RRMM, Korenblik R, van Dam RM, de Haan MW, van der Leij C. 12Fr-Pigtail Versus 14Fr-Balloon Percutaneous Radiologic Gastrostomy (PRG), Retrospective Evaluation of Outcomes and Complications; A Maastricht University Medical Centre Study. Cardiovasc Intervent Radiol 2023; 46:1231-1237. [PMID: 37592019 PMCID: PMC10471621 DOI: 10.1007/s00270-023-03527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To retrospectively compare tube and placement related results of a 12Fr-pigtail and a 14Fr-balloon gastrostomy tube. MATERIALS AND METHODS All consecutive patients who underwent percutaneous radiologic gastrostomy (PRG) between January 2016 and June 2020 were enrolled in this retrospective single-center analysis. Follow-up for all patients was 180 days. Mortality after 30 days, technical success, days to first complication within 180 days, reason of unexpected visit (tube, anchor or pain related), and tube specific complications (obstruction, pain, luxation, leakage) were taken as outcome measures. Data were obtained from both PACS software and electronic health records. RESULTS A total of 247 patients were enrolled (12Fr-pigtail: n = 139 patients and 14Fr-balloon: n = 108 patients). 30-day mortality was very low in both groups and never procedure related. Technical success was 99% in both groups. The average number of complications within 180 days after initial PRG placement was significantly higher in the 12Fr-pigtail group (12Fr-pigtail: 0.93 vs. 14Fr-balloon: 0.64, p = 0.028). Time to first complication within 180 days was significantly longer in the 14Fr-balloon group (12Fr-pigtail: 29 days vs. 14Fr-balloon: 53 days, p = 0.005). In the 14Fr-balloon group, the rate of tube-related complications (luxation and obstruction) was significantly lower compared to 12Fr-pigtail (29% vs. 45%, p = 0.011). CONCLUSION 14Fr-balloon gastrostomy tubes have significantly lower (tube-related) complications rates and longer time to first complication compared to 12Fr-pigtail tubes. No procedure-related mortality was observed in either group. Technical success was very high in both groups. Level of Evidence Level 3, non-controlled retrospective cohort study.
Collapse
Affiliation(s)
- Glenn Dams
- Department of Radiology and Nuclear Medicine, Zuyderland MC, Sittard-Geleen, Netherlands
| | - Robrecht R M M Knapen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.
- CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands.
| | - Remon Korenblik
- Department of Surgery, Zuyderland MC, Sittard-Geleen, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ronald M van Dam
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - Michiel W de Haan
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Christiaan van der Leij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
180
|
Rosenthal GE, McClain DA, High KP, Easterling D, Sharkey A, Wagenknecht LE, O’Byrne C, Woodside R, Houston TK. The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers. Acad Med 2023; 98:1002-1007. [PMID: 37099650 PMCID: PMC10453356 DOI: 10.1097/acm.0000000000005259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.
Collapse
Affiliation(s)
- Gary E. Rosenthal
- G.E. Rosenthal is professor and chair, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Donald A. McClain
- D.A. McClain is professor, Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kevin P. High
- K.P. High is professor, Department of Internal Medicine, and president, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Douglas Easterling
- D. Easterling is professor, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Angela Sharkey
- A. Sharkey is professor, Department of Pediatrics, and senior associate dean for undergraduate medical education, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lynne E. Wagenknecht
- L.E. Wagenknecht is professor and chair, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher O’Byrne
- C. O’Byrne is vice president and associate dean, Research Administration and Operations, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rachel Woodside
- R. Woodside is director, Research Strategy and Operations, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas K. Houston
- T.K. Houston is professor and vice chair for learning health systems, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
181
|
Helton MR, Pathman DE. Scholarship Criteria for Promotion in the Age of Diverse Faculty Roles and Digital Media. Fam Med 2023; 55:544-546. [PMID: 37696024 PMCID: PMC10622050 DOI: 10.22454/fammed.2023.554380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVES In academic medical centers, scholarship is essential to advancing scientific knowledge, clinical care, and teaching and is a requirement for faculty promotion. Traditional evidence of scholarship, such as publications in peer-reviewed academic journals, remains applicable to the promotions of physician and nonphysician researchers. Often, however, the same evidence does not fit the scholarly work and output of clinician-educators, whose scholarship is often disseminated through digital communications and social media. This difference challenges promotion and tenure committees to evaluate the scholarship of all faculty fairly and consistently. This study aimed to generate a list of the features that a faculty product should demonstrate to be considered scholarship, regardless of how it is disseminated. METHODS The full professors of one academic department of family medicine engaged in a mini-Delphi deliberative process to identify criteria to assess whether a scholarly product put forth by faculty in the promotion process is indeed scholarship. RESULTS The full professors identified seven criteria to evaluate a faculty product to assess whether it represents scholarship-specifically its demonstration of faculty expertise, faculty contribution, originality, peer review, quality, relative permanence, and impact. CONCLUSIONS These criteria may help promotion committees more easily and consistently assess the full scope of a faculty member's scholarly work within today's changing approaches to its dissemination.
