scholarly journals 79. Outcomes Associated with the Utilization of the Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) Assay to De-escalate Vancomycin Therapy in Patients with Suspected Pneumonia at a Rural Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S57-S57
Author(s):  
Raghavendra Tirupathi ◽  
Mackenzie Kyner ◽  
Jarett Logsdon
Keyword(s):  
Length Of Stay ◽  
Positive Impact ◽  
Average Length ◽  
Patient Characteristics ◽  
Vancomycin Therapy ◽  
Pcr Assay ◽  
Post Intervention ◽  
Patient Disposition ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Vancomycin is often added to standard inpatient community acquired pneumonia therapy, but the incidence of MRSA pneumonia is relatively low. The MRSA nasal PCR assay is used to detect if a patient’s nares are colonized with MRSA. Studies have found that this test has an excellent negative predictive value at ruling out MRSA pneumonia. In practice, there is reluctance to utilize this data to de-escalate vancomycin, possibly because little data exists investigating clinical outcomes associated with this intervention. The purpose of this study was to evaluate how this assay, in combination with antimicrobial stewardship, impacts de-escalation of vancomycin and consequently, length of stay, days of therapy, readmission, and mortality. Methods We performed a cohort study of patients who received vancomycin for pneumonia during the period 2017–2019. In July 2018, we implemented a pharmacy-led process to de-escalate vancomycin in pneumonia patients based on the results of the nasal MRSA PCR. Patient were excluded if they had concomitant skin/skin structure infection, osteomyelitis, were transferred to another facility, signed out against medical advice, or required mechanical ventilation. Data on patient characteristics, disease severity, length of stay, days of therapy, readmission, and mortality were compared between the groups. Figure 1: Patient disposition with reasons for exclusion from study Results 101 and 107 patients were included in the before and after group, respectively. The average length of stay was 5.31 (before group) vs 4.33 days (after group), resulting in a 0.98 day decrease (p=0.0095). Days of therapy was 3.16 (before group) vs 1.96 days (after group), resulting in a 1.2 day reduction (p< 0.0001). 30-day mortality was significantly higher in the before group (19.8%) than the after group (9.3%) (RR 0.47, 95% CI 0.23–0.96). 30-day readmission was similar between the two groups (21.8% pre-intervention vs 19.6% post-intervention, p=0.7). Figure 2: Length of Stay and Duration of therapy reductions between the pre- and post-intervention groups. Figure 3: 30-day readmission rate and 30-day mortality rate in the pre- and post-intervention groups. Figure 4: Vancomycin days of therapy per 1000 patient days from July 2017 to May 2020 Conclusion Use of the MRSA nasal PCR to deescalate vancomycin therapy appears to significantly reduce length of stay and days of vancomycin therapy. Use of this assay did not negatively impact readmission but, may have a positive impact on mortality. Further research is needed to determine the impact of this intervention on length of stay and mortality. Disclosures All Authors: No reported disclosures

scholarly journals The Impact of an Emergency Department Toxicology Team in the Management of Acute Intoxication

2007 ◽  
Vol 14 (3) ◽  
pp. 134-143 ◽  
Author(s):  
AHY Chung ◽  
SH Tsui ◽  
HK Tong
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Average Length ◽  
Effective Means ◽  
Acute Intoxication ◽  
Patient Disposition ◽  
Significant Difference ◽  
The Impact

