Samantha Harrison MS, Krystal Capers MPH, Guanqing Chen PhD, Ji T. Liu PharmD, Ameeka Pannu MD, Valerie Goodspeed MPH, Akiva Leibowitz MD, Somnath Bose MD, MPH, FASA
Background
Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.
Objective
To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.
Design
Single center retrospective cohort study.
Setting and Participants
Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof.
Intervention
None.
Main Outcome and Measures
Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.
Results
1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42–4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.
{"title":"New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19","authors":"Samantha Harrison MS, Krystal Capers MPH, Guanqing Chen PhD, Ji T. Liu PharmD, Ameeka Pannu MD, Valerie Goodspeed MPH, Akiva Leibowitz MD, Somnath Bose MD, MPH, FASA","doi":"10.1002/jhm.13408","DOIUrl":"10.1002/jhm.13408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Single center retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42–4.12; <i>p</i> = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 10","pages":"877-885"},"PeriodicalIF":2.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Studenmund MD, Audrey Lyndon PhD, RNC, James R. Stotts PhD, RN, Caroline Peralta-Neel MPS, Anjana E. Sharma MD, MAS, Naomi S. Bardach MD, MAS
Objectives
Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety.
Methods
In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: (1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; (2) thematic analysis to identify domains.
Results
Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only 1 (0.8%) corresponded to a staff-reported IR. Twenty-five percent of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: (1) patients and families as safety actors; (2) emotional safety; (3) system-centered care; and (4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1–3), while others fit within standard healthcare safety domains (#4).
Conclusions
Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations—collected with an option for anonymity and eliciting both positive and constructive comments.
{"title":"What do patients and families observe about pediatric safety?: A thematic analysis of real-time narratives","authors":"Christine Studenmund MD, Audrey Lyndon PhD, RNC, James R. Stotts PhD, RN, Caroline Peralta-Neel MPS, Anjana E. Sharma MD, MAS, Naomi S. Bardach MD, MAS","doi":"10.1002/jhm.13388","DOIUrl":"10.1002/jhm.13388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: (1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; (2) thematic analysis to identify domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only 1 (0.8%) corresponded to a staff-reported IR. Twenty-five percent of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: (1) patients and families as safety actors; (2) emotional safety; (3) system-centered care; and (4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1–3), while others fit within standard healthcare safety domains (#4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations—collected with an option for anonymity and eliciting both positive and constructive comments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"765-776"},"PeriodicalIF":2.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica L. Markham MD, MSc, Alaina Burns PharmD, BCPPS, Matthew Hall PhD, Matthew J. Molloy MD, MPH, John R. Stephens MD, Elisha McCoy MD, Irma T. Ugalde MD, MBE, Michael J. Steiner MD, MPH, Jillian M. Cotter MD, MSCS, Samantha A. House DO, MPH, Megan E. Collins MD, Andrew G. Yu MD, Michael J. Tchou MD, MSc, Samir S. Shah MD, MSCE
Objective
The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes.
Design, Setting and Participants
We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database.
Main Outcome and Measures
We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions.
Results
We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from <1% to 25%. Approximately 80% of hospital antibiograms demonstrated >80% Escherichia coli susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 [95% confidence interval; CI]: 30.8–35.4] h vs. broad-spectrum: 46.1 [95% CI: 44.1–48.2] h) and reduced costs (narrow-spectrum: $4570 [$3751–5568] versus broad-spectrum: $5699 [$5005–$6491]). There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible E. coli. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.
