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Intraoperative Hypotension in Non-Cardiac Surgery Patients at Providence Sacred Heart Medical Center
Genna LeDrew and Kenn B Daratha
Background Intraoperative Hypotension (IOH) during non-cardiac surgery is a common side effect of anesthesia that is associated with acute kidney injury (AKI), myocardial injury (MI), mortality, and other adverse outcomes1,3,4. These risks increase as the duration and severity of IOH exposure increase3,4. Blood pressure is a modifiable risk factor of mortality and organ damage that can be readily treated by the anesthesia provider2 . Limiting IOH can improve patient outcomes and produce monetary savings5 . The objective of this project is to report the incidence of IOH at a large tertiary teaching hospital, and extrapolate the risks of mortality and organ damage among patients with IOH. This project also identifies IOH risk factors, and reports timing of IOH during surgery.
Methods We conducted a retrospective analysis of secondary, observational data at Providence Sacred Heart Medical Center (PSHMC) • Eligibility Criteria. Inclusion: patients >18 years of age who received general anesthesia for elective non cardiac surgery from October 1, 2017 to September 30, 2018 Exclusion: cardiopulmonary bypass, emergent, cesarean & pediatric surgical populations; persons with blood pressure frequency >5 minutes • Patient demographic and surgical data from electronic medical records were extracted using a REDCap data collection tool • We defined IOH according to absolute mean arterial pressure thresholds described by Wesselink et al., 20184 • Descriptive analyses were conducted to examine baseline demographics, incidence and timing of IOH in the study population • Multivariable analyses using binary logistic regression were performed to examine risk factors associated with IOH ( = 0.5) • The risks of mortality, AKI & MI associated with each IOH definition were extrapolated based upon data from a 2018 systematic review4 • This project was approved by the PSHMC Clinical Innovation and Research Council, and deemed exempt from human subjects research by Providence Health Care institutional review board
Discussion At a large tertiary teaching hospital, we found that 24% of our study population experienced IOH associated > 50% increased risk of MI, while 8% and 6% of patients experienced IOH associated with a >2 times greater risk for AKI and mortality, respectively. Female sex, longer case duration, and interventional radiology, cardiology, and plastics service lines were among the top IOH risk factors. 42% of IOH occurred between anesthesia induction and surgical incision, even though that time period only accounted for 19% of the intraoperative time. These findings suggest that up to one-quarter of non-cardiac surgical patients may be at elevated risk for organ damage, and as much as 6% patients may double their risk of mortality due to IOH. Given these risks, anesthesia providers should minimize IOH, and be aware of patient and surgical characteristics associated with higher IOH risk. The period between anesthesia induction and surgical incision may represent a time in which the anesthesia providers can work independently to reduce IOH exposure. Future projects should examine the utility of strategies for anesthesia providers to reduce IOH exposure in patients undergoing noncardiac surgery and reassess incidence rates.
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Using AI and NLP to Alleviate Physician Burnout
Aaron Martin
Artificial Intelligence (AI) is widely recognized as a powerful tool with potential for many healthcare applications. One application gaining interest is using AI to help solve physician burnout – the state of disillusionment among doctors tired of repetitive data entry tasks, as well as administrative duties, and excessive time spent combing through patient data. In this session, one of healthcare’s top innovators will examine how the power of AI, when merged with natural language processing (NLP), can alleviate many physician burnout woes.
Aaron Martin, a former executive leader and innovator at Amazon before he moved to healthcare, will take a realistic approach, recognizing that “the next big thing” will still require time, focus, and collaboration to get it right. However, with a solid AI and NLP strategy, physician burnout – as well as better patient service, improved outcomes, and more – can all be addressed. -
The Goldilocks Method: Demonstrating Your Value in Small, Medium, and Large Bites
Heather J. Martin
Background: In an era of financial constraint hospital libraries are facing closer scrutiny and must prove their value in order to survive. Leadership at a large health system library found the traditional written annual report lacked the impact needed to capture the attention and the imagination of administration. Taking different approaches over the years, this library has found a solution that is “just right”, creating three very different documents – small, medium, and large – to demonstrate its worth.
Description: Library leadership moved away from the traditional written annual report toward a one-page infographic that depicted the library’s scope, scale, and impact. This visual representation of library statistics captured the attention of administration and patrons in a new, compelling way. As it didn’t allow for telling deeper stories of special projects and partnerships, the library later added back in a written supplement and a “Selected Thanks” section that directly quoted satisfied library patrons. But, when the library’s very existence was at stake, the need for a much more comprehensive value-case was necessary, and a 20-page white paper tied to the organization’s strategic plan and key initiatives was created. Providing an annual report in 3 different formats – small, medium, and large, allows the library to tell just the right story, to the right person, in the right place.