Objective To evaluate the impact of the recently established Emergency Department (ED) Toxicology Team of Queen Mary Hospital (QMH) in the management of acute intoxication. Method A descriptive comparative study with retrospective data collection from all intoxicated and suspected intoxicated patients over two separate half-year periods in 2001 and 2006, before and after the establishment of the ED Toxicology Team in July 2005. Data on reasons of intoxication, drugs and substances involved, ED treatments, patient disposition, length of stay in ED, length of stay in hospital, patient outcome, and 30-day ED re-attendance and hospital re-admission were collected and examined. Results A total of 333 intoxicated patients were included in the study, 171 in 2001 and 162 in 2006. The basic epidemiological data were similar in both groups. There was a marked reduction in hospital admissions from 89.5% to 40.7% (P<0.01) and significant decline in average length of hospital stay from 46.8 hours to 29.2 hours (P<0.05). There was no statistically significant difference in patient outcome, 30-day ED re-attendance and hospital re-admission. Conclusion Our findings showed that the establishment of the ED Toxicology Team in QMH achieved significant reductions in hospital admissions and the length of stay in hospital in the management of patients with acute intoxication without jeopardising patient outcome. The results illustrate that the new model has a beneficial role in reducing cost and alleviating stress on hospital bed availability, therefore it can be recognised as a cost-effective means of management of acute intoxication.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

2021 ◽  
Author(s):  
Evan D Robinson ◽  
Allison M Stilwell ◽  
April E Attai ◽  
Lindsay E Donohue ◽  
Megan D Shah ◽  
...  
Keyword(s):  
Median Time ◽  
Antimicrobial Stewardship ◽  
A Priori ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Post Intervention ◽  
Gram Negative ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P &lt; .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P &lt; .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P &lt; .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

scholarly journals Times of change in complex environments - Evaluating hospital co-payments in Palestine refugee camps

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S V Valente de Almeida ◽  
H Ghattas ◽  
G Paolucci ◽  
A Seita
Keyword(s):  
Length Of Stay ◽  
Policy Change ◽  
Negative Binomial ◽  
Negative Impact ◽  
Average Length ◽  
Lessons Learned ◽  
Policy Impact ◽  
Average Length Of Stay ◽  
Ex Post ◽  
The Impact

Abstract We measure the impact introducing a of 10% co-payment component on hospitalisation costs for Palestine refugees from Lebanon in public and private hospitals. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand and supply for healthcare. The data was collected by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and include episode level information from all public, private and Red Crescent Hospitals in Lebanon, between April 2016 and October 2017. This is a complete population episode level dataset with information from before and after the policy change. We use multinomial logit, negative binomial and linear models to estimate the policy impact on demand by type of hospital, average length of stay and treatment costs for the patient and the provider. After the new policy was implemented patients were 18% more likely to choose a (free-of-charge) PRCS hospital for secondary care, instead of a Private or Public hospital, where the co-payment was introduced. This impact was stronger for episodes with longer stays, which are also the more severe and more expensive cases. Average length of stay decreased in general for all hospitals and we could not find a statistically significant impact on costs for the provider nor the patient. We find evidence that the introduction of co-payments is hospital costs led to a shift in demand, but it is not clear to what extent the hospitals receiving this demand shift were prepared for having more patients than before, also because these are typically of less quality then the others. Regarding costs, there is no evidence that the provider managed to contain costs with the new policy, as the demand adapted to the changes. Our findings provide important information on hospitalisation expenses and the consequences of a policy change from a lessons learned perspective that should be taken into account for future policy decision making. Key messages We show that in a context of poverty, the introduction of payment for specific hospital types can be efficient for shifting demand, but has doubtable impact on costs containment for the provider. The co-payment policy can have a negative impact on patients' health since after its implementation demand increased at free-of-charge hospitals, which typically have less resources to treat patients.

Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

2018 ◽  
Vol 53 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Mary-Haston Leary ◽  
Kathryn Morbitzer ◽  
Bobbi Jo Walston ◽  
Stephen Clark ◽  
Jenna Kaplan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Positive Impact ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Readmission Rates ◽  
A Value ◽  
Pharmacist Interventions ◽  
Semistructured Interviews ◽  
The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

scholarly journals Impact of low vision services on the quality of life of low vision patients in Ghana

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Godwin O. Ovenseri-Ogbomo ◽  
Harriette Osafo-Agyei ◽  
Ralph E.U. Akpalaba ◽  
James Addy ◽  
Elizabeth O. Ovenseri
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Positive Impact ◽  
Low Vision ◽  
Care Quality ◽  
Eastern Region ◽  
Post Intervention ◽  
Low Vision Clinic ◽  
The Impact