Collapse
Affiliation(s)
- Margaret R. Helton
- Department of Family Medicine, University of North CarolinaChapel Hill, NC
| | - Donald E. Pathman
- Department of Family Medicine, University of North CarolinaChapel Hill, NC
| |
Collapse
|
182
|
Ivanovic V, Broadhead K, Beck R, Chang YM, Paydar A, Biddle G, Hacein-Bey L, Qi L. Factors Associated With Neuroradiologic Diagnostic Errors at a Large Tertiary-Care Academic Medical Center: A Case-Control Study. AJR Am J Roentgenol 2023; 221:355-362. [PMID: 36988269 DOI: 10.2214/ajr.22.28925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND. Numerous studies have explored factors associated with diagnostic errors in neuroradiology; however, large-scale multivariable analyses are lacking. OBJECTIVE. The purpose of this study was to evaluate associations of interpretation time, shift volume, care setting, day of week, and trainee participation with diagnostic errors by neuroradiologists at a large academic medical center. METHODS. This retrospective case-control study using a large tertiary-care academic medical center's neuroradiology quality assurance database evaluated CT and MRI examinations for which neuroradiologists had assigned RADPEER scores. The database was searched from January 2014 through March 2020 for examinations without (RADPEER score of 1) or with (RADPEER scores of 2a, 2b, 3a, 3b, or 4) diagnostic error. For each examination with error, two examinations without error were randomly selected (unless only one examination could be identified) and matched by interpreting radiologist and examination type to form case and control groups. Marginal mixed-effects logistic regression models were used to assess associations of diagnostic error with interpretation time (number of minutes since the immediately preceding report's completion), shift volume (number of examinations interpreted during the shift), emergency/inpatient setting, weekend interpretation, and trainee participation in interpretation. RESULTS. The case group included 564 examinations in 564 patients (mean age, 50.0 ± 25.0 [SD] years; 309 men, 255 women); the control group included 1019 examinations in 1019 patients (mean age, 52.5 ± 23.2 years; 540 men, 479 women). In the case versus control group, mean interpretation time was 16.3 ± 17.2 [SD] minutes versus 14.8 ± 16.7 minutes; mean shift volume was 50.0 ± 22.1 [SD] examinations versus 45.4 ± 22.9 examinations. In univariable models, diagnostic error was associated with shift volume (OR = 1.22, p < .001) and weekend interpretation (OR = 1.60, p < .001) but not interpretation time, emergency/inpatient setting, or trainee participation (p > .05). However, in multivariable models, diagnostic error was independently associated with interpretation time (OR = 1.18, p = .003), shift volume (OR = 1.27, p < .001), and weekend interpretation (OR = 1.69, p = .02). In subanalysis, diagnostic error showed independent associations on weekdays with interpretation time (OR = 1.18, p = .003) and shift volume (OR = 1.27, p < .001); such associations were not observed on weekends (interpretation time: p = .62; shift volume: p = .58). CONCLUSION. Diagnostic errors in neuroradiology were associated with longer interpretation times, higher shift volumes, and weekend interpretation. CLINICAL IMPACT. These findings should be considered when designing work-flow-related interventions seeking to reduce neuroradiology interpretation errors.
Collapse
Affiliation(s)
- Vladimir Ivanovic
- Department of Radiology, Section of Neuroradiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Kenneth Broadhead
- Department of Statistics, Colorado State University, Fort Collins, CO
| | - Ryan Beck
- Department of Radiology, Section of Neuroradiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Yu-Ming Chang
- Department of Radiology, Section of Neuroradiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Alireza Paydar
- Department of Radiology, Section of Neuroradiology, University of California, Davis Medical Center, Sacramento, CA
| | - Garrick Biddle
- Department of Radiology, Section of Neuroradiology, University of California, Davis Medical Center, Sacramento, CA
| | - Lotfi Hacein-Bey
- Department of Radiology, Section of Neuroradiology, University of California, Davis Medical Center, Sacramento, CA
| | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA
| |
Collapse
|
183
|
Amann N, Johnson S, Chagarlamudi K, Gupta A, Faraji N. Scheduling Musculoskeletal MRI for Patients With Metallic Hardware: Initial Observations on Decreasing Nondiagnostic and Repeat Examinations at a Multisite Academic Medical Center. Curr Probl Diagn Radiol 2023; 52:327-329. [PMID: 37037716 DOI: 10.1067/j.cpradiol.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE As healthcare delivery systems expand to include multiple imaging centers, the process of scheduling patients at the site which best meets their needs continues to become more complex. This quality improvement study aims to create a protocol for patients with metallic hardware at sites with metallic artifact reduction sequences (MARS), increasing the proportion of exams that are diagnostic and reducing the need for repeat imaging. MATERIALS AND METHODS The study population included 322 patients with metallic hardware receiving an MRI at a large multisite healthcare system, divided into a pre-intervention and postintervention cohort. A retrospective PACS query was performed using several keywords in musculoskeletal MRI reports indicating the presence of metallic hardware. This cohort was studied to better understand the existing system failures. An intervention was then implemented by meeting with the departmental RIS and scheduling teams to discuss workflow when scheduling exams for patients with metallic hardware System changes were implemented and results were again studied retrospectively. RESULTS Before protocol implementation, 134/244 (55%) of exams were performed at sites with metallic artifact reduction sequences which improved to 54 of 78 (69%) in the postintervention cohort (P = 0.02). Additionally, the number of exams performed on 3T MRI machines pre-intervention was 14 of 244 (5.7%) compared to 1 of 78 (1.2%) postintervention (P = 0.13). The rate of nondiagnostic exams in the preintervention cohort was significantly higher at 41 of 244 (16.8%) when compared to the postintervention cohort at 4 of 78 (5.1% P = 0.01). CONCLUSIONS The implementation of this quality improvement protocol reduced the rate of nondiagnostic MSK MRI exams and reduced the inappropriate use of 3T scanners, ultimately saving time and cost for both patients and the health care system.
