scholarly journals Reflex Urine Culture Practices in a Regional Community Hospital Network

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Dorothy Ling ◽  
Jessica Seidelman ◽  
Elizabeth Dodds Ashley ◽  
Sarah Lewis ◽  
Rebekah Moehring ◽  
...  
Keyword(s):  
Epithelial Cells ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Multiple Criteria ◽  
Exclusion Criterion ◽  
Community Hospitals ◽  
Indwelling Catheter ◽  
Specific Patient ◽  
Wide Variability ◽  
True Infection

Background: Reflex urine cultures (RUCs) have the potential to reduce unnecessary urine cultures and antibiotic use. However, urinalysis parameters that best predict true infection are unknown. In this study, we surveyed different RUC practices in laboratories across a regional network of community hospitals. Methods: We conducted a voluntary electronic survey of infection preventionists to describe laboratory practices relating to RUCs across 51 community hospitals in the Duke Infection Control Outreach Network (DICON) between May 15, 2019, and July 3, 2019. Results: We received 51 responses (response rate, 100%). Most hospital laboratories were located in North Carolina (n = 25, 49%) and Georgia (n = 18, 35%); 28 laboratories (55%) incorporated RUCs. Surveyed laboratories accepted urine samples from any source and various collection methods (eg, indwelling catheter specimens, clean catch specimens). Moreover, 24 laboratories (86%) offered RUCs for all patients, whereas 4 laboratories (14%) restricted RUCs to specific populations (ie, outpatient, emergency room or children). We observed wide variability in the urinalysis criteria used for RUCs (Table 1); 26 unique approaches were used among 28 laboratories. Also, 24 laboratories (86%) used multiple criteria and 4 (14%) used 1 criterion. Of those that used multiple criteria, all 24 proceeded to RUC if at least 1 UA criterion was met. Furthermore, 22 laboratories (79%) incorporated the presence of nitrites as a urinalysis criterion; 21 laboratories (75%) incorporated white blood cell count (WBC) as a criterion. The most frequent WBC cutoffs were “≥5” (n = 11, 39%) and “≥10” (n = 7, 25%). In addition, 21 laboratories (75%) incorporated leukocyte esterase as a urinalysis criterion, with criteria including “positive” (n = 15, 54%), “trace” (n = 4, 14%), “moderate” (n = 1, 4%), and “large” (n = 1, 4%). Also, 17 (61%) laboratories incorporated magnitude of bacteriuria as a urinalysis criterion. The cutoff ranged from “few” (n = 8, 29%), “moderate” (n = 7, 25%), to “many” (n = 2, 7%). Another 3 (11%) laboratories incorporated other criteria: presence of blood (n = 2, 7%) and presence of fungal elements (n = 1, 4%). Only 3 (11%) laboratories utilized epithelial cells as an exclusion criterion where urinalysis would not proceed to culture if epithelial cells in urinalysis samples exceeded the designated limit, ranging from “>5” to “>15”. Conclusions: More than half of the hospitals in our community hospital network utilize RUCs, but criteria varied widely. Future epidemiological research should aim to identify ideal urinalysis parameters as well as specific patient populations that safely benefit from RUC strategies.Funding: NoneDisclosures: None

scholarly journals Does electronic stewardship work?

2017 ◽  
Vol 24 (5) ◽  
pp. 981-985 ◽  
Author(s):  
Barbara B Lambl ◽  
Nathan Kaufman ◽  
Janice Kurowski ◽  
W O’Neill ◽  
Frederick Buckley Jr ◽  
...  
Keyword(s):  
Decision Support ◽  
High Risk ◽  
Clostridium Difficile ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Drug Resistant ◽  
Community Hospitals ◽  
Hospital Acquired ◽  
Electronic Order

Abstract Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital. Hospital-acquired Clostridium difficile infections declined 24% (P = .07).

A Pilot Study of Antibiotic Cycling in the Community Hospital Setting

2005 ◽  
Vol 26 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Lou Ann Bruno-Murtha ◽  
John Brusch ◽  
David Bor ◽  
Wenjun Li ◽  
Deborah Zucker
Keyword(s):  
Length Of Stay ◽  
Nosocomial Infections ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Community Hospitals ◽  
Antibiotic Cycling

AbstractObjective:To assess the feasibility of a quarterly antibiotic cycling program at two community hospitals and to evaluate its safety and impact on antibiotic use, expenditures, and resistance.Design:Nonrandomized, longitudinal cohort study.Setting:Two community hospitals, one teaching and one non-teaching.Patients:Adult medical and surgical inpatients requiring empiric antibiotic therapy.Intervention:We developed and implemented a treatment protocol for the empiric therapy of common infections. Between July 2000 and June 2002, antibiotics were cycled quarterly; quinolones, beta-lactam–inhibitor combinations, and cephalosporins were used. Protocol adherence, adverse drug events, nosocomial infections, antibiotic use and expenditures, resistance among clinical isolates, and length of stay were assessed during eight quarters.Results:Physicians adhered to the protocol for more than 96% of 2,494 eligible patients. No increases in nosocomial infections or adverse drug events were attributed to the cycling protocol. Antibiotic acquisition costs increased 31%; there was a 14.7% increase in antibiotic use. Length of stay declined by 1 day. Quarterly variability in the prevalence of vancomycin-resistant enterococci and ceftazidime resistance among combined gram-negative organisms were noted.Conclusions:Implementation of an antibiotic cycling program is feasible in a community hospital setting. No adverse safety concerns were identified. Antibiotic cycling was more expensive, partly due to an increase in antibiotic use to optimize initial empiric therapy. Quarterly antibiogram patterns suggested that antibiotic cycling may have impacted resistance, although the small number of isolates precluded statistical analysis. Further assessment of this approach is necessary to determine its relationship to antimicrobial resistance.