Conclusion: Reporting on library usage statistics, initiatives, and successes in different formats has allowed the health system library to tell its story in just the right way at the right time. The posted infographic provides a lasting snapshot that draws people in. As such, it has been viewed by far more people than reports in the past. The written supplement tells stories from our patrons, and is delivered to key leadership. The value-case effectively tied ALL the work the library does directly to the institution’s strategic goals, and this past year effectively convinced senior leadership to stave off cuts.
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Building a Health System Institutional Repository: Setting Yourself Up for Success from the Start
Heather J. Martin, Barbara (Basia) Delawska-Elliott, and Daina Dickman
Background: While more common in university settings, institutional repositories (IR) have a place within hospitals and healthcare systems too, though the challenges in creating them may be different. This paper looks at the development of a Digital Commons institutional repository at Providence St. Joseph Health. The authors present the necessary steps for a successful initiative beginning with the planning process and building from there. Highlighted are some of the different challenges faced in non-academic settings; considerations when selecting a platform and designing and structure; and recommendations for doing outreach and promotion to unique user groups.
Description: Library staff proactively followed trends in IRs and prepared for future state. Identifying technology requirements and platform options, exploring other health system IRs, and building a search algorithm to capture the affiliations within a newly merged enterprise meant that when approached by senior leadership about publication tracking the library was well positioned for success. Library staff selected a platform, determined the repository’s scope, and identified key stakeholders. An implementation plan included securing funding and executive support, hiring a librarian, and developing a framework for year 1 of the project. A complex organization presented unique challenges when designing a metadata and taxonomy structure. Getting buy-in from clinicians required a strong elevator pitch, and a direct tie to the organization’s strategic goals. Anticipating organizational needs meant a platform able to accommodate datasets, visual collections, Magnet documentation, and locally-published peer-reviewed journals
Conclusion: Digital Commons launched in July 2018, and within 3 months was populated with 700+ publications and included profiles from several world-renowned researchers. A successful Year 1 is on track and will be measured by hitting a publication target of 1000 and successfully importing all 2018 affiliated publications from PubMed. Library staff is now focused on marketing and outreach, with the intention to rapidly grow the Expert Gallery to include individuals from a diverse representation of disciplines and health system markets, increase submission of non-periodical scholarly activity, and to form collaborative partnerships for growth into new areas like datasets, and video.
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Managing Researcher Expectations: Defining the Scope of Your Expert Gallery
Heather J. Martin and Daina Dickman
This presentation explains Providence St. Joseph Health's experiences in creating researcher/author profiles in the Expert Gallery of Digital Commons, their institutional repository. It discusses some of the unique challenges with creating profiles in a health system environment and the need to set clearly communicated limitations of the project.
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Axial Spondyloarthritis
Philip Mease and Muhammad Asim Khan
From the Publisher:
Focusing on the key essentials you need to know, Axial Spondyloarthritis provides a quick, expert overview of axSpA from a clinical perspective. This concise resource by Drs. Philip Mease and Muhammad Khan presents practical recommendations and guidelines for the diagnosis, management, and treatment of spondyloarthritis impacting the axial skeleton alongside an overview of epidemiology, special populations, and patient education.
Key Features
- Discusses key information on genetic factors and disease biomarkers.
- Presents an overview of clinical features, classification criteria, and imaging to aid in diagnosis.
- Covers management and treatment guidelines, including non-pharmacologic management and the use of biologics.
- Consolidates essential information on this timely topic into a single, convenient resource.
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Biologic Treatment of Axial Spondyloarthritis
Philip Mease and F. Van den Bosch
From the Publisher:
Focusing on the key essentials you need to know, Axial Spondyloarthritis provides a quick, expert overview of axSpA from a clinical perspective. This concise resource by Drs. Philip Mease and Muhammad Khan presents practical recommendations and guidelines for the diagnosis, management, and treatment of spondyloarthritis impacting the axial skeleton alongside an overview of epidemiology, special populations, and patient education.
Key Features- Discusses key information on genetic factors and disease biomarkers.
- Presents an overview of clinical features, classification criteria, and imaging to aid in diagnosis.
- Covers management and treatment guidelines, including non-pharmacologic management and the use of biologics.