Collapse
Affiliation(s)
- Nathan Amann
- Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Shaun Johnson
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kaushik Chagarlamudi
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Radiology, University Hospitals, Cleveland, OH
| | - Amit Gupta
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Radiology, University Hospitals, Cleveland, OH
| | - Navid Faraji
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Radiology, University Hospitals, Cleveland, OH
| |
Collapse
|
184
|
Price T, Palokas M, Patel N. Nursing assessments of women with hypertensive disorders during labor in an academic medical center in Mississippi: a best practice implementation project. JBI Evid Implement 2023; 21:241-250. [PMID: 37022208 DOI: 10.1097/xeb.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVES The objective of this project was to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to the intrapartum unit. INTRODUCTION Hypertension during pregnancy has been associated with adverse maternal and fetal outcomes. Ongoing evaluation and nursing care are key in the prevention of complications resulting from hypertensive disorders in pregnancy. METHODS The implementation of this best practice project was guided by the JBI Model of Evidence-based Healthcare and used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to an intrapartum unit. Eight audit criteria that were representative of best-practice recommendations for nursing assessment of pregnant women with hypertensive disorders were used. A baseline audit was conducted, followed by the implementation of multiple strategies that were determined by the key stakeholders. The project was finalized with a follow-up audit to determine a change in compliance with best-practice recommendations. RESULTS Baseline audits revealed an average 45% compliance rate with the eight best practice audit criteria. An on-site simulation event, which included a nursing assessment of normal and abnormal lung sounds along with the hands-on practice of deep tendon reflexes, was provided by project members. Evidence-based assessment guidelines were presented and reviewed with all participants. Input from the nursing staff was gathered regarding current documentation practices and electronic health record accessibility. As a result, an electronic health record change was requested, and improvements in nursing practice were observed for five of the eight audit criteria. Follow-up audits revealed an average compliance rate of 73% for all eight audit criteria, a 28% improvement. CONCLUSION Continuing nursing education and ongoing competency refreshers can affect the quality of client care and outcomes by offering occasions to improve or strengthen clinical expertise and proficiency. For this project, the simulation training event improved nursing staff compliance with best practices.
Collapse
Affiliation(s)
- Tara Price
- University of Mississippi Medical Center, School of Nursing
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, Mississippi, USA
| | - Michelle Palokas
- University of Mississippi Medical Center, School of Nursing
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, Mississippi, USA
| | - Nital Patel
- Winfred L. Wiser Hospital for Women and Infants, University of Mississippi Medical Center
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, Mississippi, USA
| |
Collapse
|
185
|
Holsti M, Keenan HT, Kadish HA, Sapiro HK, Giardino AP, Osborn KA, Cline KL, Byington CL. Developing a clinical research infrastructure embedded in an academic medicine center that equitably supports future clinician scientists. Clin Transl Sci 2023; 16:1547-1553. [PMID: 37278119 PMCID: PMC10499416 DOI: 10.1111/cts.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
Clinical research in academic medical centers can be difficult to conduct and meet enrollment goals. Students under-represented in medicine (URiM) are also under-represented in academic leadership positions and as physician-scientists but are critical to help solve health disparities. Barriers in pursuing medicine as a career may be high for URiM students, therefore it is important to create pre-medicine opportunities accessible to all students interested in healthcare careers. We describe an undergraduate clinical research platform, the Academic Associate (AcA) program, embedded in the medical system that supports clinical research for academic physician scientists and provides students equitable access to experiences and mentoring opportunities. Students have the opportunity of completing a Pediatric Clinical Research Minor (PCRM) degree. This program satisfies many pre-medicine opportunities for undergraduate students, including those URiM, and allows access to physician mentors and unique educational experiences for graduate school or employment. Since 2009, 820 students participated in the AcA program (17.5% URiM) and 235 students (18% URiM) completed the PCRM. Of the 820 students, 126 (10% URiM) students matriculated to medical school, 128 (11%URiM) to graduate school, and 85 (16.5% URiM) gained employment in biomedical research fields. Students in our program supported 57 publications and were top-enrollers for several multicentered studies. The AcA program is cost-effective and achieves a high level of success enrolling patients into clinical research. Additionally, the AcA program provides equitable access for students URiM to physician mentorship, pre-medical experiences, and an avenue to early immersion in academic medicine.
