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"order set" or "order sets" or "carepath" or "care path"

Michelle K Haas, Kristen Dalton, Bryan C Knepper, Sarah A Stella, Lilia Cervantes, Connie S Price, William J Burman, Philip S Mehler, Timothy C Jenkins
Background.  Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization. Methods.  A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases...
October 2016: Open Forum Infectious Diseases
Martha L Bruce, Matthew C Lohman, Rebecca L Greenberg, Yuhua Bao, Patrick J Raue
OBJECTIVES: To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. DESIGN: Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). SETTING: Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. PARTICIPANTS: Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306)...
October 14, 2016: Journal of the American Geriatrics Society
Brandon Battis, Linda Clifford, Mostaqul Huq, Edrick Pejoro, Scott Mambourg
OBJECTIVES: Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve...
October 12, 2016: Journal of Oncology Pharmacy Practice
Sean van Diepen, Wendy I Sligl, Jeffrey B Washam, Ian C Gilchrist, Rakesh C Arora, Jason N Katz
Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies...
July 1, 2016: Canadian Journal of Cardiology
Kalli Stilos, Lesia Wynnychuk, Tracey DasGupta, Tammy Lilien, Patricia Daines
Although end of life (EoL) care has been identified as an area for quality improvement in hospitals, the quality of care Canadian patients receive at the end of life is not well-evidenced. National statistics indicate that Canadians would prefer to die at home, yet more than 50% die in acute care hospital settings. Busy and often highly specialised acute care units may be perceived as a distressing place of death for both patients and their families. Furthermore, many clinicians are not trained in diagnosing imminent dying, managing symptoms at the end of life or supporting dying patients and their families...
September 2, 2016: International Journal of Palliative Nursing
Deepashree Gupta, Meredith Kirn, Zafar A Jamkhana, Richard Lee, Stewart G Albert, Kimberly M Rollins
BACKGROUND: To assess the efficacy of a unified hyperglycemia and diabetic ketoacidosis (DKA) insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycemic targets and minimizing hypoglycemia. METHODS: An IIP was instituted in medical and surgical intensive care units for post-cardiac surgery (PCS) and other stress hyperglycemia (SH), diabetes hyperglycemia (DH), and DKA. The IIP initiated therapeutic insulin rates at elevated blood glucose (BG), and decreased insulin when target range was achieved...
September 15, 2016: Diabetes & Metabolic Syndrome
Karthik H Shankar, Inder Singh, Marc W Howard
Predicting the timing and order of future events is an essential feature of cognition in higher life forms. We propose a neural mechanism to nondestructively translate the current state of spatiotemporal memory into the future, so as to construct an ordered set of future predictions almost instantaneously. We hypothesize that within each cycle of hippocampal theta oscillations, the memory state is swept through a range of translations to yield an ordered set of future predictions through modulations in synaptic connections...
September 14, 2016: Neural Computation
Roni D Lane, Tomohiko Funai, Ron Reeder, Gitte Y Larsen
BACKGROUND AND OBJECTIVE: Septic shock impacts mortality, morbidity, and health care costs. A quality improvement (QI) initiative was launched to improve early recognition and timely treatment of patients with septic shock in a pediatric emergency department (PED). Our primary aim was to describe the longitudinal effectiveness of the program, iterative changes in clinical practice, and associated outcomes. METHODS: We implemented multiple interventions during our QI initiative (February 2007 to December 2014)...
September 7, 2016: Pediatrics
Christopher P Michetti, Heather A Prentice, Elena Lita, Jeffrey Wright, Edmond Ng, Anna B Newcomb
BACKGROUND: We sought to examine the effect on blood usage of a new electronic order set restricting transfusion orders to specific evidence-based criteria for each unit (U) of red blood cells (RBC), plasma, and platelets. METHODS: Prospectively collected transfusion data for Trauma ICU patients were compared for the 12 months before (PRE) and 8 months after (POST) order set implementation. Criteria for RBC transfusion were: 1U only for hemoglobin <7 g/dL in stable patients or <8 g/dL with angina, myocardial infarction, or cardiogenic shock; 2U for hemoglobin <5 g/dL; multiple U in the presence of shock, hypotension, or bleeding...
September 16, 2016: Journal of Trauma and Acute Care Surgery
Rebecca A Busch, Caitlin S Curtis, Cassandra E Kight, Glen E Leverson, Yue Ma, Laura Maursetter, Kenneth A Kudsk
BACKGROUND: Critically ill patients with acute kidney injury may require parenteral nutrition (PN) and continuous renal replacement therapy (CRRT). Introduction of a phosphate-free premixed renal replacement fluid without system-wide education in May 2011 resulted in increased incidence of hypophosphatemia, necessitating change in practice. Changes included (1) maximizing phosphate in PN, (2) modifying the CRRT order set, and (3) developing a CRRT competency evaluation for nutrition support team members...