- Consolidates essential information on this timely topic into a single, convenient resource.
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2018 In Review & What to Look Forward to in 2019
Pacific Neuroscience Institute
2018 flew by and was another amazing year of growth and transformation for Pacific Neuroscience Institute. Already in the first quarter of 2019 our multiple clinical and research projects are moving full steam ahead, and we look forward to further expanding our offerings, bringing world-class care to more patients. We are excited to be a cohesive, collaborative group of physicians and researchers with tremendous support from Saint John’s Health Center Foundation, Saint John’s Health Center and Providence Saint Joseph’s Health, allowing us to serve more people in need and to advance clinical care with active participation in the development of new diagnostics and therapeutics, both surgically and medically.
Here are HIGHLIGHTS of our accomplishments in 2018 and a look at what we have planned for 2019.
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Comparison of Ondansetron, Dexamethasone, and its Combination in the Prevention of Postoperative Nausea and Vomiting
Alina Palanchuk and Kenn B Daratha
Background Postoperative nausea and vomiting remains a common and unpleasant side effect for patients following surgery. Uncontrolled PONV can result in prolonged hospital stays, unanticipated hospital readmissions, and decreased patient satisfaction. The Apfel score identifies and counts independent risk factors for PONV; females, non-smokers, postoperative opioid use, and history of PONV or motion sickness. Rates of PONV increases as the number of risk factors increase. The primary intervention to decrease PONV is administration of prophylactic antiemetics. Research supports the use of combination antiemetic therapy for patients with a high number of risk factors. The purpose of this evidence based practice (EBP) project was to report the rate of PONV among surgical patients who received general anesthesia, comparing combination prophylactic antiemetics of ondansetron and dexamethasone to single antiemetic administration.
Methods A retrospective, EBP project was conducted at Providence Sacred Heart Medical Center (PSHMC) in Spokane, WA. • Permission was obtained by the facility and exemption determination was granted by the IRB. • Patient data was securely extracted and stored in a HIPPA compliant REDCap database. Patient data was fully de-identified. Data extraction included all surgeries in the 2018 calendar year. • Inclusion criteria: Adult patients > 18 years old, non-emergent surgery, general anesthesia (ETT, LMA) using volatile inhalational agents or total intravenous anesthesia. • Exclusion criteria: Pediatric, obstetric, emergency surgery, direct admission to ICU. • PONV outcome determined by nursing documentation of PONV scale, intervention, reassessment or signs/symptoms or administration of antiemetic medication. • Descriptive data analysis completed and stratified by the number of Apfel risk factors. Independent risk factors determined using binary logistic regression. Level of significance set at 0.05.
Discussion CONCLUSION When controlling for all literature reported PONV risk factors, this EBP project demonstrated that the odds of PONV reduction were similar for combination and individual antiemetic therapy. Similar to current research evidence, the identified independent risk factors for PONV were female gender, history of PONV or motion sickness, postoperative opioid administration, younger age, high risk procedures, and increased case duration. Non-smoking status and nitrous oxide use were not observed to be independent risk factors. As Apfel reported, this project similarly reported an increase rate in PONV as the number of PONV risk factors increased. The observed risk of PONV decreased among patients with at least one Apfel risk factor following prophylactic antiemetic administration. IMPLICATIONS Practice at PSHMC is demonstrating that combination prophylactic treatment is being used for patients with higher PONV risk factors. Practice is following current research evidence. Anesthetists should continue to tailor prophylactic antiemetic administration to patients based on presenting risk factors.
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Evaluating the Efficacy and Safety of Transitioning Patients from Natalizumab to Ocrelizumab (OCTAVE)
Kyle E Smoot, Kiren Kresa-Reahl, Pavle Repovic, Jessica Craddock, Chiayi Chen, Lindsay Lucas, Tiffany Gervasi-Follmar, and Stanley Cohan
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COMPARISONS OF PREOPERATIVE BLOOD PRESSURES IN SURGICAL PATIENTS
Brian Stacy and Kenn B Daratha
Background Surgical patients expect anesthesia providers to provide high quality care. Blood pressure variability must be mitigated by establishing the patient’s blood pressure baseline and sustaining it through surgery. A consensus has not been established on which blood pressure measurement should be used as the patient’s baseline. Blood pressures before surgery in multiple care settings have been shown to vary. This may result in differences in drug and fluid administration, depending on the blood pressure considered baseline by the anesthesia provider. The purpose of this observational evidence-based practice project was to compare mean blood pressures leading up to surgery among patients at Providence Sacred Heart Medical Center (PSHMC).
