scholarly journals Home-Based Outpatient Parenteral Antibiotic Therapy at an Urban Safety Net Hospital: Comparing Outcomes in Persons With and Without Noninjection Drug Use

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Ayesha Appa ◽  
Carina Marquez ◽  
Vivek Jain
Keyword(s):  
Antibiotic Therapy ◽  
Safety Net ◽  
Completion Rates ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Stimulant Use ◽  
Home Based ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Noninjection Drug

Abstract As stimulant use and infections among persons using drugs rise nationally, evidence remains limited on how best to deliver outpatient parenteral antimicrobial therapy (OPAT) to persons using noninjection drugs. In an urban safety net population including persons using noninjection drugs, home-based OPAT completion rates were similarly high as those of non-drug-using individuals.

scholarly journals 753. Outpatient Parenteral Antibiotic Therapy (OPAT) in a Large Urban Safety Net Hospital Setting: Therapy for Vulnerable Populations at Home

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S336-S336
Author(s):  
Ayesha Ashley Appa ◽  
Carina Marquez ◽  
Vivek Jain
Keyword(s):  
Drug Use ◽  
Antibiotic Therapy ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Safety Net ◽  
Comorbid Conditions ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antibiotic Therapy ◽  
Home Based ◽  
Safety Net Hospital

Abstract Background Adoption of outpatient parenteral antibiotic therapy (OPAT) is accelerating due to proven safety and value, but experience in safety-net settings remains limited, especially in those with history of illicit drug use. Emerging reports from safety-net settings have featured OPAT delivered in nursing facilities, respite care centers, and infusion centers (including some persons who inject drugs [PWID]), but literature is sparse on home-based OPAT for vulnerable patients. In a new home antibiotics program at San Francisco General Hospital, we sought to describe early safety and efficacy outcomes among adults without active injection drug use but with high rates of substance use and comorbid illnesses. Methods We conducted a cohort study of patients discharged from a large urban county medical center and enrolled in an outpatient IV antibiotics program from September 2017 to January 2019. We collected demographic and clinical data and computed outcomes of safety (30- and 90-day readmission for infection, vascular access complications, and death) and efficacy (completion of antibiotic therapy). Results Overall, 47 courses of antibiotics were given to 45 patients. Of these, 39/47 (83%) of antibiotic courses were administered in a residential setting, and 8/47 (17%) via the hospital outpatient infusion center. Comorbid conditions were common, including 9/45 (20%) with hepatitis B/C and 8/45 (18%) with HIV (Table 1). Present or prior illicit drug use was seen in 17/45 patients (38%), including recent or active illicit drug use in 11/45 (24%) (Table 1). Most common indications for antibiotics were osteomyelitis and bacteremia (Table 2). Efficacy in the OPAT program was high: overall, 44/47 (94%) courses of outpatient IV antibiotics were completed, and the 30-day and 90-day readmission rates were 13% and 20% respectively, with zero 30-day readmissions related to OPAT (Table 3). Conclusion An OPAT program embedded within a safety net hospital system delivering care in patients’ homes had high completion rate and low readmission rate, despite patients’ high prevalence of underlying comorbid conditions and noninjection illicit drug use. Home-based OPAT should be considered for broader adoption in safety-net hospital systems. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

2021 ◽  
Vol 264 ◽  
pp. 117-123
Author(s):  
Katherine F Vallès ◽  
Miriam Y Neufeld ◽  
Elisa Caron ◽  
Sabrina E Sanchez ◽  
Tejal S Brahmbhatt
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Homelessness and discharge delays from an urban safety net hospital

Public Health ◽  
2014 ◽  
Vol 128 (11) ◽  
pp. 1033-1035 ◽  
Author(s):  
J. Feigal ◽  
B. Park ◽  
C. Bramante ◽  
C. Nordgaard ◽  
J. Menk ◽  
...  
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals 338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital

2019 ◽  
Vol 114 (1) ◽  
pp. S200-S200
Author(s):  
Suaka Kagbo-Kue ◽  
Iloabueke Chineke ◽  
Taiwo Ajose ◽  
Keerthi Padooru ◽  
Florence Iloh ◽  
...  
Keyword(s):  
African Americans ◽  
Safety Net ◽  
Factors Associated ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A345-A346
Author(s):  
Erin E Finn ◽  
Lindsay Schlichting ◽  
Rocio Ines Pereira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Monitoring Program ◽  
Glucose Monitoring ◽  
Safety Net ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital. Methods: The program was implemented at a county urban safety net hospital. Patients were eligible to be started on Dexcom G6 CGM if they had hyperglycemia requiring multiple insulin injections daily, were in contact isolation, and were located in 1 of 3 units of the hospital (medical intensive care unit [MICU], surgical intensive care unit, COVID 19 floor unit). Initial program was started in the MICU and subsequently expanded. Nurses and staff underwent training using videos, in-person demonstrations, and written guides. Informational Technology modified the electronic medical system to allow for ordering and documentation of CGM values by nurses. Supplies were stored both on unit and in central supply allowing for primary team to initiate monitoring independent of diabetes team. Records of patients participating in program were maintained by the diabetes team. Amount of PPE saved was estimated to be 10 instances/day while on insulin drip and 3/day when using subcutaneous insulin. Results: A total of 69 patients used a CGM during their hospital course. Average age was 56 years old, 69 % were male, average BMI 31, and 84% had known diabetes prior to admission. The majority of patients were critically ill with 68% intubated, 48% on vasopressors, 6% requiring dialysis, 38% on insulin drip, 46% were on tube feeds, and 74% received steroids. The racial demographics of the patients were 72% White, 3% Black, 4% Native American, 4% Asian, and 14% other. For ethnicity, 73% identified as Hispanic and half spoke Spanish as their primary language. An estimated 2600 instances of PPE were saved. Challenges that were faced in implementing the program included consistent training of large numbers of staff, maintaining supplies in stock, troubleshooting discordant values, and restricting use of CGM to patients who met qualifications. Conclusion: Overall, the implementation of CGM was successful and received a positive response. Staff in the primary units quickly became comfortable with the application of the technology. Potential challenges in the future include ongoing training, improving troubleshooting of technology, validating the accuracy of the devices, and developing funding for CGM equipment and interpretation.

Rethinking Home-based Outpatient Parenteral Antibiotic Therapy for Persons Who Inject Drugs

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Raagini Jawa ◽  
Hallie Rozansky ◽  
Dylan Clemens ◽  
Maura Fagan ◽  
Alexander Y. Walley
Keyword(s):  
Antibiotic Therapy ◽  
Persons Who Inject Drugs ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antibiotic Therapy ◽  
Home Based

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

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