Abstract WP426: Implementation of a Stroke Nurse Navigator in Addition to Stroke Care Path Improves Readmission Rates

Background and Purpose: Inpatient care during the acute and post-acute phases is complex and requires an interdisciplinary approach. High quality metrics have become an integral part of achieving value-based care. The addition of Bundled Payments for Care Improvement Advanced will continue to drive Stroke Centers to deliver high quality, low cost care during the acute phase and the 90 days post discharge. A pilot program was implemented to create a stroke care pathway and incorporate stroke nurse navigators in the interdisciplinary team to improve patient outcomes and quality metrics. Acute stroke patients are followed by nurse navigators throughout the hospitalization and for 90 days post discharge. Methods: A retrospective analysis of a prospectively collected database was carried out. This database incorporated data from the electronic medical records and crossed referenced with insurance claims data. We included patients admitted to our stroke center from January 2017 until December 2018. The stroke care path was initiated in May of 2017. We collected quality metrics including length of stay, readmission rates, inpatient therapy days as well as 90 day total episode costs. Patient demographics and clinical data were also collected. Results: We identified 1407 patient that met inclusion criteria. 48.3% of these patients were pre-care path. All cause re-admissions significantly decreased from 10.1% to 5.3% (OR 0.49; 95%CI 0.33 - 0.74, p <0.001) after the implementation of the care pathway. Length of stay reduced from 6.3 to 5.9 days post carepath. Inpatient therapy days have increased from 3.3 days to 4.7 days per hospitalization. Total costs per episode decreased from $41,576 to $40,580. Conclusions: The implementation of nurse navigators in addition to standardized care pathway led to significant reduction in readmission rates, increased inpatient therapy utilization days, increased patient and decreased overall episode costs.

Severe acute ocular hypertension following pulsed methylprednisolone for juvenile idiopathic arthritis

We report the case of a 6-year-old girl with juvenile idiopathic arthritis and anterior uveitis who was treated with two doses of intravenous methylprednisolone for acute arthritis. She developed severe ocular hypertension (intraocular pressures (IOPs) of 54 mm Hg in the right eye and 61 mm Hg in the left eye) requiring inpatient therapy with intravenous acetazolamide. The normal range of values for IOP is 12–22 mm Hg. This severe case of acute intraocular hypertension due to systemic steroids highlights the need to consider monitoring of IOPs for children on high-dose topical and systemic steroids with risk factors for raised IOP.

ANALYSIS OF INA-CBG’S FARE AND GOVERNOR REGULATION FAREON SURGERY AT INPATIENT ROOM OF UNDATA REGIONAL PUBLIC HOSPITAL IN PALU

Aim: In order to determine the fares of surgery, there are two types of fares used by hospitals namely Indonesian Case Based Groups fare (INA-CBG s) and Governor Regulation fare. This study aimed to identify and analyze both types of fares in orthopedic surgery, general, eyes, midwifery, mouth, ENT, urology at inpatient room of Undata Regional Public Hospital in Palu during year 2014.Method: This was a quantitative study with descriptive approach with 46 cases as the number of surgery. Data were collected through observation and analysis of secondary data were gotten from medical record, pharmaceutical installation of IBS/IDR, inpatient therapy room (Matahari, Aster, and Teratai pavilions) and cashier of inpatient room in form of cost details and patient data from January to December 2014. Data Presentation was formed on tables, where the existing fares are grouped based on the component of each cost then summed and calculated the deviation between the two types of fares.Results: This study indicated that orthopedic surgery with deviation of Rp 11.311.365, general surgery with deviation of Rp 6.438.409, eyes surgery with deviation of Rp 45.173.741, midwifery surgery with deviation of Rp 6.645.765, oral surgery with deviation of Rp 6.105.659, and urological surgery with deviation of Rp. 3.809.959.Conclusion: It can be concluded that INA-CBG's fares are higher than Governor Regulation fares except orthopedic surgery, where the Governor Regulation faresare higher than INA-CBG’s fares. Key Words :INA-CBG’s Fares, Governor Regulation Fares,Surgery

Cryptococcus gattiiin an Immunocompetent Patient in the Southeastern United States

Cryptococcal infections are seen throughout the United States in both immunocompromised and immunocompetent patients. The most common form isC. neoformans. In the Northwestern United States,C. gattiihas received considerable attention secondary to increased virulence resulting in significant morbidity and mortality. There are no cases in the extant literature describing a patient withC. gattiirequiring neurosurgical intervention in Alabama. A middle-aged immunocompetent male with no recent travel or identifiable exposure presented with meningitis secondary toC. gattii. The patient underwent 12 lumbar punctures and a ventriculoperitoneal shunt and required 83 days of inpatient therapy with 5-flucytosine and amphotericin B. The patient was found to have multiple intracranial lesions and a large intramedullary spinal cryptococcoma within his conus. Following an almost 3-month hospitalization the patient required treatment with oral voriconazole for one year. In the United States meningitis caused byC. gattiiinfection is not isolated to the Northwestern region.