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https://www.readbyqxmd.com/read/29770752/ventilator-bundle-compliance-and-risk-of-ventilator-associated-events
#1
Bryan D Harris, Gale A Thomas, Matthew H Greene, Steven S Spires, Thomas R Talbot
OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type...
June 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29762868/candidemia-in-children-epidemiology-prevention-and-management
#2
REVIEW
Elpis Mantadakis, Zoe Dorothea Pana, Theoklis Zaoutis
Candidemia is the leading cause of invasive fungal infections in hospitalized children. The highest rates of candidemia have been recorded in neonates and infants <1 year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10 years, a declining trend has been noted in the incidence of pediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasize full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity...
May 15, 2018: Mycoses
https://www.readbyqxmd.com/read/29759290/anesthesiology-s-future-with-specialists-in-population-health
#3
REVIEW
Mike Schweitzer
In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759286/bundled-payments-and-hidden-costs
#4
REVIEW
Stanley W Stead, Sharon K Merrick
In a fee-for-service environment, anesthesiologists are paid for the volume of services billed, with little relation to the cost of delivering the services. In bundled payments, anesthesiologists are paid a set fee for an episode of care inclusive of all the anesthesia, pain medicine, and related services for the surgical episode and a period of time after the initial procedure to cover complications and redo procedures. When calculating a bundled payment, all the services typically used by a patient must be counted when calculating both the costs and expected payment...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759258/improving-maternal-safety-at-scale-with-the-mentor-model-of-collaborative-improvement
#5
Elliott K Main, Ravi Dhurjati, Valerie Cape, Julie Vasher, Anisha Abreo, Shen-Chih Chang, Jeffrey B Gould
BACKGROUND: Obstetric safety bundles, consisting of action steps shown to improve outcomes, have been developed to address the most common and preventable causes of maternal morbidity and mortality. Implementing these best practices across all birthing facilities remains an important and challenging clinical and public health priority. METHODS: The California Maternal Quality Care Collaborative (CMQCC) developed an innovative external mentor model for large-scale collaborative improvement in which participating organizations were subdivided into small teams of six to eight hospitals, led by a paired dyad of physician and nurse leaders...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29756070/reducing-severe-hypoglycaemia-in-hospitalised-patients-with-diabetes-early-outcomes-of-standardised-reporting-and-management
#6
Katherine A Araque, Deepak K Kadayakkara, Nino Gigauri, Diane Sheehan, Sachin Majumdar, Gregory Buller, Clare A Flannery
Background: Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. Objective: To investigate the effectiveness of system-based interventions to improve management response to HGEs. Methods: System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29753618/predictors-and-cost-of-readmission-in-total-knee-arthroplasty
#7
Kenneth L Urish, Yongmei Qin, Benjamin Y Li, Tudor Borza, Michael Sessine, Peter Kirk, Brent K Hollenbeck, Jonathan E Helm, Mariel S Lavieri, Ted A Skolarus, Bruce L Jacobs
BACKGROUND: The Comprehensive Care for Joint Replacement bundle was created to decrease total knee arthroplasty (TKA) cost. To help accomplish this, there is a focus on reducing TKA readmissions. However, there is a lack of national representative sample of all-payer hospital admissions to direct strategy, identify risk factors for readmission, and understand actual readmission cost. METHODS: We used the Nationwide Readmission Database to examine national readmission rates, predictors of readmission, and associated readmission costs for elective TKA procedures...
April 17, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29746270/evidence-regarding-the-use-of-bubble-continuous-positive-airway-pressure-in-the-extremely-low-birth-weight-infant-benefits-challenges-and-implications-for-nursing-practice
#8
Samantha Alessi
BACKGROUND: Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neonatal intensive care units worldwide. Bubble continuous positive airway pressure (BCPAP) has been in use in newborn intensive care since 1975. PURPOSE: To synthesize the current evidence on the use of BCPAP in the ELBW infant and its relationship to outcomes, particularly morbidity and mortality...
