scholarly journals The Accuracy of Point-of-Care Creatinine Testing in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Moises Moreno ◽  
Adam Schwartz ◽  
Ronald Dvorkin
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Risk Category ◽  
Sample Population ◽  
Significant Discrepancy ◽  
Academic Medical

Objective. To determine the accuracy of Point-Of-Care testing (PoCT) creatinine values when compared to standard central laboratory testing (IDMS) and to demonstrate if and how a discrepancy could lead to improper risk stratification for contrast induced nephropathy (CIN). Methods. We conducted a descriptive retrospective chart review of patients seen in the Emergency Department of a single suburban, community, and academic medical center. We included patients who presented to the department between March 2013 and September 2014 who had blood samples analyzed by both PoCT and IDMS. Results. Mean IDMS creatinine values were 0.23 mg/dL higher when compared with i-Stat values. 95% of the time, the IDMS creatinine value was variable and ranged from −0.45 mg/dL to +0.91 mg/dL when compared to the i-Stat creatinine. When using i-Stat creatinine values to calculate GFR, 47 out of 156 patients had risk category variations compared to using the IDMS value. This affected 30.1% of the total eligible sample population (22.9% to 37.3% with 95% CI). Conclusion. We found a significant discrepancy between PoCT and IDMS creatinine values and found that this discrepancy could lead to improper risk stratification for CIN.

Implementation of a Point-of-Care Satellite Laboratory in the Emergency Department of an Academic Medical Center

2003 ◽  
Vol 127 (4) ◽  
pp. 456-460 ◽  
Author(s):  
Elizabeth Lee-Lewandrowski ◽  
Daniel Corboy ◽  
Kent Lewandrowski ◽  
Julia Sinclair ◽  
Steven McDermot ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Test Accuracy ◽  
Central Laboratory ◽  
Urine Dipstick ◽  
Academic Medical ◽  
Clinician Satisfaction ◽  
Satisfaction Surveys

Abstract Context.—Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS). Objectives.—To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center. Setting.—The ED of the Massachusetts General Hospital, Boston, Mass. Design and Outcome Measures.—Evaluation of physician satisfaction, turnaround time (TAT), and ED LOS before and after implementation of a POCT laboratory. ED LOS was measured by patient chart audits. TAT was assessed by manual and computer audits. Clinician satisfaction surveys measured satisfaction with test TAT and test accuracy. Results.—Blood glucose, urine human chorionic gonadotropin, urine dipstick, creatine kinase–MB, and troponin tests were performed in the ED POCT laboratory. Test TAT declined an average of 87% after the institution of POCT. The ED LOS decreased for patients who received pregnancy testing, urine dipstick, and cardiac markers. Although these differences were not significant for individual tests, when the tests were combined, the decreased LOS was, on average, 41.3 minutes (P = .006). Clinician satisfaction surveys documented equivalent satisfaction with test accuracy between the central laboratory and the POCT laboratory. These surveys also documented dissatisfaction with central laboratory TAT and increased satisfaction with TAT of the POCT program (P < .001). Conclusions.—The POCT satellite laboratory decreased test TAT and decreased ED LOS. There was excellent satisfaction with test accuracy and TAT.

scholarly journals Implementation of Point-of-Care Rapid Urine Testing for Drugs of Abuse in the Emergency Department of an Academic Medical Center

2008 ◽  
Vol 129 (5) ◽  
pp. 796-801 ◽  
Author(s):  
Kent Lewandrowski ◽  
James Flood ◽  
Christine Finn ◽  
Bakhos Tannous ◽  
Alton B. Farris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drugs Of Abuse ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Urine Testing

scholarly journals 1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S668
Author(s):  
Ann-Marie Idusuyi ◽  
Maureen Campion ◽  
Kathleen Belusko
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Therapeutic Goals ◽  
Academic Medical ◽  
Progress Notes ◽  
Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

scholarly journals Using design and innovation principles to reduce avoidable emergency department visits among employees of a large academic medical center

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 100514
Author(s):  
Krisda H. Chaiyachati ◽  
Katy Mahraj ◽  
Carolina Garzon Mrad ◽  
Christina J. O'Malley ◽  
Marguerite Balasta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Emergency Department Visits ◽  
Academic Medical

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

Abstract 208: Effects of Gender and BMI on Comorbidities in Patients With Non Hemorrhagic Stroke

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael Ashamalla ◽  
Justin Pieper ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Mikhail Torosoff
Keyword(s):  
Hemorrhagic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Obesity Paradox ◽  
Morbidly Obese ◽  
Academic Medical ◽  
Conflicting Evidence ◽  
Stage Renal Disease ◽  
End Stage

Background: There is conflicting evidence concerning the obesity paradox in stroke patients. We sought to examine the relationship between gender, BMI, and prevalence of comorbidities in patients with non-hemorrhagic stroke. Materials and Methods: Retrospective chart review was performed in 996 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided according to gender and specific BMI groups according to the National Institute of Health. This study was approved by the institutional IRB. Results: Patients with BMI from 0-18.5 and 18.5-24.9 were more likely to be female (63.2% and 58.4% p<.05). Whereas patients with BMI over 25-30 and 30-35 were more likely to be male (60.82% and 59.2% p<.05). Morbidly obese patients (BMI>35) were equally likely to be men or women. In men higher BMI correlated with presentation at younger age. Diabetes was most prevalent in patients with BMI over 35 (40% males, 44% females, p<.05). In females, HTN was associated with BMI 30-34.5 and 35+ (80.5% and 73.3%, P<.05). Males showed a similar though non-significant trend. The prevalence of end stage renal disease, systemic atherosclerosis, and PVD was not significantly correlated with BMI in either gender. Conclusion: Gender and BMI significantly affect associated comorbidities in patients with non-hemorrhagic stroke, possibly suggestive of unique gender specific disease mechanisms. Additional studies investigating the effect of gender and BMI on diagnostic evaluation and treatment of patients with non-hemorrhagic stroke are warranted.

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