Collapse
Affiliation(s)
- Maija Holsti
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | | | | | | | | | | | | | - Carrie L. Byington
- University of California HealthUniversity of CaliforniaOaklandCaliforniaUSA
| |
Collapse
|
186
|
Blackburn KW, Turrentine FE, Schirmer BD, Hallowell PT, Kubicki NS, Hu Y, Kligman MD. Monitoring performance in laparoscopic gastric bypass surgery using risk-adjusted cumulative sum at 2 high-volume centers. Surg Obes Relat Dis 2023; 19:1049-1057. [PMID: 36931965 DOI: 10.1016/j.soard.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/09/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Traditional surgical outcomes are measured retrospectively and intermittently, limiting opportunities for early intervention. OBJECTIVES The objective of this study was to use risk-adjusted cumulative sum (RA-CUSUM) to track perioperative surgical outcomes for laparoscopic gastric bypass. We hypothesized that RA-CUSUM could identify performance variations between surgeons. SETTING Two mid-Atlantic quaternary care academic centers. METHODS Patient-level data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) were abstracted for laparoscopic gastric bypasses performed by 3 surgeons at 2 high-volume centers from 2014 to 2021. Estimated probabilities of serious complications, reoperation, and readmission were derived from the MBSAQIP risk calculator. RA-CUSUM curves were generated to signal observed-to-expected odds ratios (ORs) of 1.5 (poor performance) and .5 (superior performance). Control limits were set based on a false positive rate of 5% (α = .05). RESULTS We included 1192 patients: Surgeon A = 767, Surgeon B = 188, and Surgeon C = 237. Overall rates of serious complications, 30-day reoperations, and 30-day readmissions were 3.9%, 2.5%, and 5.2% respectively, with expected rates of 4.7%, 2.2%, and 5.8%. RA-CUSUM signaled lower-than-expected (OR < .5) rates of readmission and serious complication in Surgeon A, and higher-than-expected (OR > 1.5) readmission rate in Surgeon C. Surgeon A further demonstrated an early period of higher-than-expected (OR > 1.5) reoperation rate before April 2015, followed by superior performance thereafter (OR < .5). Surgeon B's performance generally reflected expected standards throughout the study period. CONCLUSIONS RA-CUSUM adjusts for clinical risk factors and identifies performance outliers in real-time. This approach to analyzing surgical outcomes is applicable to quality improvement, root-cause analysis, and surgeon incentivization.
Collapse
Affiliation(s)
- Kyle W Blackburn
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Florence E Turrentine
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Bruce D Schirmer
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Peter T Hallowell
- Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Natalia S Kubicki
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mark D Kligman
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| |
Collapse
|
187
|
Birken SA, Matulewicz R, Pathak R, Wagi CR, Peluso AG, Bundy R, Witek L, Krol B, Parchman ML, Nielsen M, Dharod A. Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use. Urol Pract 2023; 10:511-519. [PMID: 37499130 PMCID: PMC10609652 DOI: 10.1097/upj.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Citing high costs, limited diagnostic benefit, and ionizing radiation-associated risk from CT urogram, in 2020 the AUA revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with low- to intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown. METHODS With the overarching objective of improving guideline implementation, we used a mixed-method convergent explanatory design with electronic health record data for a retrospective cohort at a single academic tertiary medical center in the southeastern United States and semistructured interviews with urology and nonurology providers to describe determinants of low-value CT urogram following guideline revision. RESULTS Of 391 patients with microscopic hematuria, 198 (51%) had a low-value CT urogram (136 [69%] pre-guideline revision, 62 [31%] postrevision). The odds of ordering a low-value CT urogram were lower after guideline revisions, but the change was not statistically significant (OR: 0.44, P = .08); odds were 1.89 higher (P = .06) among nonurology providers than urology providers, but the difference was not statistically significant. Provider interviews suggested low-value CT urogram related to nonurology providers' limited awareness of revised guidelines, the role of clinical judgment in microscopic hematuria evaluation, and professional and patient influences. CONCLUSIONS Our findings suggest low-value CT urogram deimplementation may be improved with guidelines and implementation support directed at both urology and nonurology providers and algorithms to support guideline-concordant microscopic hematuria evaluation approaches. Future studies should test these strategies.
Collapse
Affiliation(s)
- Sarah A. Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Richard Matulewicz
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ram Pathak
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Cheyenne R. Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexandra G. Peluso
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Richa Bundy
- Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lauren Witek
- Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Bridget Krol
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Matthew Nielsen
- Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ajay Dharod
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Wake Forest University School of Medicine, Department of Internal Medicine (IM), Section on General Internal Medicine (GIM), Winston-Salem, North Carolina
- Wake Forest Center for Healthcare Innovation (CHI), Winston-Salem, North Carolina
- Wake Forest Center for Biomedical Informatics (WFBMI), Winston-Salem, North Carolina
| |
Collapse
|
188
|
Singh D, Cai L, Watt D, Scoggins E, Wald S, Nazerali R. Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center. J Healthc Qual 2023; 45:308-313. [PMID: 37596242 DOI: 10.1097/jhq.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Delays in operating room (OR) first-case start times can cause additional costs for hospitals, healthcare team frustration and delay in patient care. Here, a novel process improvement strategy to improving first-case start times is presented. METHODS First case in room start times were recorded for ORs at an academic medical center. Three interventions-automatic preoperative orders, dot phrases to permit re-creation of unavailable consent forms, and improved H&P linking to the surgical encounter-were implemented to target documentation-related delays. Monthly percentages of first-case on-time starts (FCOTS) and time saved were compared with the "preintervention" time period, and total cost savings were estimated. RESULTS During the first 3-months after implementation of the interventions, the percentage of FCOTS improved from an average of 36.7%-52.7%. Total time savings across all ORs over the same time period was found to be 55.63 hours, which is estimated to have saved a total of $121,834.52 over the 3-month interventional period. CONCLUSIONS By implementing multiple quality improvement interventions, delays to first start in room OR cases can be meaningfully reduced. Quality improvement protocols targeted toward root causes of OR delays can be a significant driver to reduce healthcare costs.
