Reduction in Pediatric Ambulatory Adenotonsillectomy Length of Stay Using Clinical Care Guidelines

2021 ◽  
Author(s):  
Jennifer Lavin ◽  
Abbey Studer ◽  
Dana Thompson ◽  
Jonathan Ida ◽  
Jeff Rastatter ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Clinical Care ◽  
Care Guidelines

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

2021 ◽  
pp. 105566562110174
Author(s):  
Thomas R. Cawthorn ◽  
Anna R. Todd ◽  
Nina Hardcastle ◽  
Adam O. Spencer ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cleft Palate ◽  
Care Pathway ◽  
Clinical Care ◽  
Oral Intake ◽  
Opioid Consumption ◽  
Complication Rates ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

A Review of Implementation Concepts and Strategies Surrounding Traumatic Brain Injury Clinical Care Guidelines

2021 ◽  
Author(s):  
Angela Lumba-Brown ◽  
Eric M Prager ◽  
Nicole Harmon ◽  
Michael McCrea ◽  
Michael J. Bell ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Care ◽  
Care Guidelines

scholarly journals Home spirometry utilisation in telemedicine clinic for cystic fibrosis care during COVID-19 pandemic: a quality improvement process

2021 ◽  
Vol 10 (3) ◽  
pp. e001529
Author(s):  
Martina Compton ◽  
Rhonda List ◽  
Elissa Starheim ◽  
Lindsay Somerville ◽  
Lauren Williamson ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Quality Improvement ◽  
Chronic Care ◽  
Clinical Care ◽  
Forced Expiratory Volume ◽  
University Of Virginia ◽  
Care Model ◽  
Lung Function Decline ◽  
Quality Improvement Process ◽  
Care Guidelines

IntroductionThe Cystic Fibrosis (CF) Foundation chronic care guidelines recommend monitoring spirometry during quarterly multidisciplinary visits to identify early lung function decline. During the COVID-19 pandemic, the CF adult clinic at University of Virginia (UVA) transitioned from the classic CF care model to a model that included quarterly multidisciplinary telemedicine visits. While using telemedicine, CF care needed to include spirometry monitoring. Only a fraction of adult CF patients at UVA owned and used home spirometers (HS) in March 2020.AimThe specific aims of this quality improvement (QI) project were to increase the percentage of eligible adult CF patients who owned an HSs from 37% to 85% and to increase the percentage of adult CF patients seen at UVA with available spirometry in telemedicine from 50% to 95% by 31 December 2020.MethodsFollowing the Model for Improvement QI methodology, a standardised process was developed for monitoring forced expiratory volume in 1 s with HS during multidisciplinary telemedicine visits during the COVID-19 pandemic.Intervention(1) HSs were distributed to eligible patients and (2) Home spirometry was monitored in eligible patients with each telemedicine visit and results were used for clinical care decisions.ResultsBoth specific aims were achieved ahead of expected date. In March 2020, the beginning of the pandemic, 37% (49/131) of patients owned an HS and 50% (9/18) of patients seen via telemedicine performed spirometry at home. By September 2020, 97% (127/131) of adult patients at UVA owned an HS and by October 2020, 96% (24/25) of patients provided spirometry results during their telemedicine encounters.ConclusionEmploying QI tools to standardise the process of monitoring spirometry data with home devices via telemedicine is reliable and sustainable and can be replicated across centres that provide care for patients with CF.

Reduction of Inpatient Hospital Length of Stay in Lumbar Fusion Patients With Implementation of an Evidence-Based Clinical Care Pathway

Spine ◽  
2017 ◽  
Vol 42 (3) ◽  
pp. 169-176 ◽  
Author(s):  
Alison Bradywood ◽  
Farrokh Farrokhi ◽  
Barbara Williams ◽  
Mark Kowalczyk ◽  
C. Craig Blackmore
Keyword(s):  
Length Of Stay ◽  
Care Pathway ◽  
Lumbar Fusion ◽  
Clinical Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Evidence Based ◽  
Inpatient Hospital ◽  
Clinical Care Pathway

Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer

2013 ◽  
Vol 21 (7) ◽  
pp. 1911-1917 ◽  
Author(s):  
Kimberley Cullen ◽  
Karen Fergus ◽  
Tracey DasGupta ◽  
Iwa Kong ◽  
Marg Fitch ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Care ◽  
Care Guidelines

scholarly journals Clinical Care Guidelines: Too Much of a Good Thing?

Diabetes Care ◽  
2010 ◽  
Vol 33 (12) ◽  
pp. 2716-2718 ◽  
Author(s):  
D. Kirk ◽  
J. B. Buse
Keyword(s):  
Clinical Care ◽  
Good Thing ◽  
Care Guidelines

scholarly journals Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care

2015 ◽  
Vol 12 (3) ◽  
pp. 539-545 ◽  
Author(s):  
Michael J. Rovito ◽  
Janna Manjelievskaia ◽  
James E. Leone ◽  
Michael Lutz ◽  
Chase T. Cavayero ◽  
...  
Keyword(s):  
Task Force ◽  
Clinical Care ◽  
Significant Risk ◽  
Standard Of Care ◽  
Health Practitioner ◽  
Ethical Implications ◽  
Legal Term ◽  
Health Practitioners ◽  
Care Guidelines ◽  
Self Examination

The phrase “standard of care” is primarily a legal term representing what procedure a reasonable person (i.e., health practitioner) would administer to patients across similar circumstances. One major concern for health practitioners is delivering and advocating for treatments not defined as a standard of care. While providing such treatments may meet certain ethical imperatives, doing so may unwittingly trigger medical malpractice litigation fears from practitioners. Apprehension to deviate, even slightly, from the standard of care may (seem to) put the practitioner at significant risk for litigation, which, in turn, may limit options for treatment and preventive measures recommended by the practitioner. Specific to testicular treatment, certain guidelines exist for cancer, torsion, vasectomy, and scrotal masses, among others. As it relates to screening, practitioner examination is expected for patients presenting with testicular abnormalities. Testicular self-examination (TSE) advocacy, however, is discouraged by the U.S. Preventive Services Task Force, which may prompt a general unwillingness among health practitioners to promote the behavior. Considering the benefits TSE has beyond cancer detection, and the historical support it has received among health practitioners, it is paramount to consider the ethical implications of its official “exclusion” from preventive health and clinical care recommendations (i.e., standard of care). Since good ethics should lead practitioner patient care guidelines, not fear of increased malpractice risks, we recommend the development of a standard of care for counseling males to perform TSE.

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