Methods Literature review identified five high quality studies to inform this project. • Institutional approval sought and obtained. IRB determined exempt research. • Data on adult, elective surgical patients receiving a general anesthetic from 09/30/2017-10/1/2018 were extracted in an anonymized fashion. • Patients characterized by demographic and clinical characteristics (table 1). • Mean blood pressures calculated from three settings: ambulatory clinics in the 12 months prior to surgery, the surgical admit unit (SAU) and the “first on table” (FOT) or first pressure recorded in the operating room. Patients without blood pressures recorded in each care setting excluded. • Repeated measures ANOVA and multiple linear regression (α=0.05).
Discussion SBP increased significantly from the pre-surgical ambulatory period to the first on table (FOT) blood pressure taken in the operating room. Changes in MAP were statistically, but not clinically, significant. A multivariable regression model revealed age, sex, heart failure, atrial fibrillation, hypertension, chronic kidney disease and peripheral vascular disease to be factors predictive of increasing FOT SBP. Our findings are consistent with current research evidence. Providence Sacred Heart Medical Center patients may experience over-treatment for hypotension if the first-ontable SBP is utilized as a baseline. This overtreatment may result in increased monetary and physical costs.
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2018 System Library Services Visual Annual Report
Amanda Steinvall
A visual report of the 2018 activities and accomplishments by System Library Services at Providence St. Joseph Health
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Impact of Early Mobilization on 90-Day Outcomes in Thrombectomy Patients
Tamela Stuchiner, Diane Clark, Lindsay Lucas, John Robinson, and Lisa Yanase
Introduction: Early mobilization of ischemic stroke patients receiving IV alteplase (tPA) did not worsen 90-day outcome at two urban stroke centers in a prior study, but there are no studies evaluating outcomes of early mobilization after thrombectomy. The mobility protocol used in the previous study was also utilized to mobilize stroke patients receiving thrombectomy treatment at these two centers, once minimum number of hours for groin precautions was complete and the groin puncture site was stable. The objective of this study was to determine for post-thrombectomy patients mobilized within 24 hours, whether earlier mobilization worsened outcomes.
Methods: Medical records of ischemic stroke patients receiving thrombectomy at two urban stroke centers between May 2013 and December 2017 were reviewed for early mobilization (within 24 hours of groin puncture). Patients who did not expire in hospital and had complete data were included in the analysis. Ordinal regression was used to determine if, with each hour delay in time first up, patients’ functional outcomes worsened at 90 days using the modified Rankin scale (mRS), adjusting for pre-symptom onset mRS, admission NIHSS, age, sex, and post-treatment thrombolysis in cerebral infarction (TICI) grade. The mRS at 90 days was categorized as no symptoms or no significant disability (0 - 1), mild or moderate disability (2 - 3), and severe disability or death (4 - 6).
Results: Of 147 patients mobilized within 24 hours, 91 patients were included in the analysis. Overall, 51% (n=46) were female, 74% (n=67) had no disability prior to their stroke, mean age was 68.0 (±14.1), mean admission NIHSS was 15.9 (±6.7), and 85% (n=78) had a post treatment TICI score of 2b or greater. Median time first mobilized was 14.1 hours [interquartile range: 9.4, 19.1]. Ordinal regression showed no evidence that earlier mobilization had an effect on patient outcomes at 90 days, patients were neither worse or better by time first mobilized within the first 24 hours (p=.706).
Conclusions: Ischemic stroke patients receiving thrombectomy were mobilized within 24 hours of groin puncture by the early mobility protocol. Patients experienced no impact on outcomes at 90 days by time first mobilized. This result may have been limited by small sample size.
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Cost Analysis of Implementing Standardized Stroke Patient Education Materials in a Large Five State Health System
Natalie Swearingen, Leslie Corless, Jessica Swann, Kailey Cox, Diane Lada, and Elizabeth Baraban
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Large Five State Health System Standardizes Stroke Patient Education While Significantly Improving Health Literacy
Natalie Swearingen, Leslie Corless, Jessica Swann, Kailey Cox, Diane Lada, and Elizabeth Baraban
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Evaluating Bundle Adherence in Ventilated Patients: A Quality Improvement Project
Melanie Webb and Lindsay Iverson
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General Anesthetic Induction Sequence High Fidelity Simulation: Determining Efficacy Among Novice Student Registered Nurse Anesthetists
Alex Wilkie, Steven Urbick, and Kenn B Daratha
Background High Fidelity Simulation (HFS) is used across multiple health professions. Despite the wide variety of clinical experiences that Student Registered Nurse Anesthetists (SRNA) possess prior to training, the induction sequence to a General Anesthetic (GA) is a daunting task. Although the efficacy of HFS has been widely studied within undergraduate nursing programs, there are no studies published determining the efficacy of HFS on SRNA training. The purpose of this study was to determine the efficacy of simulation training amongst entry-level SRNA’s and examine any individual participant factors that may influence clinical performance within HFS.
