scholarly journals Bridging Policy and Service Performance of Hospital-Based Nutrition Support by Healthcare Information Technology

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 595
Author(s):  
Jungwon Cho ◽  
Young Suk Park ◽  
Do Joong Park ◽  
Soyeon Kim ◽  
Haekyung Lee ◽  
...  
Keyword(s):  
Information Technology ◽  
Response Times ◽  
Service Performance ◽  
Nutrition Support ◽  
Healthcare Information Technology ◽  
Average Response ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Timely Completion

Although the healthcare policy was implemented to incentivize the multidisciplinary services of hospital-based nutrition support team (NST) in South Korea, timely completion of the services has been challenging in the hospitals. We enhanced NST healthcare information technology (NST−HIT) to bridge the gap between policy implementation and seamless execution of the policy in the hospital system. A 48 month pre-test−post-test study was performed, including a 12 month pre-intervention period, a six month intervention period, and a 30 month post-intervention period. The enhanced NST−HIT provided sufficient patient data and streamlined communication processes among end-users. A Student’s t-test showed that the timely completion rate of NST consultations, the reimbursement rate of NST consultations, average response times of NST physicians and nurses, and length of hospital stay significantly improved during the post-intervention period. A segmented regression analysis of interrupted time series showed that the average response times of NST physicians had sustained after the interventions. We believe that well-structured, multi-pronged initiatives with leadership support from the hospital improved service performance of hospital NST in response to national-level healthcare policy changes.

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

2021 ◽  
pp. 001857872110557
Author(s):  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
Casey J. Dempsey ◽  
Joseph L. Kuti ◽  
David P. Nicolau ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Provider Education ◽  
Broad Spectrum Antibiotic ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Days Of Therapy ◽  
Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

scholarly journals 1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S412-S412
Author(s):  
Bhagyashri D Navalkele ◽  
Nora Truhett ◽  
Miranda Ward ◽  
Sheila Fletcher
Keyword(s):  
Infection Prevention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prevention Strategies ◽  
Intervention Period ◽  
Post Intervention ◽  
Frontline Staff ◽  
Post Intervention Period ◽  
Tract Infections ◽  
The Impact

Abstract Background High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days. Methods At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data. Results Prior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1). Conclusion At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

scholarly journals Enhanced infection control interventions reduced catheter-related bloodstream infections in the neonatal department of Hung Vuong Hospital, Vietnam, 2011–2012: a pre- and post-intervention study

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Hang Thi Phan ◽  
Thuan Huu Vo ◽  
Hang Thi Thuy Tran ◽  
Hanh Thi Ngoc Huynh ◽  
Hong Thi Thu Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intervention Study ◽  
Bloodstream Infections ◽  
Incidence Rates ◽  
Intervention Period ◽  
Intravenous Catheter ◽  
Aseptic Technique ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Factors Associated

Abstract Background Catheter-related bloodstream infections (CR-BSI) cause high neonatal mortality and are related to inadequate aseptic technique during the care and maintenance of a catheter. The incidence of CR-BSI among neonates in Hung Vuong Hospital was higher than that of other neonatal care centres in Vietnam. Methods An 18-month pre- and post-intervention study was conducted over three 6-month periods to evaluate the effectiveness of the intervention for CR-BSI and to identify risk factors associated with CR-BSI. During the intervention period, we trained all nurses in the Department of Neonatology on BSI preventive practices, provided auditing and feedback about aseptic technique during catheter care and maintenance, and reorganised preparation of total parenteral nutrition. All neonates with intravenous catheter insertion ≥48 h in the pre- and post-intervention period were enrolled. A standardised questionnaire was used to collect data. Blood samples were collected for cultures. We used Poisson regression to calculate rate ratio (RR) and 95% confidence interval (CI) for CR-BSI incidence rates and logistic regression to identify risk factors associated with CR-BSI. Results Of 2225 neonates enrolled, 1027 were enrolled in the pre-intervention period, of which 53 CR-BSI cases occurred in 8399 catheter-days, and 1198 were enrolled in the post-intervention period, of which 32 CR-BSI cases occurred in 8324 catheter-days. Incidence rates of CR-BSI significantly decreased after the intervention (RR = 0.61, 95% CI 0.39–0.94). Days of hospitalisation, episodes of non-catheter–related hospital-acquired infections, and the proportion of deaths significantly decreased after the intervention (p < 0.01). The CR-BSI was associated with days of intravenous catheter (odds ratio [OR] = 1.05, 95% CI 1.03–1.08), use of endotracheal intubation (OR = 2.27, 95% CI 1.27–4.06), and intravenous injection (OR = 8.50, 95% CI 1.14–63.4). Conclusions The interventions significantly decreased the incidence rate of CR-BSI. Regular refresher training and auditing and feedback about aseptic technique during care and maintenance of catheters are critical to reducing CR-BSI.