Collapse
Affiliation(s)
- Dylan Singh
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Lawrence Cai
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Dominique Watt
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Elise Scoggins
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Samuel Wald
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| | - Rahim Nazerali
- Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA
- Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA
- Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA
- Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA
| |
Collapse
|
189
|
Duivenvoorden AAM, Clarysse M, Ceulemans LJ, Geelkerken RH, Derikx JPM, de Vries JPPM, Buscher HCJL, Olde Damink SWM, van Schooten FJ, Lubbers T, Lenaerts K. Diagnostic potential of plasma biomarkers and exhaled volatile organic compounds in predicting the different stages of acute mesenteric ischaemia: protocol for a multicentre prospective observational study (TACTIC study). BMJ Open 2023; 13:e072875. [PMID: 37643848 PMCID: PMC10465895 DOI: 10.1136/bmjopen-2023-072875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Acute mesenteric ischaemia (AMI) is a life-threatening condition with short-term mortality of up to 80%. The diagnosis of AMI has remained troublesome due to the non-specific clinical presentation, symptoms and laboratory findings. Early unambiguous diagnosis of AMI is critical to prevent progression from reversible to irreversible transmural intestinal damage, thereby decreasing morbidity and improving survival. The present study aims to validate a panel of plasma biomarkers and investigate volatile organic compound (VOC) profiles in exhaled air as a tool to timely and accurately diagnose AMI. METHODS AND ANALYSIS In this international multicentre prospective observational study, 120 patients (>18 years of age) will be recruited with clinical suspicion of AMI. Clinical suspicion is based on: (1) clinical manifestation, (2) physical examination, (3) laboratory measurements and (4) the physician's consideration to perform a CT scan. The patient's characteristics, repetitive blood samples and exhaled air will be prospectively collected. Plasma levels of mucosal damage markers intestinal fatty acid-binding protein and villin-1, as well as transmural damage marker smooth muscle protein 22-alpha, will be assessed by ELISA. Analysis of VOCs in exhaled air will be performed by gas chromatography time-of-flight mass spectrometry. Diagnosis of AMI will be based on CT, endovascular and surgical reports, clinical findings, and (if applicable) verified by histopathological examination. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Research Ethics Committee (METC) of Maastricht University Medical Centre+ and Maastricht University (METC azM/UM), the Netherlands (METC19-010) and the Ethics Committee Research UZ/KU Leuven, Belgium (S63500). Executive boards and local METCs of other Dutch participating centres Gelre Ziekenhuizen (Apeldoorn), Medisch Spectrum Twente (Enschede), and University Medical Centre Groningen have granted permission to carry out this study. Study results will be disseminated via open-access peer-reviewed scientific journals and national/international conferences. TRIAL REGISTRATION NUMBER NCT05194527.
Collapse
Affiliation(s)
- Annet A M Duivenvoorden
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mathias Clarysse
- Abdominal Transplant Laboratory, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University of Groningen, Groningen, The Netherlands
| | | | - Steven W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frederik Jan van Schooten
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Tim Lubbers
- Department of Surgery, GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
190
|
Mosisa W, Gezehagn Y, Kune G, Chego M, Yigezu HF, Getnet M. Survival status and predictors of mortality among adult Stroke patients admitted to Jimma University Medical Center, South west Ethiopia: A retrospective Cohort study. Vasc Health Risk Manag 2023; 19:527-541. [PMID: 37649671 PMCID: PMC10464890 DOI: 10.2147/vhrm.s399815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Background Stroke is the leading cause of cardiovascular disease death in sub-Saharan Africa and the second leading cause of mortality worldwide. In 2016, 6.23% of all fatalities in Ethiopia were stroke-related. Objective To assess survival status and predictors of mortality among adult stroke patients admitted to Jimma University Medical Center from April 1/2017 to March 31/2022. Methods A retrospective cohort study was conducted on 480 adult stroke patients selected by simple random sampling from patients admitted to the Jimma University Medical Center Stroke Unit from April 1, 2017 to March 31, 2022. Data were extracted from May to June 2022 and entered Epi-data v.3.1 and analyzed by R v.4.2. The Kaplan-Meier curve with Log rank test was used to estimate survival time and to compare survival experience between categories of explanatory variables. The Cox regression model was computed to identify predictors of survival status in stroke patients. Then the 95% CI of the hazard ratio was set with corresponding p-value < 0.05 to declare statistical significance. Results During 4350 person-days of follow-up; 88 (18.33%) patients died; resulting in an incidence mortality of 20.23 per 1000 person-days, with a median survival time of 38 days. Glasgow coma score <8 on admission (AHR = 7.71; 95% CI: 3.78, 15.69), dyslipidemia (AHR = 3.96; 95% CI: 2.04, 7.69), aspiration pneumonia (AHR 2.30; 95% CI: 1.23-4.26), and increased intracranial pressure (AHR = 4.27; 95% CI: 2.33, 7.81), were the independent predictors of the time until death. Conclusion The incidence of stroke mortality was higher at the seven and fourteen days. Glasgow Coma Scale, increased intracranial pressure, dyslipidemia, and aspiration pneumonia were independent predictors of mortality.