{"title":"Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections","authors":"Jessica L. Markham MD, MSc, Alaina Burns PharmD, BCPPS, Matthew Hall PhD, Matthew J. Molloy MD, MPH, John R. Stephens MD, Elisha McCoy MD, Irma T. Ugalde MD, MBE, Michael J. Steiner MD, MPH, Jillian M. Cotter MD, MSCS, Samantha A. House DO, MPH, Megan E. Collins MD, Andrew G. Yu MD, Michael J. Tchou MD, MSc, Samir S. Shah MD, MSCE","doi":"10.1002/jhm.13390","DOIUrl":"10.1002/jhm.13390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting and Participants</h3>\u0000 \u0000 <p>We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from <1% to 25%. Approximately 80% of hospital antibiograms demonstrated >80% <i>Escherichia coli</i> susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 [95% confidence interval; CI]: 30.8–35.4] h vs. broad-spectrum: 46.1 [95% CI: 44.1–48.2] h) and reduced costs (narrow-spectrum: $4570 [$3751–5568] versus broad-spectrum: $5699 [$5005–$6491]). There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible <i>E. coli</i>. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"777-786"},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Maintaining public trust in organ donation while expanding the organ pool","authors":"Brendan Parent JD","doi":"10.1002/jhm.13409","DOIUrl":"10.1002/jhm.13409","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"863-865"},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aksharananda Rambachan MD, MPH, Mihir Joshi MD, Andrew D. Auerbach MD, Margaret C. Fang MD, MPH
Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician–patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: −4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.
{"title":"Sex concordance between physicians and patients and discharge opioid prescribing","authors":"Aksharananda Rambachan MD, MPH, Mihir Joshi MD, Andrew D. Auerbach MD, Margaret C. Fang MD, MPH","doi":"10.1002/jhm.13389","DOIUrl":"10.1002/jhm.13389","url":null,"abstract":"<p>Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician–patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: −4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 7","pages":"605-609"},"PeriodicalIF":2.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maitreya Coffey MD, FAAP, FRCP(C), Monica E. Kleinman MD, FAAP
{"title":"Handle with care: Preventing harm during critical care unit relocation","authors":"Maitreya Coffey MD, FAAP, FRCP(C), Monica E. Kleinman MD, FAAP","doi":"10.1002/jhm.13361","DOIUrl":"10.1002/jhm.13361","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 7","pages":"650-651"},"PeriodicalIF":2.4,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allison Bond MD, Sandra Oreper MPH, Priya Prasad PhD, Emily Abdoler MD, Sarah Doernberg MD, MAS
Background
Closing the gap between evidence-supported antibiotic use and real-world prescribing among clinicians is vital for curbing excessive antibiotic use, which fosters antimicrobial resistance and exposes patients to antimicrobial side effects. Providing prescribing information via scorecard improves clinician adherence to quality metrics.
Objective
We aimed to delineate actionable, relevant antimicrobial prescribing metrics extractable from the electronic health record in an automated way.
Design
We used a modified Delphi consensus-building approach.
Settings and Participants
Our study entailed two iterations of an electronic survey disseminated to hospital medicine physicians at 10 academic medical centers nationwide.
Main Outcomes and Measures
Main outcomes comprised consensus metrics describing the quality of antibiotic prescribing to hospital medicine physicians.
Results
Twenty-eight participants from 10 United States institutions completed the first survey version containing 38 measures. Sixteen respondents completed the second survey, which contained 37 metrics. Sixteen metrics, which were modified based on qualitative survey feedback, met criteria for inclusion in the final scorecard. Metrics considered most relevant by hospitalists focused on the appropriate de-escalation of antimicrobial therapy, selection of guideline-concordant antibiotics, and appropriate duration of treatment for common infectious syndromes. Next steps involve prioritization and implementation of these metrics based on quality gaps at our institution, focus groups exploring impressions of clinicians who receive a scorecard, and analysis of antibiotic prescribing patterns before and after metric implementation. Other institutions may be able to implement metrics from this scorecard based on their own quality gaps to provide hospitalists with automated feedback related to antibiotic prescribing.