SEC Scrutiny and the Evolution of Non-GAAP Reporting

2008 ◽  
Vol 83 (1) ◽  
pp. 157-184 ◽  
Author(s):  
Kalin Kolev ◽  
Carol A. Marquardt ◽  
Sarah E. McVay
Keyword(s):  
Securities And Exchange Commission ◽  
Unintended Consequences ◽  
Intervention Period ◽  
Post Intervention ◽  
Special Items ◽  
Post Intervention Period

We empirically examine the effects of intensified scrutiny over non-GAAP reporting on the quality of non-GAAP earnings exclusions. We find that, on average, exclusions are of higher quality (i.e., more transitory) following intervention by the Securities and Exchange Commission (SEC) into non-GAAP reporting. We further find that firms that stopped releasing non-GAAP earnings numbers after the SEC intervention had lower quality exclusions in the pre-intervention period. These results are consistent with the SEC's objectives of improving the quality of non-GAAP earnings figures. However, when we decompose total exclusions into special items and other exclusions, we find evidence that the quality of special items has decreased in the post-intervention period, which suggests that managers adapted to the new disclosure environment by shifting more recurring expenses into special items. This suggests that there may be unintended consequences arising from the heightened scrutiny over non-GAAP reporting.

scholarly journals A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 648-655 ◽  
Author(s):  
Julie Copeland ◽  
Andrew Gray
Keyword(s):  
Emergency Department ◽  
Fast Track ◽  
Community Hospital ◽  
Wait Time ◽  
Intervention Period ◽  
Post Intervention ◽  
Study Objective ◽  
Post Intervention Period ◽  
Left Without Being Seen ◽  
Physician Coverage

AbstractObjectivesFast tracks are one approach to reduce emergency department (ED) crowding. No studies have assessed the use of fast tracks in smaller hospitals with single physician coverage. Our study objective was to determine if implementation of an ED fast track in a single physician coverage setting would improve wait times for low-acuity patients without negatively impacting those of higher acuity.MethodsA daytime fast track opened in 2010 at Strathroy Middlesex General Hospital, a southwestern Ontario community hospital. Before and after intervention groups comprised of ED visits in 2009 and 2011 were compared. Pooled comparison of all Canadian Triage and Acuity Scale (CTAS) patients in each period, and between subgroups CTAS 2-5 comparisons were performed for: wait time (WT), length of stay (LOS), WTs that met national CTAS time guidelines (MNCTG), and proportion of patients that left without being seen (LWBS).ResultsWT and LOS were six minutes (88 min to 82 min, p=0.002) and 15 minutes (158 min to 143 min, p<0.001) lower, respectively, in the post-intervention period. Subgroup analysis showed CTAS 4 had the most pre- to post-intervention decrease in WT, of 13 minutes (98 min to 85 min, p<0.001). There was statistical improvement in MNCTG in the post-intervention period. No differences were found in outcome measures for higher-acuity patients or LWBS rates.ConclusionsImplementation of a fast track in a medium-volume community hospital with single physician coverage can improve patient throughput by decreasing WT and LOS without negatively impacting high-acuity patients. This may be clinically relevant, particularly for hospital administrators, given the improvement in meeting national WT standards we found post-intervention.

scholarly journals Assessing Efficacy of Provider and Family Education, Electronic Health Record Documentation Tools, and Information Technology to Increase Use of Hydroxyurea in Children with Sickle Cell Anemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2288-2288
Author(s):  
Kyle Hickman ◽  
Steve McCalley ◽  
Vinay Vaidya ◽  
Esteban Gomez ◽  
Christine M. Knoll ◽  
...  
Keyword(s):  
Information Technology ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Family Education ◽  
Cell Phenotype ◽  
Daily Routine ◽  
Intervention Period ◽  
Post Intervention ◽  
Modifying Agent ◽  
Disease Modifying

