scholarly journals Do We Really Need Those Labs: A Student-Led Investigation of Cross-Disciplinary Attitudes on Daily Lab Ordering in Academic Inpatient Medicine

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Brandon Yeshoua ◽  
Jonathan Dullea ◽  
Joo Yeon Shin ◽  
William Zhao ◽  
Oluremi Konigbagbe ◽  
...  
Keyword(s):  
Inpatient Medicine

scholarly journals Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation

2018 ◽  
Vol 7 (2) ◽  
pp. 36
Author(s):  
Rangachari P. ◽  
Dellsperger K.C. ◽  
Fallaw D. ◽  
Davis I. ◽  
Sumner M. ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medication Reconciliation ◽  
Phase 1 ◽  
Transitions Of Care ◽  
Social Knowledge ◽  
Importance Rating ◽  
Health Records ◽  
Professional Affiliation ◽  
Inpatient Medicine ◽  
Electronic Health

Background: In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from “limited use” of electronic health records (EHR) Medication Reconciliation (MedRec) Technology, to “meaningful use”. Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1.Methods: Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health.Results: Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners’ importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated “Important” or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6)Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI.Conclusions: There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.

Length of Attending-Student and Resident-Student Interactions in the Inpatient Medicine Clerkship

2015 ◽  
Vol 27 (2) ◽  
pp. 130-137 ◽  
Author(s):  
Nora Y. Osman ◽  
Jessica L. Walling ◽  
Vivian G. Mitchell ◽  
Erik K. Alexander
Keyword(s):  
Student Interactions ◽  
Medicine Clerkship ◽  
Inpatient Medicine

scholarly journals Multisite Study to Examine the Amount of Inpatient Physician Continuity Experienced by Hospitalized Patients

2015 ◽  
Vol 7 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Siddhartha Singh ◽  
Jeff Whittle ◽  
Vishal Ratkalkar ◽  
Alexis M. Visotcky ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Inpatient Medicine ◽  
The Mean ◽  
Handoff Of Care

ABSTRACT Background Continuity for inpatient medicine has been widely discussed, but methods for measuring it have been lacking. Objective To measure the continuity of care experienced by hospitalized patients and to identify predictors of continuity. Methods This was a multisite prospective cohort study and retrospective chart review that took place at 3 hospitals: an academic tertiary care center, a Veterans Affairs medical center, and a community teaching hospital. Subjects were general medicine patients and internal medicine residents. We measured continuity of care using 3 metrics: (1) the percentage of hospital time covered by the primary intern; (2) the amount of time between admission and the first handoff of care; and (3) admission-discharge continuity. We conducted univariate analyses to identify patient and hospital factors that may be associated with each type of continuity of care. Results Our sample included 869 patients with a mean age of 62.6 years (SD = 17.2) and 34% female patients. The mean percentage of hospital time covered by the primary intern was 39.2% (SD = 16.3%). The mean time between admission and the first handoff of care was 13.3 hours (SD = 7.1). Forty percent of patients experienced admission-discharge continuity. In univariate and multivariable modeling, the site was significantly associated with each type of continuity. Conclusions The amount of continuity varied greatly and was influenced by the site and other factors. No site maximized every aspect of continuity. Programs and institutions should decide which aspects of continuity are most important locally and design schedules accordingly.

Transitions to Inpatient Medicine Clerkship's SOAP: Notes and Presenting on Rounds

MedEdPORTAL ◽  
2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Teena Hadvani ◽  
Erica Hubenthal ◽  
Lindsay Chase
Keyword(s):  
Inpatient Medicine

Heparin-Induced Thrombocytopenia: Analysis of Risk Factors In Medicine Inpatients.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3689-3689
Author(s):  
Shumei Kato ◽  
Koichi Takahashi ◽  
Kengo Ayabe ◽  
Reza Samad ◽  
Eri Fukaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
New York ◽  
Autoimmune Disease ◽  
Conflicts Of Interest ◽  
Heparin Induced Thrombocytopenia ◽  
Medicine Service ◽  
Increased Risk ◽  
Medical Inpatients ◽  
Inpatient Medicine