September 1, 2016: Nutrition in Clinical Practice
Jennifer L Hefner, Ravi S Tripathi, Erik E Abel, Michelle Farneman, Jason Galloway, Susan D Moffatt-Bruce
BACKGROUND: In 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. OBJECTIVES: To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. METHODS: A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record...
September 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
OBJECTIVE: The initiation of bundled payment for care improvement (BPCI) by Centers for Medicare & Medicaid Services (CMS) has led to increased financial and performance accountability. As the majority of vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multi-disciplinary pathway for the elderly vascular patient, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity arterial bypass (LEB)...
August 12, 2016: Annals of Vascular Surgery
Jie Bai, Andreas Fügener, Jan Schoenfelder, Jens O Brunner
The intensive care unit (ICU) is a crucial and expensive resource largely affected by uncertainty and variability. Insufficient ICU capacity causes many negative effects not only in the ICU itself, but also in other connected departments along the patient care path. Operations research/management science (OR/MS) plays an important role in identifying ways to manage ICU capacities efficiently and in ensuring desired levels of service quality. As a consequence, numerous papers on the topic exist. The goal of this paper is to provide the first structured literature review on how OR/MS may support ICU management...
August 12, 2016: Health Care Management Science
Ronnie Aronson, Naomi Orzech, Chenglin Ye, Ruth E Brown, Ronald Goldenberg, Vivien Brown
OBJECTIVE: To highlight the utility of a large patient registry to identify functionally refractory patients (persistent HbA1c ≥75 mmol/mol [9.0%]) with type 2 diabetes, identify their barriers to glycemic control, and implement barrier-specific care path strategies to improve glycemic control. RESEARCH DESIGN AND METHODS: A working group developed a structured tool to optimize the collection of information on barriers to glycemic control and designed structured care paths to address each barrier...
October 2016: Diabetes Care
Thomas H Payne
Electronic health records (EHRs) are now broadly used, following decades of development and incentive programmes for their use. EHRs have been shown through use of reminders, electronic order sets and other means to improve reliability of performance of many basic tasks in acute, preventive and chronic care. They assist with collecting, summarising and displaying the large volumes of information in patient records and support the implementation of guidelines and care pathways. Broad use of EHRs has brought into focus weaknesses of the current generation of EHRs: their user interface, implementation difficulties, time required to use them and others...
August 8, 2016: Heart: Official Journal of the British Cardiac Society
Elizabeth A Crabtree, Emily Brennan, Amanda Davis, Jerry E Squires
PROBLEM: Evidence-based practice (EBP) skills are crucial for delivering high-quality patient care. It is essential that medical students learn EBP concepts through a practical, in-depth research project. To date, literature on preparing students in this manner is limited. APPROACH: In academic year 2014-2015, the Medical University of South Carolina's (MUSC's) Center for Evidence-Based Practice (now known as the Value Institute) partnered with College of Medicine faculty to revitalize the undergraduate medical student EBP curriculum...
August 2, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Alexander C Flint, Carol Conell, Jeff G Klingman, Vivek A Rao, Sheila L Chan, Hooman Kamel, Sean P Cullen, Bonnie S Faigeles, Steve Sidney, S Claiborne Johnston
BACKGROUND: Statin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization. METHODS AND RESULTS: This is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering...
2016: Journal of the American Heart Association
Benjamin I Shepple, William A Thistlethwaite, Christopher L Schumann, Kwame O Akosah, Robert C Schutt, Ellen C Keeley
As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay...
September 2016: Critical Pathways in Cardiology
Sandra Susanibar-Adaniya, Kevin Kuriakose, Sunita Parajuli, Krystina Walker, Jorge Jo-Kamimoto, Karam Ayoub, Marie Saylors, Jeremy Bariola
No abstract text is available yet for this article.
December 2015: Open Forum Infectious Diseases
Angela M Statile, Amanda C Schondelmeyer, Joanna E Thomson, Laura H Brower, Blair Davis, Jacob Redel, Julie Hausfeld, Karen Tucker, Denise L White, Christine M White
BACKGROUND AND OBJECTIVE: Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS: We used quality improvement methods to identify key drivers and inform interventions...
August 2016: Pediatrics
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