Background: Hydroxyurea (HU) is an imperative disease-modifying agent in the treatment of sickle cell anemia (SCA). Over the past 30 years, numerous clinical trials have demonstrated both safety and efficacy of this medication in prevention of acute and long-term complications of SCA; however HU continues to be under-utilized in clinical practice. Possible reasons include a lack of provider and family education on the drug, a family's belief in the lack of severity of their child's disease, families not wanting to add additional medications to daily routine and fear of side effects. We sought to increase HU use by a multi-pronged approach of using provider and family education, information technology (IT) tools and weekly reinforcement at pre-visit planning (PVP) team meetings. Methods: We conducted provider education sessions to disseminate knowledge about HU. These included review of NHLBI guidelines, dosing guidelines and tips to optimize HU use and merits of escalating to maximum tolerated dose. The target audience was physicians, fellows, mid-level providers and nurses. ECHO sessions provided by a regional collaborative augmented this effort. A consensus HU guideline document was readily available electronically. The IT team in collaboration with the sickle cell team modified the clinic visit electronic note. The new note included check boxes to document eligibility for HU (based on sickle cell phenotype and severity of disease), and initial and ongoing HU counselling. A table in the clinic note tracked HU dose modifications. A practical algorithm regarding initiation, escalation and monitoring of HU was available as a pop-up in the note to assist providers. An electronic "Sickle Cell Dashboard" was created using real-time data. The dashboard flagged HU eligible patients not yet started on HU. Strategies to successfully initiate HU therapy for these patients were discussed at weekly PVP meetings. We provided HU counselling early and often during first months of life. Successful counselling strategies were shared among providers at PVP meetings. Ancillary staff was trained in utilization of dashboard. Percentage of HU eligible patients who were prescribed HU was measured for two periods: August 1, 2017 to July 31, 2018 (pre-intervention) and August 1, 2018 to July 31, 2019 (post-intervention). A two-sided Fisher's exact test measured statistical significance. Results: In the pre-intervention period 94 of 138 (68%) HU eligible patients were prescribed HU. In the post-intervention period 131 of 164 (80%) HU eligible patients received HU prescription. The 12% increase was statistically significant (p=0.021). Increased education and counselling fostered provider enthusiasm and confidence in prescribing HU. An early start of HU therapy resulted in better compliance with treatment. The collaboration with IT team and creation of electronic "Sickle Cell Dashboard" identified several areas of improvement and inspired additional quality improvement projects. Discussion: Aggressive provider and family education, enhanced electronic records, weekly PVP meetings, readily available HU dosing guidelines and an automated dashboard to flag eligible patients for targeted counselling improved the utilization of this important disease-modifying agent in a significant way. Further improvements can be made by monitoring pharmacy database for prescription fill rates, flagging patients who are overdue for follow-up visits and providing ongoing counselling. Infrastructure established for and lessons learned from this project can be applied to improve comprehensive care for SCA in a sustainable and cost-effective fashion. Figure Disclosures Gomez: Alnylam: Consultancy; Novo Nordisk, Novartis, Pfizer, Sanofi, Takeda, UniQure: Research Funding.

scholarly journals Door to needle time for thrombolysis: A secondary analysis of the TIPS cluster randomized controlled trial

2019 ◽  
Author(s):  
Md Hasnain ◽  
Christine L Paul ◽  
John R Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intravenous Thrombolysis ◽  
Practice Change ◽  
Intervention Period ◽  
Post Intervention ◽  
Intervention Effects ◽  
Post Intervention Period ◽  
Active Intervention ◽  
Randomized Controlled

Abstract Background The Thrombolysis ImPlementation in Stroke (TIPS) study evaluated a hospital-based intervention aimed at improving the rates of intravenous thrombolysis in Australia. The current study assessed the effects of this intervention on the door-to-needle time for intravenous thrombolysis and also determined the intervention effects on door-to-needle time within metropolitan and non-metropolitan hospital locations. Methods TIPS was a clustered randomized controlled trial that involved 20 hospitals in Australia, with 10 hospitals receiving a multi-component practice-change intervention. De-identified patient data collected in the trial included the arrival, assessment, and treatment times for acute ischemic stroke patients. A posthoc exploration using mixed-effects regression modelling was used to assess intervention effects on door-to-needle time, and the effects within hospital location (metropolitan versus non-metropolitan). Results The intervention vs. control difference in the door-to-needle times was non-significant overall or within a hospital location. To provide additional context for the findings, we also evaluated the results within each intervention hospitals. During the active-intervention period, the intervention hospitals showed a significant decrease in the door-to-needle time of 9.25 minutes (95%CI: -16.93, -1.57), but during the post-intervention period, the result was not significant. During the active intervention period, control hospitals showed a significant decrease in the door-to-needle time of 5.26 minutes (95% CI: -8.37; -2.14) and during the post-intervention period, the decrease was 12.13 minutes (95%CI: -17.44, -6.81). Conclusion Across these primary stroke care centres in Australia, a secular trend towards shorter door-to-needle times across both intervention and control hospitals was evident. The intervention resulted in only a modest but significant reduction within experimental groups during the active intervention period, which was not sustained during the post-intervention period.