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

Letter to the Editor

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 497-497
Author(s):  
Charles D. Cook ◽  
Raymond S. Duff
Keyword(s):  
Community Hospital ◽  
Hospital Admissions ◽  
House Staff ◽  
Full Time ◽  
Ivory Tower ◽  
Community Hospitals ◽  
Educational Value ◽  
Professional Groups ◽  
Letter To The Editor

We certainly agree with Dr. Rako that a fulltime Chief of Pediatrics in a Community Hospital should decrease unnecessary hospital admissions. We currently have an opportunity to reexamine the admission practices of one of the community hospitals studied earlier to see if such is the case; our preliminary findings suggest that the full-time chief, without a critical house staff, may have disappointingly little influence on the criteria used for admission. In regard to the comment of "I. M. Tired": we are having pediatricians from community hospitals review records from the "Ivory Tower" and from the community hospitals; hopefully this will have an educational value for both professional groups.

scholarly journals 5 Close to Home: Implementation of a transfer process for paediatric inpatients from tertiary to community care

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e2-e2
Author(s):  
Beth Gamulka ◽  
Kathleen Abreo ◽  
Frances Lee
Keyword(s):  
Transfer Process ◽  
Community Hospital ◽  
Community Care ◽  
Patient Flow ◽  
Tertiary Care ◽  
Text Messages ◽  
Community Hospitals ◽  
Levels Of Care ◽  
Medical Teams ◽  
Inpatient Units

Abstract Background Patients presenting to the emergency department who require inpatient care are either admitted to our tertiary care inpatient units or transferred directly to a community hospital. When patients appropriate for community care cannot be transferred due to a lack of community beds and instead remain in a tertiary care bed, there are palpable downstream effects on patient flow. A pre-study audit confirmed that, once admitted, transfers from the inpatient unit to a community bed are rare. This project aimed to improve access to tertiary care beds by increasing inpatient transfers to community hospitals. Objectives The project aimed to transfer 25% of all eligible patients from the Paediatric Medicine inpatient units to community hospitals over a 4-month period by identifying eligible patients and streamlining the transfer process. Design/Methods An Ishikawa diagram with input from inpatient physicians and nurses and community hospital colleagues identified 4 modifiable barriers. A process map was created along with a simplified transfer process. Medical teams and nurse leaders were provided with the charts of contact numbers, geographic locations and levels of care for community hospitals. Intake nurses tracked eligible patients. Encrypted text messages were sent to inpatient physicians on their mobile devices every morning reminding them to assess specific patients for transfer. The outcomes of all identified patients including process and balancing measures were tracked. Results Multiple PDSA cycles focused on improving the success of identifying eligible patients at multiple points in the process. The study’s outcome measure was the rate of successful inpatient transfers for all eligible patients. From November 2018 to March 2019, 120 patients were identified as eligible for transfer at the time of admission: 45 (37.5%) were discharged within 24 hours, 42 (35%) were not considered clinically appropriate for transfer by the attending physician and 33 were considered appropriate for transfer. Twenty-four were approached for transfer (72.7%); 9 were not approached for non-clinical reasons. Six (18.2%) refused transfer and 10 (30%) were successfully transferred. These rates were sustained over the study period. Conclusion A streamlined transfer process can improve patient flow, optimize utilization of tertiary care beds and provide care closer to home. A more robust method of tracking patients that could flag patients and send physicians electronic reminders is needed. Most importantly, optimal use of tertiary care beds requires a culture shift to ensure every patient is considered for transfer to the community when medically appropriate.

scholarly journals Feasibility of laparoscopic abdominal wall reconstruction in an outpatient community-hospital setting using cPTFE prosthetic mesh: a prospective, multicenter case series

2016 ◽  
Vol 44 (6) ◽  
pp. 1506-1513
Author(s):  
Terry Unruh ◽  
Joseph Adjei Boachie ◽  
Eduardo Smith-Singares
Keyword(s):  
Community Hospital ◽  
Abdominal Wall Reconstruction ◽  
Hospital Setting ◽  
Case Series ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Community Hospitals ◽  
Patient Reported ◽  
Secondary Endpoints