Collapse
Affiliation(s)
- Wakgari Mosisa
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Yenealem Gezehagn
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Guta Kune
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Melese Chego
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Hamba Fida Yigezu
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
191
|
Proumen R, Connolly H, Debick NA, Hopkins R. Assessing the accuracy of electronic health record gender identity and REaL data at an academic medical center. BMC Health Serv Res 2023; 23:884. [PMID: 37608282 PMCID: PMC10463428 DOI: 10.1186/s12913-023-09825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Collection of accurate patient race, ethnicity, preferred language (REaL) and gender identity in the electronic health record (EHR) is essential for equitable and inclusive care. Misidentification of these factors limits quality measurement of health outcomes in at-risk populations. Therefore, the aim of our study was to assess the accuracy of REaL and gender identity data at our institution. METHODS A survey was administered to 117 random patients, selected from prior day admissions at a large academic medical center in urban central New York. Patients (or guardians) self-reported REaL and gender identity data, selecting from current EHR options. Variables were coded for the presence or absence of a difference from data recorded in the EHR. RESULTS Race was misreported in the EHR for 13% of patients and ethnicity for 6%. For most White and Black patients, race was concordant. However, self-identified data for all multiracial patients were discordant with the EHR. Most Non-Hispanic patients had ethnicity correctly documented. Some Hispanic patients were misidentified. There was a significant association between reporting both a race and an ethnicity which differed from the EHR on chi square analysis (P < 0.001). Of those who reported an alternative ethnicity, 71.4% also reported an alternative race. Gender identity was missing for most patients and 11% of the gender-identity entries present in the EHR were discordant with the patient's self-identity. Preferred language was 100% concordant with the EHR. CONCLUSIONS At an academic medical center, multiracial and Hispanic patients were more likely to have their demographics misreported in the EHR, and gender identity data were largely missing. Healthcare systems need strategies that support accurate collection of patients' self-reported ReAL and gender identity data to improve the future ability to identify and address healthcare disparities.
Collapse
Affiliation(s)
- Rachael Proumen
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, 750 E. Adams St, Syracuse, New York, USA.
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA.
| | - Hannah Connolly
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
| | - Nadia Alexandra Debick
- State University of New York (SUNY) Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
| | - Rachel Hopkins
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, 750 E. Adams St, Syracuse, New York, USA
- Department of Medicine, Division of Endocrinology, State University of New York (SUNY) Upstate Medical University, 750 E Adams St., Syracuse, NY, 13210, USA
| |
Collapse
|
192
|
Christensen SM, Andrews SR, Fox ER. Development of a proactive process to harmonize policy, infusion pump library, and electronic health record entries for continuous infusions at an academic medical center. Am J Health Syst Pharm 2023; 80:S119-S122. [PMID: 36566506 DOI: 10.1093/ajhp/zxac384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Standardized processes to order and prepare medications can decrease the potential for error and provider uncertainty. Our health system utilizes a standard concentration policy, smart infusion pumps, and the electronic health record (EHR) to catalog, order, and deliver intravenous medications. A need for a more proactive and formalized process to ensure medication listings are harmonized between these 3 resources was identified. Standardizing these resources can reduce confusion, reduce time spent in pharmacy operations and nursing workflow, and may improve patient safety. The purpose of this quality improvement project was to compare and resolve inconsistencies between these 3 sources and to create a new process to assure uniformity in a complex work environment. SUMMARY An audit-style comparison and evaluation of entries for continuous infusions within the standard concentration policy, the pump library, and the EHR was conducted. All continuous infusion entries within any one of these 3 sources were included. Key exclusion criteria included pediatric and neonatal infusions, intermittent infusions, and infusions in procedural areas. We compared the policy, the pump library, and the EHR to identify, document, and resolve discrepancies in medication name, concentration, rate, and volume; fluid restriction concentration; and upper and lower pump limits. A new method to ensure proactive continuity and consistent updates to the 3 sources was implemented into existing operational workflows. We recommended a total of 82 updates to policy (n = 48), the pump library (n = 30), and the EHR (n = 4) out of 187 continuous infusion entries. CONCLUSION Standardizing infusion resources will reduce confusion, and improve pharmacy operations, nursing workflow, and patient safety.
Collapse
Affiliation(s)
- Sean M Christensen
- Drug Information Service, University of Utah Health, Salt Lake City, UT, USA
| | - Stephen R Andrews
- Drug Information Service, University of Utah Health, Salt Lake City, UT, USA
| | - Erin R Fox
- Drug Information Service, University of Utah Health, Salt Lake City, UT, USA
| |
Collapse
|
193
|
Seifen C, Schlaier NA, Pordzik J, Staufenberg AR, Matthias C, Gouveris H, Bahr-Hamm K. Anatomic Features of the Nasal and Pharyngeal Region Do Not Influence PAP Therapy Response. Int J Environ Res Public Health 2023; 20:6580. [PMID: 37623166 PMCID: PMC10454205 DOI: 10.3390/ijerph20166580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
The objective of this study was to investigate to which extent anatomic features of the nasal and pharyngeal region contribute to the severity of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy response. Therefore, 93 patients (mean age 57.5 ± 13.0 years, mean body mass index 32.2 ± 5.80 kg/m2, 75 males, 18 females) diagnosed with OSA who subsequently started PAP therapy were randomly selected from the databank of a sleep laboratory of a tertiary university medical center. Patients were subdivided based on nasal anatomy (septal deviation, turbinate hyperplasia, their combination, or none of the above), pharyngeal anatomy (webbing, tonsillar hyperplasia, their combination, or none of the above), and (as a separate group) tongue base anatomy (no tongue base hyperplasia or tongue base hyperplasia). Then, polysomnographic data (e.g., arousal index, ARI; respiratory disturbance index, RDI; apnea index, AI; hypopnea index, HI; and oxygen desaturation index, ODI) of diagnostic polysomnography (PSG) and PAP therapy control PSG were collected, grouped, and evaluated. Septal deviation, turbinate hyperplasia, or their combination did not significantly affect the assessed PSG parameters or the response to PAP therapy compared with patients without nasal obstruction (p > 0.05 for all parameters). Accordingly, most PSG parameters and the response to PAP therapy were not significantly affected by webbing, tonsil hyperplasia, or their combination compared with patients without pharyngeal obstruction (p > 0.05 for RDI, AI, HI, and ODI, respectively). However, in the pharyngeal anatomy group, ARI was significantly higher in patients with tonsil hyperplasia (p = 0.018). Further, patients with tongue base hyperplasia showed a significantly higher HI in the diagnostic PSG (p = 0.025) compared with patients with normal tongue base anatomy, but tongue base anatomy did not significantly affect the response to PAP therapy (p > 0.05 for all parameters). The influence of anatomic features of the nasal and pharyngeal region on PAP therapy response appears to be small, and generalizability of these results requires further studies.
