scholarly journals Operationalizing and Evaluating Synchronous Virtual Group Health Interventions: Wide-Scale Implementation at a Tertiary-Care Academic Hospital (Preprint)

10.2196/29841 ◽  
2021 ◽  
Author(s):  
Neesha Hussain-Shamsy ◽  
Ian McMillan ◽  
Sheridan Cook ◽  
Alyssa Furfaro-Argier ◽  
Andrea Sadler ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Health Interventions ◽  
Academic Hospital ◽  
Group Health ◽  
Virtual Group ◽  
Wide Scale

Operationalizing and Evaluating Synchronous Virtual Group Health Interventions: Wide-Scale Implementation at a Tertiary-Care Academic Hospital (Preprint)

2021 ◽  
Author(s):  
Neesha Hussain-Shamsy ◽  
Ian McMillan ◽  
Sheridan Cook ◽  
Alyssa Furfaro-Argier ◽  
Andrea Sadler ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Health Service Delivery ◽  
Health Interventions ◽  
Patient Portal ◽  
Academic Hospital ◽  
Implementation Quality ◽  
Group Visits ◽  
Wide Scale ◽  
Video Group

UNSTRUCTURED Group-based health interventions are an important component of health promotion and management. In order to provide continuity of care through the COVID-19 pandemic, our institution undertook a rapid pivot to deliver group-based health interventions via a videoconferencing service which was securely embedded into both the electronic medical record and the patient portal in order to sustainably address immediate health service delivery needs during the pandemic and beyond. In this paper, we: 1) describe the institutionally-driven operationalization of a system to provide integrated synchronous video group visits across our hospital, and 2) present a proposed strategy to comprehensively evaluate outcomes regarding their implementation, quality, and impact. Lessons for other institutions and the potential future role of synchronous video group visits to enhance the ways in which care can be scaled for delivery are discussed.

scholarly journals Diagnosis and treatment delay of head and neck cancers during COVID-19 era in a tertiary care academic hospital: what should we expect?

2021 ◽  
Author(s):  
Pietro De Luca ◽  
Antonella Bisogno ◽  
Vito Colacurcio ◽  
Pasquale Marra ◽  
Claudia Cassandro ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Retrospective Analysis ◽  
Tertiary Care ◽  
Diagnostic Delay ◽  
Treatment Delay ◽  
Head And Neck Cancers ◽  
Control Measures ◽  
Academic Hospital ◽  
The Impact

Abstract Background Since the spreading of SARS-CoV-2 from China, all deferrable medical activities have been suspended, to redirect resources for the management of COVID patients. The goal of this retrospective study was to investigate the impact of COVID-19 on head and neck cancers’ diagnosis in our Academic Hospital. Methods A retrospective analysis of patients treated for head and neck cancers between March 12 and November 1, 2020 was carried out, and we compared these data with the diagnoses of the same periods of the 5 previous years. Results 47 patients were included in this study. We observed a significative reduction in comparison with the same period of the previous 5 years. Conclusions Our findings suggest that the COVID-19 pandemic is associated with a decrease in the number of new H&N cancers diagnoses, and a substantial diagnostic delay can be attributable to COVID-19 control measures.

scholarly journals Code status documentation at admission in COVID-19 patients: a descriptive cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e050268
Author(s):  
Saskia Briedé ◽  
Harriet M R van Goor ◽  
Titus A P de Hond ◽  
Sonja E van Roeden ◽  
Judith M Staats ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Academic Hospital ◽  
Medical Field ◽  
Intensive Care Admission ◽  
Code Status ◽  
Public Media ◽  
Treatment Limitation

ObjectivesThe COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients.SettingUniversity Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands.ParticipantsA total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018).Primary and secondary outcome measuresWe described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status.ResultsFrequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, ‘no intensive care admission’ (81% vs 51%) and ‘no intubation’ (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in ‘other limitation’ (17% vs 9%), while ‘no resuscitation’ (96% vs 92%) was comparable between both periods.ConclusionWe observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially ‘no intubation’ and ‘no intensive care admission’.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

Maxillary Frenulum in Newborns: Association with Breastfeeding

2020 ◽  
Vol 162 (6) ◽  
pp. 954-958 ◽  
Author(s):  
Reena Razdan ◽  
Sarah Callaham ◽  
Renee Saggio ◽  
Mary Chafin ◽  
Michele M. Carr
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Academic Hospital ◽  
Birth Mothers ◽  
Cross Sectional ◽  
Breastfeeding Education ◽  
Biological Children ◽  
The Mean ◽  
First Time

Objective To relate maxillary and lingual frenulum configuration to breastfeeding success. Study Design Cross-sectional study. Setting Newborn nursery in tertiary care academic hospital. Subjects and Methods Newborns were observed between 24 and 72 hours after birth. Mothers were asked a series of questions relating to their breastfeeding experience. The maxillary and lingual frenula were examined and scored. Corresponding LATCH scores were recorded. Results A total of 161 mothers with newborns participated. The mean gestational age of newborns was 38.81 weeks (95% CI, 38.65-38.98); 82 (50.9%) male and 79 (49.1%) female newborns were included. In sum, 70.8% had the maxillary frenulum attached to the edge of the alveolar ridge; 28.6%, attached to the fixed gingiva; and 0.6%, attached to mobile gingiva. In addition, 3.7% had anterior ankyloglossia, and 96.3% had no obvious anterior ankyloglossia. There was no significant correlation between maxillary frenulum scores or lingual frenulum scores and LATCH scores ( P > .05). Of the mothers included in the study, 56.5% were first-time mothers. Overall, 43.5% of the mothers had other biological children, with 70.0% of those mothers having previously breastfed. Experienced mothers who had breastfed for >3 months had significantly higher LATCH scores. Those who had previously breastfed had a mean LATCH score of 9.16 (95% CI, 8.80-9.52), as compared with those who had not, with a mean of 8.14 (95% CI, 7.43-8.85). Conclusion We did not find that maxillary frenulum configuration correlated with LATCH scores. Mothers experienced with breastfeeding had better LATCH scores. Attention toward breastfeeding education, particularly in new mothers, should precede maxillary frenotomy in neonates with breastfeeding difficulties.

scholarly journals S0729 All-Cause Hospitalization Rates Among IBD Patients in a Tertiary-Care Academic Hospital

2020 ◽  
Vol 115 (1) ◽  
pp. S366-S366
Author(s):  
Amit K. Agarwal ◽  
Zeba Hussaini ◽  
Joshua Hamsher ◽  
Patricia Kozuch ◽  
Raina Shivashankar
Keyword(s):  
Tertiary Care ◽  
Academic Hospital ◽  
Hospitalization Rates
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