scholarly journals Association of Antimicrobial Stewardship Activities With Acute Care Antimicrobial Usage at Veterans Affairs Medical Centers, 2012

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Christopher J. Graber ◽  
Makoto Jones ◽  
Ann F. Chou ◽  
Yue Zhang ◽  
Matthew Bidwell Goetz ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Veterans Affairs ◽  
Antimicrobial Usage ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

2018 ◽  
Vol 39 (10) ◽  
pp. 1163-1169 ◽  
Author(s):  
Lauren D. Stevenson ◽  
Richard E. Banks ◽  
Krysttel C. Stryczek ◽  
Christopher J. Crnich ◽  
Emma M. Ide ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Pilot Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Veterans Affairs ◽  
Acceptance Rate ◽  
Term Care ◽  
Limited Access ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

AbstractObjectiveTo test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.DesignA prospective quasi-experimental pilot study.SettingTwo rural VAMCs with acute-care and long-term care units.InterventionAt each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.MethodsDescriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.ResultsEach site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.ConclusionsThis pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.

scholarly journals Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Jesse D Sutton ◽  
Ronald Carico ◽  
Muriel Burk ◽  
Makoto M Jones ◽  
XiangMing Wei ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Medication Use ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Soft Tissue Infections ◽  
Gram Negative ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

Abstract Background Skin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics. Methods A retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5–10 days of antibiotics. Data were analyzed and reported using descriptive statistics. Results Of the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days. Conclusions We identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.

Association of Hospital Employee Satisfaction with Patient Safety and Satisfaction within Veterans Affairs Medical Centers

2019 ◽  
Vol 132 (4) ◽  
pp. 530-534.e1 ◽  
Author(s):  
Ravinder Kang ◽  
Samuel T. Kunkel ◽  
Jesse A. Columbo ◽  
Philip P. Goodney ◽  
Sandra L. Wong
Keyword(s):  
Patient Safety ◽  
Employee Satisfaction ◽  
Veterans Affairs ◽  
Hospital Employee ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

GEOGRAPHIC VARIATION ACROSS VETERANS AFFAIRS MEDICAL CENTERS IN THE TREATMENT OF EARLY STAGE PROSTATE CANCER

2004 ◽  
Vol 172 (6 Part 1) ◽  
pp. 2362-2365 ◽  
Author(s):  
BENJAMIN A. SPENCER ◽  
CONSTANCE H. FUNG ◽  
MINGMING WANG ◽  
LISA V. RUBENSTEIN ◽  
MARK S. LITWIN
Keyword(s):  
Prostate Cancer ◽  
Geographic Variation ◽  
Early Stage ◽  
Veterans Affairs ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

scholarly journals Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers

2021 ◽  
Author(s):  
Brian E Dixon ◽  
Kimberly M Judon ◽  
Ashley L Schwartzkopf ◽  
Vivian M Guerrero ◽  
Nicholas S Koufacos ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Acute Care ◽  
Health Systems ◽  
Veterans Affairs ◽  
Care Team ◽  
Primary Care Team ◽  
Medical Centers ◽  
Event Notification

Abstract Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. Results Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). Discussion ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. Conclusion Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. Trial Registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.

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