Collapse
Affiliation(s)
- Christopher Seifen
- Sleep Medicine Center, Department of Otolaryngology, Head and Neck Surgery, University Medical Center Mainz, 55131 Mainz, Germany
| | | | | | | | | | | | | |
Collapse
|
194
|
Baumann SM, De Stefano P, Kliem PSC, Grzonka P, Gebhard CE, Sarbu OE, De Marchis GM, Hunziker S, Rüegg S, Kleinschmidt A, Pugin J, Quintard H, Marsch S, Seeck M, Sutter R. Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation. Crit Care 2023; 27:308. [PMID: 37543625 PMCID: PMC10403848 DOI: 10.1186/s13054-023-04592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers. METHODS In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women. RESULTS Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004). CONCLUSIONS This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.
Collapse
Affiliation(s)
- Sira M Baumann
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Pia De Stefano
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Paulina S C Kliem
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
| | - Caroline E Gebhard
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Oana E Sarbu
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Andreas Kleinschmidt
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Jérôme Pugin
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Hervé Quintard
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical Faculty of the University of Geneva, Geneva, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
195
|
Moore BB, Ballinger MN, Bauer NN, Blackwell TS, Borok Z, Budinger GRS, Camoretti-Mercado B, Erzurum SC, Himes BE, Keshamouni VG, Kulkarni HS, Mallampalli RK, Mariani TJ, Martinez FJ, McCombs JE, Newcomb DC, Johnston RA, O'Reilly MA, Prakash YS, Ridge KM, Sime PJ, Sperling AI, Violette S, Wilkes DS, Königshoff M. Building Career Paths for Ph.D., Basic and Translational Scientists in Clinical Departments in the United States: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1077-1087. [PMID: 37526479 PMCID: PMC10405615 DOI: 10.1513/annalsats.202304-305st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Rationale: To identify barriers and opportunities for Ph.D., basic and translational scientists to be fully integrated into clinical units. Objectives: In 2022, an ad hoc committee of the American Thoracic Society developed a project proposal and workshop to identify opportunities and barriers for scientists who do not practice medicine to develop successful careers and achieve tenure-track faculty positions in clinical departments and divisions within academic medical centers (AMCs) in the United States. Methods: This document focuses on results from a survey of adult and pediatric pulmonary, critical care, and sleep medicine division chiefs as well as a survey of workshop participants, including faculty in departmental and school leadership roles in both basic science and clinical units within U.S. AMCs. Results: We conclude that full integration of non-clinically practicing basic and translational scientists into the clinical units, in addition to their traditional placements in basic science units, best serves the tripartite mission of AMCs to provide care, perform research, and educate the next generation. Evidence suggests clinical units do employ Ph.D. scientists in large numbers, but these faculty are often hired into non-tenure track positions, which do not provide the salary support, start-up funds, research independence, or space often associated with hiring in basic science units within the same institution. These barriers to success of Ph.D. faculty in clinical units are largely financial. Conclusions: Our recommendation is for AMCs to consider and explore some of our proposed strategies to accomplish the goal of integrating basic and translational scientists into clinical units in a meaningful way.
Collapse
|
196
|
Sinha MS, Dzara K, Mueller SK. How Male Allies Can Support the Advancement of Women in Academic Medicine. Acad Med 2023; 98:969. [PMID: 36731079 DOI: 10.1097/acm.0000000000004994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Michael S Sinha
- assistant professor of law, Center for Health Law Studies, Saint Louis University School of Law
| | - Kristina Dzara
- director, Center for Leadership and Innovation in Medical Education, and associate professor of biomedical informatics and medical education, University of Washington School of Medicine
| | | |
Collapse
|
197
|
Vohra SS, Rajupet SR, Kaminski MA, White MA, Fagerlin A, Ellerbeck EF. Evolution of Population Health Within US Schools of Medicine and Academic Medical Centers. Popul Health Manag 2023; 26:268-274. [PMID: 37590082 DOI: 10.1089/pop.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Schools of medicine are increasingly focusing on efforts beyond the immediate needs of individual patients and addressing the needs of whole populations. This study examined the characteristics of population health departments and related programs within, and affiliated with, schools of medicine and how these programs address the schools' educational, clinical care, research, and service missions. Structured reviews of school of medicine websites were used to identify population health departments and related programs. An on-line survey was distributed to a subset of these programs to capture details on their activities and organizational characteristics. The authors convened leaders of population health programs to elaborate on core themes. Of 154 school of medicine websites reviewed, 37 (24%) had affiliated population health programs, including 28 (18%) with distinct departments of population health. Departments reported a variety of teaching activities related to undergraduate medical education, graduate degree programs, and certificate programs addressing a variety of population health domains including public health, health administration, epidemiology, biostatistics, informatics, and research methods. Research was a core activity for most departments with significant support coming from federal funding, with many playing major roles in clinical and translational research institutes and cancer centers. Most departments had research, data sharing, and other collaborations with affiliated health systems. All departments engaged in community service activities, including activities supporting the response to the COVID-19 pandemic. Population health programs are playing an increasingly important role in the teaching, clinical care, research, and community service missions in schools of medicine and academic medical centers.