Abstract Abstract 3689 Background: Heparin-induced thrombocytopenia (HIT) is an unpredictable drug reaction to heparin characterized by thrombocytopenia and increased risk of life threatening venous and/or arterial thrombosis. Although HIT is uncommon, it is a serious side effect in patients receiving heparin. Data are lacking if there are additional risk factors that may be associated with the development of HIT. Accordingly, the aim of this study was to identify the risk factors that may be associated with the development of HIT in medical inpatients receiving heparin. Methods: This is a retrospective cohort study with 25,653 patients who were admitted to the medicine service and received heparin products (unfractionated heparin [UFH] or enoxaparin) in an urban teaching hospital in New York City from August 2005 to January 2010. Computerized discharge summaries, medical charts, radiology and laboratory reports were used in this retrospective study. Demographics such as age, gender and race were recorded. Details of medical history and hospital course of each patient was reviewed to obtain the known risk factors for HIT as well as possible confounding factors that may be related to the development of HIT. The diagnosis of HIT was confirmed if the platelet count dropped >50% from baseline and there was a positive laboratory HIT assay. Results: Fifty-five cases of in-hospital HIT (raw incidence, 0.21%, 95% CI [0.16, 0.28]) were observed (Table 1). After multivariate analysis, patients whose race was either Asian or Hispanic demonstrated an increased risk of developing HIT (relative risk [RR]= 2.61; 95% CI [1.10, 6.17]; p= 0.03 and RR= 2.21; 95% CI [1.22, 4.02]; p= 0.01 respectively). Additionally, patients who received full anticoagulation dose with UFH (RR= 3.66; 95% CI [1.98, 6.75]; p= <0.0001) or were exposed to heparin products for more than 5 days also had an increased risk of HIT (RR= 5.51; 95% CI [2.48, 12.2]; p= <0.0001 if heparin given 5 to 10 days, RR= 7.66; 95% CI [3.31, 17.8]; p= <0.0001 if heparin given more than 10 days). Moreover, patients who were on hemodialysis, carried a diagnosis of autoimmune disease, gout or heart failure remained as a independent risk factor for HIT (RR= 9.68; 95% CI [4.90, 19.1]; p= <0.0001, RR= 3.47; 95% CI [1.93, 6.26]; p= <0.0001, RR= 2.89; 95% CI [1.09, 7.68]; p= 0.03, and RR= 2.10; 95% CI [1.09, 4.08]; p= 0.03 respectively) (Table 2). Conclusion: Among patients admitted to inpatient medicine service receiving heparin products, patients who were Asian or Hispanic, who were treated with full anticoagulation dose with UFH or who received heparin product >5 days were at increased risk of HIT. Furthermore, patients who were on hemodialysis, had autoimmune disease, gout and heart failure were also at increased risk of in-hospital HIT. The results suggest that when using heparin products in these patient cohorts, increased surveillance of HIT is necessary. Disclosures: No relevant conflicts of interest to declare.

Organizational predictors of coordination in inpatient medicine

2014 ◽  
Vol 39 (4) ◽  
pp. 279-292 ◽  
Author(s):  
Nathalie McIntosh ◽  
Mark Meterko ◽  
James F. Burgess ◽  
Joseph D. Restuccia ◽  
Anand Kartha ◽  
...  
Keyword(s):  
Inpatient Medicine

scholarly journals Graying of the HIV epidemic: a challenge for inpatient medicine providers

2015 ◽  
Vol 5 (6) ◽  
pp. 29428 ◽  
Author(s):  
Ché Matthew Harris ◽  
Robin McKenzie ◽  
Seema Nayak ◽  
Dmitry Kiyatkin ◽  
Dorcas Baker ◽  
...  
Keyword(s):  
Hiv Epidemic ◽  
Inpatient Medicine
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