{"title":"Development of antibiotic metrics for hospitalists via multi-institutional modified Delphi survey","authors":"Allison Bond MD, Sandra Oreper MPH, Priya Prasad PhD, Emily Abdoler MD, Sarah Doernberg MD, MAS","doi":"10.1002/jhm.13377","DOIUrl":"10.1002/jhm.13377","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Closing the gap between evidence-supported antibiotic use and real-world prescribing among clinicians is vital for curbing excessive antibiotic use, which fosters antimicrobial resistance and exposes patients to antimicrobial side effects. Providing prescribing information via scorecard improves clinician adherence to quality metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to delineate actionable, relevant antimicrobial prescribing metrics extractable from the electronic health record in an automated way.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We used a modified Delphi consensus-building approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Settings and Participants</h3>\u0000 \u0000 <p>Our study entailed two iterations of an electronic survey disseminated to hospital medicine physicians at 10 academic medical centers nationwide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes and Measures</h3>\u0000 \u0000 <p>Main outcomes comprised consensus metrics describing the quality of antibiotic prescribing to hospital medicine physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-eight participants from 10 United States institutions completed the first survey version containing 38 measures. Sixteen respondents completed the second survey, which contained 37 metrics. Sixteen metrics, which were modified based on qualitative survey feedback, met criteria for inclusion in the final scorecard. Metrics considered most relevant by hospitalists focused on the appropriate de-escalation of antimicrobial therapy, selection of guideline-concordant antibiotics, and appropriate duration of treatment for common infectious syndromes. Next steps involve prioritization and implementation of these metrics based on quality gaps at our institution, focus groups exploring impressions of clinicians who receive a scorecard, and analysis of antibiotic prescribing patterns before and after metric implementation. Other institutions may be able to implement metrics from this scorecard based on their own quality gaps to provide hospitalists with automated feedback related to antibiotic prescribing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 8","pages":"680-684"},"PeriodicalIF":2.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140826548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mithun R. Suresh MD, Najib Nassani MD, MSc, Luis A. Servin-Abad MD, Deanne B. Walz MSN, BSN, CGRN, Paul R. Davis MD, Christopher W. Boelter MD, MBA, Tyler G. Goettl MD, Greg J. Beilman MD, Martin L. Freeman MD, Andrew P. J. Olson MD, Fateh Bazerbachi MD
<p>Access to interventional endoscopy expertise is often restricted to tertiary care centers and may not be available in rural or critical access hospitals. In central Minnesota, St. Cloud Hospital is the tertiary referral center for the state's central region, with 489 licensed beds and a level II trauma center, comprehensive stroke center, intensive care unit (ICU), and staffed with physicians from nearly all medical and surgical subspecialties. During the COVID-19 pandemic, patients presenting to rural or critical access hospitals in central Minnesota and needing urgent endoscopic procedures had difficulty accessing timely care due to the lack of beds at our institution or other capable facilities in Minnesota,<span><sup>1</sup></span> a problem which persists to the present day. Critical access hospitals generally have fewer than 25 inpatient beds, are located in rural areas over 35 miles from another hospital, and have limited on-site subspecialty support.<span><sup>2</sup></span> Accordingly, our operational objective was to develop a round-trip, same-day endoscopic procedures service where patients would transfer by ambulance to our institution to undergo the necessary procedures and then return to the referring hospital for further care. The purpose of this manuscript is to describe our experience and outcomes with this service, given the dearth of published reports on this care model.<span><sup>3-5</sup></span></p><p>This service aims to provide interventional endoscopy care for rural and critical access hospital patients that are appropriate candidates in 1–2 days from receiving a request from a referring provider, avoid admission to our institution following the procedures, and recover post-procedurally in the referring hospital and not need to transfer back to our institution during the index hospitalization (with index hospitalization being the hospitalization during which the round-trip occurs). These were the desired outcomes over the first 20 months of the operation of this service, and we concurrently sought to ensure the safety and feasibility of this service to improve access to endoscopic care for patients in rural and critical access hospitals.</p><p>We received approval to gather and publish data using our electronic medical record (EMR) Epic (including Care Everywhere and paper records) from the CentraCare Institutional Review Board. The general workflow algorithm for round-trip procedures is shown in Figure 1, with some additional information as follows. During daytime hours, referring providers caring for patients needing endoscopic procedures would contact our institution's transfer center and be connected with the medical officer of the day (MOD), a role filled daily by a hospitalist who is the accepting physician for all patients directly admitted to the hospital medicine service; all patients needing endoscopic procedures are admitted by the hospital medicine service with gastroenterology consultation at our institu