scholarly journals Thrombolysis implementation intervention and clinical outcome: a secondary analysis of a cluster randomized trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Md Golam Hasnain ◽  
Christine L. Paul ◽  
John R. Attia ◽  
Annika Ryan ◽  
Erin Kerr ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Post Treatment ◽  
Trial Registration ◽  
Control Group ◽  
Intervention Period ◽  
Post Intervention ◽  
Individual Level ◽  
Post Intervention Period

Abstract Background Multiple studies have attempted to increase the rate of intravenous thrombolysis for ischemic stroke using interventions to promote adherence to guidelines. Still, many of them did not measure individual-level impact. This study aimed to make a posthoc comparison of the clinical outcomes of patients in the “Thrombolysis ImPlementation in Stroke (TIPS)” study, which aimed to improve rates of intravenous thrombolysis in Australia. Methods A posthoc analysis was conducted using individual-level patient data. Excellent (Three-month post treatment modified Rankin Score 0–2) and poor clinical outcome (Three-month post treatment modified Rankin Score 5–6) and post treatment parenchymal haematoma were the three main outcomes, and a mixed logistic regression model was used to assess the difference between the intervention and control groups. Results There was a non-significant higher odds of having an excellent clinical outcome of 57% (odds ratio: 1.57; 95% CI: 0.73–3.39) and 33% (odds ratio: 1.33; 95% CI: 0.73–2.44) during the active-and post-intervention period respectively, for the intervention compared to the control group. A non-significant lower odds of having a poor clinical outcome was also found in the intervention, relative to control group of 4% (odds ratio: 0.96; 95% CI: 0.56–2.07) and higher odds of having poor outcome of 44% (odds ratio: 1.44 95% CI: 0.61–3.41) during both active and post-intervention period respectively. Similarly, a non-significant lower odds of parenchymal haematoma was also found for the intervention group during the both active- (odds ratio: 0.53; 95% CI: 0.21–1.32) and post-intervention period (odds ratio: 0.96; 95% CI: 0.36–2.52). Conclusion The TIPS multi-component implementation approach was not effective in reducing the odds of post-treatment severe disability at 90 days, or post-thrombolysis hemorrhage. Trial registration Clinical Trial Registration-URL: http://www.anzctr.org.au/ Unique Identifier: ACTRN12613000939796.

scholarly journals 770. Multimodal Sepsis Performance Improvement Initiative Improves Early and Appropriate Treatment, Reduces Sepsis-related Readmissions, and Reduces Overall Mortality

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S343-S343
Author(s):  
Seife Yohannes
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Performance Improvement ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Sepsis And Septic Shock

Abstract Background CMS has implemented the SEP-1 Core Measure, which mandates that hospitals implement sepsis quality improvement initiatives. At our hospital, a 900-bed tertiary hospital, a sepsis performance improvement initiative was implemented in April 2016. In this study, we analyzed patient outcomes before and after these interventions. Methods We studied coding data in patients with a diagnosis of Sepsis reported to CMS using a third-party performance improvement database between October, 2015 and July, 2017. The interventions included a hospital-wide education campaign about sepsis; a 24–7 electronic warning system (EWS) using SIRS criteria; a rapid response nursing team that monitors the EWS; a 24–7 mid-level provider team; a database to monitor compliance and timely treatment; and education in sepsis documentation and coding. We performed a before and after analysis of patient outcomes. Results A total of 4,102 patients were diagnosed with sepsis during the study period. 861 (21%) were diagnosed during the pre-intervention period and 3,241 (80%) were diagnosed in the post-intervention period. The overall incidence of sepsis, severe sepsis, and septic shock were 59%, 13%, and 28% consecutively. Regression analysis showed age, admission through the ED, and severity of illness as independent risk factors for increased mortality. Adjusted for these risk factors, the incidence of severe sepsis and septic was reduced by 5.3% and 6.9% in the post-intervention period, while the incidence of simple sepsis increased by 12%. In the post-intervention period, compliance with all 6 CMS mandated sepsis bundle interventions improved from 11% to 37% (P = 0.01); hospital length of stay was reduced by 1.8 days (P = 0.05); length of stay above predicted was less by 1.5 days (P = 0.05); re-admission rate was reduced by 1.6% (P = 0.05); and death from any sepsis diagnosis was reduced 4.5% (P = 0.01). Based on an average of 2000 sepsis cases at our hospital, this amounted to 90 lives saved per year. Death from severe sepsis and septic shock both were also reduced by 5% (P = 0.01) and 6.5% (P = 0.01). Conclusion A multi-modal sepsis performance improvement initiative reduced the incidence of severe sepsis and septic shock, reduced hospital length of stay, reduced readmission rates, and reduced all-cause mortality. Disclosures All authors: No reported disclosures.

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