Journal of Maine Medical Center最新文献

Problem: Postoperative complications after cardiac surgery significantly impact both the short-term and long-term survival of patients. Cardiovascular diseases are a major health concern, accounting for 12% of health expenditures in the United States. A substantial number of patients with cardiovascular disease undergo invasive procedures, including cardiac surgery, and the incidence of postoperative complications is notable. This information underscores the need to effectively prevent postoperative adverse events to improve outcomes, reduce morbidity, shorten hospital stays, and lower health care costs.

Approach: The Healthcare Enabled by Artificial Intelligence in Real Time (HEART) project is a collaborative effort involving clinicians from MaineHealth, industry experts from Nihon Kohden, and data scientists from the Roux Institute. The project aims to develop a real-time predictive analytics model as a decision support tool for clinicians in the cardiothoracic intensive care unit who care for patients after cardiac surgery. The team is using a supervised, closed-loop, machine learning design to train the model. The initiative involves collecting static and dynamic preoperative, intraoperative, and postoperative variables from a cohort of patients undergoing cardiac surgery at Maine Medical Center. These variables, including data on blood product transfusions and inotropic and vasoactive medications administered, are being transmitted from the electronic health record to a data warehouse. The model will predict the following adverse outcomes: acute kidney injury, renal failure, new onset postoperative atrial fibrillation, prolonged ventilation, reoperation, operative mortality, delirium, stroke, deep sternal wound infection, and extended hospital length of stay.

Outcomes: The HEART team successfully established a data-collecting infrastructure. Data collection and validation are ongoing, with an emphasis on accuracy and completeness.

Next steps: The project will advance by developing a user-friendly, real-time interface, incorporating feedback from clinicians in the operating room and cardiothoracic intensive care unit to ensure practicality and acceptance of the technology. This interface will provide adverse outcome predictions in real time, support clinical decision-making, and become a regular part of patient care.

Introduction: Average length of stay (ALOS) has increased in many US hospitals in the post-COVID-19-pandemic world. We undertook a process improvement initiative to reduce the ALOS in our community hospital.

Methods: Three core tactics were developed with a goal of reducing our ALOS by 10%. These tactics were early mobilization, Interprofessional Partnership to Advance Care and Education rounding, and structured interdisciplinary care rounds. Workgroups in each of these domains designed the improvement, devised measures of success, and implemented the tactic. A process improvement specialist worked with each workgroup using elements of the Model for Improvement. Process measures were reported weekly. Outcome measures (ALOS, observed vs expected LOS) were reported weekly. A central steering committee oversaw the initiative. All tactics were fully implemented by February 2023.

Results: For the first 6 months after implementing our tactics, the ALOS on our inpatient medical units decreased from 6.3 to 5.5 days (13.7%) when compared with the same 6-month period in the prior year (P < .01).

Discussion: We used 3 interventions to impact the ALOS in our community hospital. Preliminary data show a significant improvement. We cannot isolate the independent contribution of each intervention and did not control for confounders.

Conclusions: Our interdisciplinary team developed and implemented tactics to reduce the ALOS in our community hospital by 13.7%.

Introduction: Given the uncertainties related to IV iron therapy and the potential risk of infection, health care providers may hesitate to use this preparation to treat hospitalized patients with bacterial infections, even if clinically indicated. The aim of this study was to examine patterns of prescribing IV iron in patients who were hospitalized and treated for a bacterial infection, and their associated clinical outcomes.

Methods: This retrospective chart review evaluated adult patients who received both IV iron sucrose and antibiotics during the same admission at Maine Medical Center in 2019. Data collected included iron studies, practices for prescribing IV iron, and clinical outcomes. Data were summarized using descriptive statistics.

Results: A total of 197 patients were evaluated. The median duration of antibiotic therapy was 5(4-9) days. Iron and antibiotic administration overlapped in 153(77.7%) patients, with a mean overlap of 2.7(1-7) days. In the 44 patients without overlap, 20(46%) received IV iron before antibiotics. More than half (57%) of infection types involved urinary tract and respiratory systems. Approximately 2% of patients had antibiotic therapy broadened or duration extended, 7% died, and 16% were readmitted within 30 days of discharge.

Discussion: Prior studies evaluating the risk of infection with IV iron published conflicting results. This is the only study that analyzed outcomes in patients receiving IV iron and antibiotics for infection but not undergoing hemodialysis during a hospital admission. Although our findings support that IV iron treatment is safe among patients with concomitant infection and iron deficiency, this finding may not be the case for all clinical subgroups.

Conclusions: This study showed that when patients were administered IV iron in the setting of acute bacterial infection in our facility, most patients did not have negative outcomes.