May 9, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29745619/incidence-and-risk-factors-of-ventilator-associated-pneumonia-in-neonatal-intensive-care-unit-a-first-french-study
#9
Guillaume Geslain, Isabelle Guellec, Romain Guedj, Julia Guilbert, Sandrine Jean, Cécile Valentin, Maryne Demoulin, Yohann Soreze, Ricardo Carbajal, Pierre-Louis Leger, Jerome Rambaud
BACKGROUND: Ventilator-associated pneumonia (VAP) is a severe intensive complication and remains under estimated in neonatal intensive care unit (NICU). Center for Disease Control defined criteria for adults and pediatrics without neonatal criteria. The objective of this article was to evaluate the rate, the risks factors and the outcome of neonates suffering from ventilator-associated pneumonia in a French NICU. METHODS: We conducted a prospective observational study within a one-year period in our NICU...
May 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29744261/antimicrobial-stewardship-without-infectious-disease-physician-for-patients-with-candidemia-a-before-and-after-study
#10
Minoru Murakami, Hirokazu Komatsu, Masahide Sugiyama, Yuhei Ichikawa, Kyoko Ide, Rumi Tsuchiya, Kenji Kunieda, Akiko Magishi, Gaku Akiyama, Fumihide Miura, Kunihiko Okada, Masaya Ikezoe
Background: Little is known about the effects of antimicrobial stewardship team (AST) without infectious disease physician (IDP) on clinical outcome in patients with candidemia. Methods: We conducted a before and after study involving patients with hospital-acquired candidemia at a tertiary hospital without IDPs. The AST consisted of physicians, pharmacists, nurse, microbiologist, and administrative staff. A candidemia care bundle was developed based on the Infectious Disease Society of America (IDSA) guideline...
May 2018: Journal of General and Family Medicine
https://www.readbyqxmd.com/read/29740196/quality-improvement-initiative-to-improve-inpatient-outcomes-for-neonatal-abstinence-syndrome
#11
Elisha M Wachman, Matthew Grossman, Davida M Schiff, Barbara L Philipp, Susan Minear, Elizabeth Hutton, Kelley Saia, Fnu Nikita, Ahmad Khattab, Angela Nolin, Crystal Alvarez, Karan Barry, Ginny Combs, Donna Stickney, Jennifer Driscoll, Robin Humphreys, Judith Burke, Camilla Farrell, Hira Shrestha, Bonny L Whalen
OBJECTIVES: To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program. DESIGN: Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment...
May 8, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29738398/revenue-for-initial-orthopaedic-trauma-care-effects-of-patient-and-injury-characteristics
#12
Christopher D Flanagan, Alexander S Rascoe, David M Wang, Heather Vallier
OBJECTIVE: To characterize the charges and collections associated with the initial inpatient management of trauma patients who undergo operative fracture management DESIGN:: Retrospective SETTING:: Level 1 trauma center PARTICIPANTS:: 440 consecutive adult trauma patients INTERVENTION:: fixation for fracture of the spine, pelvis, acetabulum, and/or femur fractures MAIN OUTCOME MEASUREMENT:: Professional and technical (facility) charges and collections from the initial inpatient management and 6 months of subsequent related care RESULTS:: Patient were predominantly male (74...
May 3, 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29733731/assessing-medicare-s-approach-to-covering-new-drugs-in-bundled-payments-for-oncology
#13
L Daniel Muldoon, Pamela M Pelizzari, Kelsey A Lang, Joe Vandigo, Bruce S Pyenson
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments...
May 2018: Health Affairs
https://www.readbyqxmd.com/read/29729659/improving-health-care-for-critically-ill-patients-using-an-evidence-based-collaborative-approach-to-abcdef-bundle-dissemination-and-implementation
#14
Mary Ann Barnes-Daly, Brenda T Pun, Lori A Harmon, Diane G Byrum, Vishakha K Kumar, John W Devlin, Joanna L Stollings, Kathleen A Puntillo, Heidi J Engel, Patricia J Posa, Juliana Barr, William D Schweickert, Cheryl L Esbrook, Ken D Hargett, Shannon S Carson, J Matthew Aldrich, E Wesley Ely, Michele C Balas
BACKGROUND: Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices...