Objective This study investigated the use of prosthetic condensed polytetrafluoroethylene (cPTFE) for laparoscopic ventral hernia repair (LVHR) in an outpatient community-hospital setting. Methods Patients underwent LVHR with cPTFE at one of three community hospitals. Primary endpoint was hernia recurrence at 1-year postoperatively. Secondary endpoints included pain, surgical site infection, medical/surgical complications, and patient-reported outcomes. Results This study included 65 females and 52 males, aged 46.6 ± 13.2 years (mean ± SD; range 18–84 years). Mean prosthetic size was 413.8 ± 336.11 cm2 (range 165–936 cm2). Mean follow-up was 30 months (range 12–46 months). Hernia recurrence rate was 4.3%. Rate of hospitalization in the first postoperative week was 2.6%. Early and late secondary endpoint complication rates were 24.8% and 27.4%, respectively; pain was the most common complication, followed by seroma (8.5%). Conclusions Outpatient LVHR using cPTFE is feasible in community hospitals. Complication rates were similar to previous reports, and the seroma rate was markedly lower.

How Frequent Are Outbreaks of Nosocomial Infection in Community Hospitals?

1985 ◽  
Vol 6 (6) ◽  
pp. 233-236 ◽  
Author(s):  
Robert W. Haley ◽  
James H. Tenney ◽  
James O. Lindsey ◽  
Julia S. Garner ◽  
John V. Bennett
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Nosocomial Infections ◽  
Small Proportion ◽  
Community Hospital ◽  
Control Measures ◽  
Community Hospitals ◽  
Control Programs ◽  
Site Investigations ◽  
And Control

AbstractA statistical algorithm was used to identify potentially important clusters among nosocomial infections reported each month by 7 community hospitals. Epidemiologic review and on-site investigations distinguished outbreaks of clinical disease from factitious clusters. In 1 year, 8 outbreaks were confirmed. They involved 82 patients—approximately 2% of patients with nosocomial infections and 0.09% of all discharges. One true outbreak occurred for every 12,000 discharges—at least 1 outbreak per year for the average community hospital. Five (63%) outbreaks were recognized independently by the hospitals' infection control personnel. Four (50%) resolved spontaneously; the hospitals' own control measures were necessary in 2; and 2 resolved only after an outside investigation. Organized surveillance appears necessary to detect some outbreaks, and control measures are needed to stop many. Since, however, outbreaks account for such a small proportion of nosocomial infections, infection control programs should be sufficiently staffed and managed so that most of the effort is directed toward the surveillance and control of endemic infection problems, but with adequate resources remaining to respond to outbreaks when they occur.

scholarly journals Pro: Bronchoscopy is essential for pulmonary infections in patients with haematological malignancies

Breathe ◽  
2020 ◽  
Vol 16 (4) ◽  
pp. 200228
Author(s):  
Eliza J.T. Milliken ◽  
Joshua S. Davis
Keyword(s):  
Cohort Studies ◽  
Patient Group ◽  
Illness Perceptions ◽  
Haematological Malignancy ◽  
Diagnostic Yield ◽  
Antibiotic Use ◽  
Mucosal Injury ◽  
Cell Transplant ◽  
Respiratory Impairment ◽  
Specific Patient

Up to 60% of patients with haematological malignancy will develop pulmonary infiltrates at some point in their disease course. Bronchoscopy should be used early in patients without respiratory failure as diagnostic yield is highest in the first 1–2 days of illness. Perceptions that patients with haematological malignancy are at higher risk of complications from bronchoscopy has led to a reluctance to perform the procedure. However, cohort studies have not demonstrated any increase in complications for this specific patient group. Common concerns include mucosal injury, respiratory impairment and haemorrhage. However, prospective cohort studies demonstrate that this patient group do not experience a higher than baseline level of complications. Specific pathogen diagnosis reduces morbidity and mortality in lung infection. Additionally, complex infections with multidrug-resistant organisms, the increasing prevalence of which is largely driven by empirical antibiotic use, make specific diagnosis more crucial than ever if we are to maintain our ability to manage myelosuppressive therapies and stem cell transplant.

scholarly journals Completeness of Prenatal Records in Community Hospital Charts

2018 ◽  
Author(s):  
Nedra W ◽  
Laura B. Strange ◽  
Sara M. Kennedy ◽  
Katrina D. Burson ◽  
Gina L. Kilpatrick
Keyword(s):  
Intensive Care ◽  
Medical Care ◽  
Medical Records ◽  
Laboratory Tests ◽  
Community Hospital ◽  
Medical Condition ◽  
Medical Conditions ◽  
Community Hospitals ◽  
Newborn Intensive Care ◽  
Common Laboratory

We describe the completeness of prenatal data in maternal delivery records and the prevalence of selected medical conditions and complications among patients delivering at community hospitals around Atlanta, Georgia. Medical charts for 199 maternal-infant dyads (99 infants in normal newborn nurseries and 104 infants in newborn intensive care nurseries) were identified by medical records staff at 9 hospitals and abstracted on site. Ninety-eight percent of hospital charts included prenatal records, but over 20 percent were missing results for common laboratory tests and prenatal procedures. Forty-nine percent of women had a pre-existing medical condition, 64 percent had a prenatal complication, and 63 percent had a labor or delivery complication. Missing prenatal information limits the usefulness of these records for research and may result in unnecessary tests or procedures or inappropriate medical care.

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