Methods • Human subjects were protected (Spokane IRB ID: STUDY18000465) • Pilot study participants recruited from 1st semester SRNAs in the Doctorate of Nurse Anesthesia Practice (DNAP) • Full study participants recruited from prospective DNAP students • Primary endpoints: efficacy of GA induction sequence HFS • Secondary endpoints: individual participant factors that may influence clinical performance within HFS • Scoring tool developed to measure primary outcome (Figure 2) • PowerPoint and didactic lecture provided to all participants • Pretest assessment following didactic training, using scoring tool, prior to HFS • Participants guided through HFS and subsequently debriefed • Posttest assessment completed following HFS using scoring tool • Each participant allotted 60 minutes for individual HFS session • Analysis of variance utilizing a waitlisted study design • A priori confidence level (α < 0.05)
Discussion Our sufficiently powered study detected a 29.0% (mean pre-test 23.7, mean post-test 33.4) improvement in Simulation Assessment Tool scores following HFS (p < 0.001). Despite variations in pre HFS scores, post HFS scores remain homogeneous across all participants confirming the effectiveness of our training. Our study also indicated that there were no statistically significant group differences in HFS pre-test scores amongst the participants for the demographic factors we assessed; type of ICU (p=0.76), years of ICU experience (p=0.36), and age (p=0.91). GA induction sequence training using HFS was proven to be effective among novice SRNA’s. In alignment with the current research evidence, the use of HFS among SRNA’s may help to improve learning, self-efficacy, and subsequently patient safety. Doctoral nurse anesthesia programs should consider the integration of HFS throughout program curriculum.
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Transfusion Ratios Following Activation of a Massive Transfusion Protocol: An Evidence Based Practice Project
Cody Woodbury and Kenn B Daratha
Background Accidental injury is one of the leading causes of death in the United States and worldwide. Severe hemorrhage from injury is the leading cause of preventable death. Effective management of hemorrhaging trauma patients has been evolving since the early 1900’s. Recent studies have demonstrated the benefits of using a balanced resuscitation technique, revolving around the goal of recreating whole blood. The purpose of this project was to identify what ratios of blood products are being transfused at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH).
Methods A literature review was performed identifying seven high quality peer-reviewed studies. • Institutional approval and IRB review for exemption determination completed. Human subjects were protected. • Registry data extraction in an anonymized fashion. • Patients who received no packed red blood cells or had no age specified were excluded. • Patients organized by demographic and clinical characteristics. • 24-hour mortality rates extracted from the electronic health record. • Post hoc power analysis was completed. • High ratio transfusion was defined as a ratio approaching or greater than 1:1 with packed red blood cells always being the denominator (i.e. FFP:PRBC, PLT:PRBC).
Discussion Massive transfusion ratios among hemorrhaging patients at PSHMC and PHFH were observed at high ratio 35% of the time, when comparing fresh frozen plasma to packed red blood cells, and 49% of the time, when comparing platelets to packed red blood cells. Trauma patients account for 39% of all massive transfusions at PSHMC and PHFH. Though some cases of massive transfusions observed in this project did achieve high transfusion ratios, it is unclear what reasons prevented high transfusion ratios. Research evidence suggest that mortality risk is higher when lower ratios are utilized during massive transfusions. However, this project was not powered to detect mortality differences by ratios.
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Complications from IV Alteplase in Mild Stroke Patients in a Multi-state Health System
Lisa R. Yanase, Lindsay Lucas, Leslie Corless, and Elizabeth Baraban
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Implementation of Coordinated Telestroke Program in an Urban Setting Improves Acute Stroke Care
John Zurasky, Leslie Corless, Lindsay Lucas, and Elizabeth Baraban
Purpose: Telestroke has been shown to improve acute ischemic stroke (AIS) care in rural settings, but few studies have examined the impact of telestroke in an urban setting. In an urban area, there was a planned transition from an outpatient-based acute stroke provider pool to a centralized telehealth team of neurovascular and neurocritical care providers. This study assessed the impact of this change by comparing patient outcomes during three time periods: pre-initiation (PRE), transition after initiation (TRAN) and post-transition (POST).