Collapse
Affiliation(s)
- Sameer S Vohra
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Sritha R Rajupet
- Department of Family Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Mitchell A Kaminski
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Megan A White
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Edward F Ellerbeck
- Department of Population Health, Kansas University Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
198
|
Pascarella L, Marulanda K, Duchesneau ED, Sanchez-Casalongue M, Kapadia M, Farrell TM. Preferred Feedback Styles Among Different Groups in an Academic Medical Center. J Surg Res 2023; 288:215-224. [PMID: 37028209 PMCID: PMC10681023 DOI: 10.1016/j.jss.2023.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/23/2023] [Accepted: 02/18/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Feedback is an essential component in complex work environments. Different generations have been shown to have different sets of values, derived from societal and cultural changes. We hypothesize that generational differences may be associated with preferred feedback patterns among medical trainees and faculty in a large academic institution. METHODS A survey was distributed to all students, residents/fellows, and faculty at a large academic medical institution from April 2020 through June 2020. Survey questions evaluated feedback methods for six domains: preparedness, performance, attitude, technical procedures, inpatient, and outpatient care. Participants selected a preferred feedback method for each category. Patient demographics and survey responses were described using frequency statistics. We compared differences in feedback preferences based on generation and field of practice. RESULTS A total of 871 participants completed the survey. Preferred feedback patterns in the medical field do not seem to align with sociologic theories of generational gaps. Most participants preferred to receive direct feedback after an activity away from their team, irrespective of their age or medical specialty. Individuals preferred direct feedback during an activity in front of their team only for technical procedures. Compared to nonsurgeons, surgeons were more likely to prefer direct feedback in front of team members for preparedness, performance, and attitude. CONCLUSIONS Generational membership is not significantly associated with preferred feedback patterns in this complex medical academic environment. Variations in feedback preferences are associated with field of practice that may be due to specialty-specific differences in culture and personality traits present within certain medical specialties, particularly surgery.
Collapse
Affiliation(s)
- Luigi Pascarella
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Kathleen Marulanda
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emilie D Duchesneau
- Department of Epidemiology, Gillings School of Global Public Health, of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Manuel Sanchez-Casalongue
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera Kapadia
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M Farrell
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
199
|
Gotthardt CJ, Haynes SC, Sharma S, Yellowlees PM, Luce MS, Marcin JP. Patient Satisfaction with Care Providers During the COVID-19 Pandemic: An Analysis of Consumer Assessment of Healthcare Providers and Systems Survey Scores for In-Person and Telehealth Encounters at an Academic Medical Center. Telemed J E Health 2023; 29:1114-1126. [PMID: 36595515 DOI: 10.1089/tmj.2022.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Previous research has demonstrated high patient satisfaction with telehealth encounters. The objective of this study was to compare patient satisfaction scores regarding their physician using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys between in-person and telehealth outpatient encounters during the pandemic at a large academic health center. Methods: We analyzed CAHPS patient satisfaction survey data within the UC Davis Health system between August 2020 and February 2022. The questions analyzed pertained to patients' satisfaction with their care provider; whether they felt included in discussions, would recommend their physician, received clear explanations, and that their concerns were heard. Using logistic regression models adjusting for confounders, we compared CAHPS care provider top box scores-a score of 4 or 5 on the 5-point scale-for 5 survey items. Results: Survey results from 76,687 (84.2%) in-person encounters and 14,404 (15.8%) telehealth encounters were evaluated. The odds of a telehealth patient giving a top box score for whether they would recommend their care provider to others were 0.97 those of an in-person patient (95% confidence interval [0.87-1.06]; p = 0.494). Similarly, there was no significant difference in odds of giving a top box score between telehealth and in-person patients for the other four questions analyzed. Discussion: Our findings indicate that patient experience and care provider rankings for in-person care and telehealth care are comparable across a variety of specialties and conditions at a large academic health center. Future studies should investigate patient satisfaction with in-person and telehealth encounters by diagnosis and specialty.
Collapse
Affiliation(s)
| | | | - Sristi Sharma
- University of California, Davis, Davis, California, USA
| | | | | | | |
Collapse
|
200
|
Klitzman R. Overturning Roe v Wade : Implications for Academic Medical Centers. Acad Med 2023; 98:871. [PMID: 37162204 DOI: 10.1097/acm.0000000000005235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Robert Klitzman
- Professor of psychiatry, and director, Masters of Bioethics Program, Columbia University, New York, New York; ; ORCID: https://orcid.org/0000-0002-6827-8063
| |
Collapse
|