{"title":"Implementation of a same-day, round-trip interventional endoscopy service for rural and critical access hospital patients","authors":"Mithun R. Suresh MD, Najib Nassani MD, MSc, Luis A. Servin-Abad MD, Deanne B. Walz MSN, BSN, CGRN, Paul R. Davis MD, Christopher W. Boelter MD, MBA, Tyler G. Goettl MD, Greg J. Beilman MD, Martin L. Freeman MD, Andrew P. J. Olson MD, Fateh Bazerbachi MD","doi":"10.1002/jhm.13333","DOIUrl":"10.1002/jhm.13333","url":null,"abstract":"<p>Access to interventional endoscopy expertise is often restricted to tertiary care centers and may not be available in rural or critical access hospitals. In central Minnesota, St. Cloud Hospital is the tertiary referral center for the state's central region, with 489 licensed beds and a level II trauma center, comprehensive stroke center, intensive care unit (ICU), and staffed with physicians from nearly all medical and surgical subspecialties. During the COVID-19 pandemic, patients presenting to rural or critical access hospitals in central Minnesota and needing urgent endoscopic procedures had difficulty accessing timely care due to the lack of beds at our institution or other capable facilities in Minnesota,<span><sup>1</sup></span> a problem which persists to the present day. Critical access hospitals generally have fewer than 25 inpatient beds, are located in rural areas over 35 miles from another hospital, and have limited on-site subspecialty support.<span><sup>2</sup></span> Accordingly, our operational objective was to develop a round-trip, same-day endoscopic procedures service where patients would transfer by ambulance to our institution to undergo the necessary procedures and then return to the referring hospital for further care. The purpose of this manuscript is to describe our experience and outcomes with this service, given the dearth of published reports on this care model.<span><sup>3-5</sup></span></p><p>This service aims to provide interventional endoscopy care for rural and critical access hospital patients that are appropriate candidates in 1–2 days from receiving a request from a referring provider, avoid admission to our institution following the procedures, and recover post-procedurally in the referring hospital and not need to transfer back to our institution during the index hospitalization (with index hospitalization being the hospitalization during which the round-trip occurs). These were the desired outcomes over the first 20 months of the operation of this service, and we concurrently sought to ensure the safety and feasibility of this service to improve access to endoscopic care for patients in rural and critical access hospitals.</p><p>We received approval to gather and publish data using our electronic medical record (EMR) Epic (including Care Everywhere and paper records) from the CentraCare Institutional Review Board. The general workflow algorithm for round-trip procedures is shown in Figure 1, with some additional information as follows. During daytime hours, referring providers caring for patients needing endoscopic procedures would contact our institution's transfer center and be connected with the medical officer of the day (MOD), a role filled daily by a hospitalist who is the accepting physician for all patients directly admitted to the hospital medicine service; all patients needing endoscopic procedures are admitted by the hospital medicine service with gastroenterology consultation at our institu","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 10","pages":"971-976"},"PeriodicalIF":2.4,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140826650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha F. Sanders MD, MBA, Michael S. Shen MD, Daniel Alaiev BBA, Brianna Knoll MD, MBA, Hyung J. Cho MD, Surafel Tsega MD, Mona Krouss MD, Ian Fagan MD, Amanda Klinger MD
{"title":"Don't hold the metformin: Enhancing inpatient diabetes education to encourage best practices in a public hospital","authors":"Samantha F. Sanders MD, MBA, Michael S. Shen MD, Daniel Alaiev BBA, Brianna Knoll MD, MBA, Hyung J. Cho MD, Surafel Tsega MD, Mona Krouss MD, Ian Fagan MD, Amanda Klinger MD","doi":"10.1002/jhm.13269","DOIUrl":"10.1002/jhm.13269","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 6","pages":"551-556"},"PeriodicalIF":2.6,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140826827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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