Methods: Data for AIS patients 18 and older from five urban hospitals were used. Outcomes were hospital length of stay (LOS) and percentage of patients who had a door-to-needle time (DTN) <45 and><60 >minutes, IV-alteplase or endovascular treatment, an IV-alteplase-related complication, and a discharge other than to home or rehab. Generalized linear and Cox proportional hazard models were used to compare outcomes for patients discharged during PRE (June 2015 - June 2016), TRAN (July 2016 – December 2016) and POST (January 2017 – March 2018) time periods adjusting for arrival mode, gender, admit NIHSS, age, and arrival time.
Results: Of 4,984 patients that met inclusion criteria, there were 2,075 treated in PRE, 1,052 in TRAN and 1,857 in POST. After adjustment, TRAN patients were 1.77 times more likely to be treated with IV-alteplase than PRE patients (p=.013). POST patients were 2.46 times more likely to receive endovascular treatment than PRE patients (p=.009) and 2.07 times as likely as those in the TRAN period (p=.007). Patients in the TRAN period were 1.63 times more likely to be treated with IV alteplase in <60 minutes>(p<.001) and 2.22 times more likely in the POST period (p=.002) compared to those in PRE. There were no significant differences in the odds of being treated in <45 minutes, LOS, or discharge disposition.
Conclusion: A transition to a specialty stroke care through a telestroke network showed improvements in treatment rates and percentage of patients with DTN less than 60 minutes.
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Intratumoral Delivery of MDNA55, an Interleukin-4 Receptor Targeted Immunotherapy, by MRI-Guided Convective Delivery for the Treatment of Recurrent Glioblastoma
Achal Achrol, Manish Aghi, Krystof Bankiewicz, Martin Bexon, Sotirios Bisdas, Steven Brem, Andrew Brenner, Nicholas Butowski, Melissa Coello, Seunggu Jude Han, Santosh Kesari, Fahar Merchant, Dina Randazzo, Diana Roettger, Michael Vogelbaum, Frank Vrionis, Miroslaw Zabek, and John Sampson
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Changes in Hospital Performance and Transition-Care Measures 1-Year After Initiation of the Patient Navigator Program
Nancy M. Albert, Tyler J Gluckman, Robert McNamara, Gregg C. Fonarow, Adnan Malik, Ralph Brindis, Di Lu, Matthew Roe, Judy Tingley, Smita Negi, Lee R. Goldberg, Susan Rogers, Julie Mobayed, Shilpa Patel, Beth Pruski, Kathleen Hewitt, Zaher Fanari, and Joseph Lucas
Background
Despite high rates of early readmission in patients with acute myocardial infarction (AMI) and heart failure (HF), little data exists regarding the impact of best practices on hospital-based transition-care measures. This project sought to evaluate early changes in AMI and HF program performance after implementing the American College of Cardiology Patient Navigator Program—a transition-care improvement initiative at 35 acute care hospitals.
Methods
Baseline and 1-year post intervention data from 3860 patients with AMI or HF were analyzed using Wilcoxon signed rank test for 17 care measures related to hospital processes (8), medication reconciliation (3), education delivery/documentation (2), HF patient identification prior to discharge (1), scheduling a follow-up appointment within seven days (1), and associated 30-day unadjusted rates of AMI and HF readmission (2).
Results
Among Patient Navigator hospitals, 68.6% were urban and 77.1% were teaching. Baseline and 1-year assessments demonstrated wide variability in aherence for many measures. Compared with baseline, median (25th, 75th percentiles) performance improved for use of an evidence-based beta-blocker among patients with HF, from 91.6% (86.2%, 95.0%) to 93.8% (88.2%, 98.6%), p= 0.028; medication reconciliation at admission, discharge and both admission and discharge (all p≤ 0.05); scheduling of HF follow-up appointments (p= 0.004) and self-care education (p= 0.005). Post-AMI in-hospital mortality improved from 4.0% (4.0%, 5.0%) to 3.7% (3.3%, 4.3%), p= 0.015 and 30-day unadjusted HF readmission was non-significantly lower by 1.9%; from 19.0% (15.2%, 21.0%) to 17.1% (14.1%, 19.1%), (p= 0.09).
Conclusion
Transition-care interventions were associated with significant improvement in 6 processes of care and 1 outcome performance measure for patients with AMI or HF.
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