Patients’ perspectives on the impact of clinical interventions have been recognised as critical elements in patient care. Quality-of-life instruments are designed to measure these perspectives. We used the National Eye Institute’s 25-item Visual Function Questionnaire (NEI VFQ) to measure the impact of optical low vision devices on the quality of life of 22 low vision patients who obtained and were using low vision devices from a secondary low vision clinic in the Eastern Region, Ghana. The study employed a pre- and post-intervention technique. We found statistically significant improvements in measured visual acuity and NEI VFQ scores in 8 of the 10 domains evaluated. We conclude that optical low vision devices have a positive impact on the quality of life of low vision patients in Ghana.Keywords: low vision; quality of life; visual acuity; visual impairment; Ghana

Impact of Length of Stay on Functional Outcomes of TBI Patients

2005 ◽  
Vol 71 (11) ◽  
pp. 920-930 ◽  
Author(s):  
M.L. Hawkins ◽  
F.D. Lewis ◽  
R.S. Medeiros
Keyword(s):  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Care ◽  
Average Length ◽  
Functional Independence ◽  
Average Length Of Stay ◽  
Group 2 ◽  
The Impact ◽  
Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

Evaluating the Elklan Talking Matters Programme: Exploring the impact of a training programme for early years professionals on pre-school children’s language development

2020 ◽  
Vol 36 (2) ◽  
pp. 108-125
Author(s):  
Judy Clegg ◽  
Carla Rohde ◽  
Henrietta McLachlan ◽  
Liz Elks ◽  
Alex Hall
Keyword(s):  
Language Development ◽  
Positive Impact ◽  
Training Programme ◽  
Early Years ◽  
Post Intervention ◽  
Main Effect ◽  
Tentative Evidence ◽  
Effectiveness Of Training ◽  
And Control ◽  
The Impact

Training early years practitioners to facilitate the language development of young children is a widely used intervention. Evidence to support the effectiveness of training in terms of the impact of children’s language development is limited. The Elklan Talking Matters programme is an accredited training programme for early years practitioners. Practitioners train to be Lead Communication Practitioners (LCPs) who cascade training across early years settings or Key Communication Practitioners (KCPs) who are embedded into these settings. The aim of this study was to identify if the Talking Matters Programme is effective in facilitating the language development of pre-school children. One hundred and twenty-six children from 13 early years settings were recruited (mean age 27.81 months; SD 4.90). Thirteen settings participated in the Talking Matters Programme (five LCP+KCP settings, four LCP settings and four control settings). At time 1, prior to practitioners participating in the programme, children completed the Pre-School Language Scales 5th Edition (PLS-5), a standardized assessment of receptive and expressive language. At time 1, 126 children completed the baseline assessment ( n = 43 in the LCP+KCP settings, n = 43 in the LCP settings and n = 40 in the control settings). Children then completed the post intervention (time 2) assessment approximately six months later. Children in the intervention groups (LCP+KCP settings and LCP settings) made more progress in their language development from time 1 to time 2 compared to the control. The children in the LCP+KCP settings made more gains than the children in the LCP settings. A significant main effect of groups and time was found but not an interaction of group scores with time, meaning the increases in scores were not statistically significant between the intervention and control groups. The study provides tentative evidence that the Talking Matters programme has a positive impact on pre-school children’s language development.

scholarly journals THE IMPACT OF PILATES EXERCISES ON THE POSTURAL ALIGNMENT OF HEALTHY ADULTS

2016 ◽  
Vol 22 (6) ◽  
pp. 485-490
Author(s):  
Bruna Krawczky ◽  
Míriam Raquel Meira Mainenti ◽  
Antonio Guilherme Fonseca Pacheco
Keyword(s):  
Sagittal Plane ◽  
Positive Impact ◽  
Healthy Adults ◽  
The Body ◽  
Exercise Session ◽  
Post Intervention ◽  
Horizontal Alignment ◽  
Postural Alignment ◽  
Pilates Method ◽  
The Impact