May 5, 2018: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/29727348/a-quality-initiative-a-system-wide-reduction-in-serious-medication-events-through-targeted-simulation-training
#15
Kiran B Hebbar, Nora Colman, Lorisa Williams, Jessica Pina, Lisa Davis, James E Bost, Halli Jones, Gary Frank
INTRODUCTION: Medication administration events (MAEs) are a great concern to the healthcare industry, because they are both common and costly. Pediatric patients pose unique challenges to healthcare systems, particularly regarding the safety of medication administration. Our objectives were to improve adherence to best practices, decrease MAEs, and decrease cost related to error reduction rates by implementing a scenario-based simulation training program for frontline nursing staff in the general care units, emergency departments, and intensive care units within our institution...
April 30, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29726671/the-ethics-of-bundled-payments-in-total-joint-replacement-cherry-picking-and-lemon-dropping
#16
Casey Jo Humbyrd
The Centers for Medicare & Medicaid Services has initiated bundled payments for hip and knee total joint replacement in an effort to decrease healthcare costs and increase quality of care. The ethical implications of this program have not been studied. This article considers the ethics of patient selection to improve outcomes; specifically, screening patients by body mass index to determine eligibility for total joint replacement. I argue that this type of screening is not ethically defensible, and that the bundled payment program as structured is likely to lead to unfair restrictions on who receives total joint replacements...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29723630/quantitative-market-survey-of-non-woody-plants-sold-at-kariakoo-market-in-dar-es-salaam-tanzania
#17
Chantal Posthouwer, Sarina Veldman, Siri Abihudi, Joseph N Otieno, Tinde R van Andel, Hugo J de Boer
ETHNOPHARMACOLOGICAL RELEVANCE: In Tanzania, traditional medicine plays a significant role in health care and local economies based on the harvesting, trade and sale of medicinal plant products. The majority of this plant material is said to originate from wild sources, and both traditional healers and vendors are concerned about the increasing scarcity of certain species. AIM OF THE STUDY: A market survey of non-powdered, non-woody medicinal plants was conducted at Kariakoo Market in Dar es Salaam, the major hub for medicinal plant trade in Tanzania, to assess sustainability of traded herbal medicine...
April 30, 2018: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/29718416/drivers-of-variability-in-90-day-cost-for-elective-anterior-cervical-discectomy-and-fusion-for-cervical-degenerative-disease
#18
Silky Chotai, Ahilan Sivaganesan, Scott L Parker, John A Sielatycki, Matthew J McGirt, Clinton J Devin
BACKGROUND: Value-based episode of care reimbursement models is being investigated to curb unsustainable health care costs. Any variation in the cost of index spine surgery can affect the payment bundling during the 90-d global period. OBJECTIVE: To determine the drivers of variability in cost for patients undergoing elective anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. METHODS: Four hundred forty-five patients undergoing elective ACDF for cervical spine degenerative diagnoses were included in the study...
May 1, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29716911/early-warning-score-communication-bundle-a-pilot-study
#19
EDITORIAL
Cheryl Gagne, Susan Fetzer
BACKGROUND: Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. OBJECTIVE: To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer...
May 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29715251/time-spent-in-the-emergency-department-and-outcomes-in-patients-with-severe-sepsis-and-septic-shock
#20
RaeAnn Hirschy, Ethan Sterk, Rachel Dobersztyn, Megan A Rech
A majority of patients with severe sepsis and septic shock are first evaluated in the emergency department (ED). Methods such as screening tools have proven advantageous in earlier identification, allowing for timely initiation of treatment. Delay in symptom presentation and ED overcrowding contribute to deferment of sepsis bundle components and admission. To examine the impact of time from ED arrival to inpatient admission on mortality and length of stay (LOS) in patients with severe sepsis or septic shock...
April 2018: Advanced Emergency Nursing Journal
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