scholarly journals Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1172
Author(s):  
Anna M. Maw ◽  
Megan A. Morris ◽  
Juliana G. Barnard ◽  
Juliana Wilson ◽  
Russell E. Glasgow ◽  
...  
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Point Of Care Ultrasound ◽  
High Fidelity ◽  
Structured Interviews ◽  
Academic Medical ◽  
Multi Level ◽  
Fidelity Implementation

There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.

scholarly journals Preparing Clinical Text for Use in Biomedical Research

2011 ◽  
pp. 2085-2095
Author(s):  
John P. Pestian ◽  
Lukasz Itert ◽  
Charlotte Andersen
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Text ◽  
Delivery Of Care ◽  
Radiology Reports ◽  
Academic Medical ◽  
Textual Data ◽  
Regulatory Actions

Approximately 57 different types of clinical annotations construct a patient’s medical record. These annotations include radiology reports, discharge summaries, and surgical and nursing notes. Hospitals typically produce millions of text-based medical records over the course of a year. These records are essential for the delivery of care, but many are underutilized or not utilized at all for clinical research. The textual data found in these annotations is a rich source of insights into aspects of clinical care and the clinical delivery system. Recent regulatory actions, however, require that, in many cases, data not obtained through informed consent or data not related to the delivery of care must be made anonymous (as referred to by regulators as harmless), before they can be used. This article describes a practical approach with which Cincinnati Children’s Hospital Medical Center (CCHMC), a large pediatric academic medical center with more than 761,000 annual patient encounters, developed open source software for making pediatric clinical text harmless without losing its rich meaning. Development of the software dealt with many of the issues that often arise in natural language processing, such as data collection, disambiguation, and data scrubbing.

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.

scholarly journals The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anelah McGinness ◽  
Margaret Lin-Martore ◽  
Newton Addo ◽  
Ashkon Shaahinfar
Keyword(s):  
Online Survey ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Perceived Usefulness ◽  
Point Of Care Ultrasound ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Pediatric Residents ◽  
Unmet Demand

Abstract Background Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. Methods In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. Results Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. Conclusions There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.

Breast Imaging and Image-guided Intervention in Tanzania: Initial Experience

2020 ◽  
Vol 2 (3) ◽  
pp. 269-274
Author(s):  
Roselyne Okello ◽  
Timothy B Rooney ◽  
Mwajuma Jumbe ◽  
Lulu Sakafu ◽  
Troy Koch ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Breast Cancer Incidence ◽  
Breast Disease ◽  
Point Of Care Ultrasound ◽  
Sustainable Improvement ◽  
Image Guided Intervention ◽  
Clinical Breast

Abstract Breast imaging capacity in Tanzania is currently very limited. In a country of almost 60 million people, mammographic units are exceedingly rare. The few existing units are compromised by lack of maintenance and quality control and extremely limited technologist training. Breast cancer incidence continues to increase in East Africa, while the ability to accurately diagnose and differentiate benign and malignant breast disease remains a challenge. However, as ultrasound technology improves and becomes more affordable, there is increased access to devices including hand-held point of care ultrasound. Additionally, there has been a recent expansion in the training of academic radiologists in Tanzania, creating an opportunity for possible sustainable improvement of breast imaging and intervention. Our initial efforts at the Muhimbili Academic Medical Center (MAMC) included social media advertising for symptomatic and asymptomatic women, followed by screening (clinical breast exam) and subsequent ultrasound imaging of symptomatic women. We then initiated a workflow for ultrasound-guided breast intervention, performed biopsies, reviewed results by local pathologists, and brought the postbiopsy patients back for radiologic–pathologic correlation, wound assessment, and coordination of follow-up and treatment.

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 Physicians' Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

2006 ◽  
Vol 3 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Dietlind L. Wahner-Roedler ◽  
Ann Vincent ◽  
Peter L. Elkin ◽  
Laura L. Loehrer ◽  
Stephen S. Cha ◽  
...  
Keyword(s):  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Educational Interventions ◽  
Level Of Evidence ◽  
Web Based ◽  
Academic Medical ◽  
Complementary And Alternative

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

Description of a point-of-care testing program in a large urban academic medical center: Technologies, management and program cost

2021 ◽  
Vol 522 ◽  
pp. 127-131
Author(s):  
Elizabeth-Lee Lewandrowski ◽  
Kimberly Gregory ◽  
Jeannette Le ◽  
Lee Goldstein ◽  
Kent Lewandrowski
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Point Of Care Testing ◽  
Testing Program ◽  
Program Cost ◽  
Academic Medical
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