ABSTRACT Introduction: Exercises of Pilates method have been widely used to improve postural alignment. There is strong evidence favoring their use in improving flexibility and balance, as well as some evidence of improvement in muscle strength. However, the benefits related to posture are not well established. Objective: To investigate in healthy adults, the impact of the Pilates method in the postural alignment through some angles in the sagittal plane and the occurrence of pain before and after an exercise session, and after the completion of a 16-session program. Methods: This is a quasi-experimental study of pre and post-intervention type. Healthy adults (n = 37) interested in starting Pilates were evaluated for acute effects on posture after a Pilates session (n = 37) and after a 16-session program, for a period of 10 weeks (n = 13). Using the postural assessment software (SAPO), six angles were analyzed: head horizontal alignment (HHA), pelvis horizontal alignment (PHA), hip angle (HA), vertical alignment of the body (VAB), thoracic kyphosis (TK), and lumbar lordosis (LL). The occurrence of pain was investigated to control adverse effects. Results: Statistically significant (p<0.05) differences found after one session include increased HHA (left view), decreased VAB (left view) and TK (both side views). After 16 sessions, we observed an increase of HHA, and a decrease of TK, LL (both side views) and HA (right view). All the differences point to an improvement of postural alignment. A significant reduction of prevalence of pain was verified after the first session (40.5% vs. 13.5%; p=0.004) and after the full program (30.8% vs. 15.3%; p=0.02). Conclusions: Our results suggest that the Pilates method has a positive impact on postural alignment in healthy adults, besides being a safe exercise.

scholarly journals 1030. Analysis of a Novel Mortality Prediction Rule for Organizing and Guiding Antimicrobial Stewardship Team Activities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S363
Author(s):  
Curtis D Collins ◽  
Caleb Scheidel ◽  
Christopher J Dietzel ◽  
Lauren R Leeman ◽  
Cheryl A Morrin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Risk Score ◽  
Antimicrobial Stewardship ◽  
Prediction Rule ◽  
Mortality Prediction ◽  
Audit And Feedback ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship team (AST) surveillance at our hospital is facilitated by an internally-developed database. In 2013, the database was expanded to incorporate a validated internally-developed prediction rule for patient mortality within 30 days of hospital admission. AST prospective audit and feedback expanded to include all antimicrobials prescribed in patients with the highest risk for mortality determined by risk score. This study describes the impact of an expanded AST review in patients at the highest risk for mortality. Methods This retrospective, observational study analyzed all adult patients with the highest mortality risk score who received antimicrobials not historically captured via AST review. Patients were identified through administrative and AST databases. Study periods were defined as 2011 – Q3 2013 (historical group) and Q4 2013 – 2018 (intervention group). Primary and secondary outcomes were assessed for confounders including demographic data and infection-related diagnoses. Outcomes were assessed using both unweighted and propensity score weighted versions of the t-test or Wilcoxon rank-sum test for continuous variables and the chi-squared test or Fisher’s Exact test for discrete variables. Results A total of 2,852 and 5,460 patients were included in the historical and intervention groups, respectively. After adjusting for demographic and clinical characteristics, there were significant reductions in median antimicrobial duration (5 vs. 4, P = 0.002), antimicrobial days of therapy (7 vs. 7, P = 0.001), length of stay (LOS) (6 vs. 5 days, P = 0.001), intensive care unit (ICU) LOS (3 vs. 2 days, P < 0.001), and total hospital cost ($11,017 vs. $9,134, P < 0.001) in the intervention cohort. There were no significant differences observed in 30-day mortality or 30-day readmissions. Secondary analyses showed significant decreases in fluroquinolone and intravenous vancomycin utilization between cohorts. Conclusion Reductions in antimicrobial use, inpatient and ICU length of stay, and total hospital costs were observed in a cohort of patients following incorporation of a novel mortality prediction rule to guide AST surveillance. Disclosures All authors: No reported disclosures.

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