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Matthew A Wheatley
ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis...
August 2017: Emergency Medicine Clinics of North America
Patricia Chapman, David Cleveland, Paula A Lewis-Patterson, Guadalupe R Palos, Maria Alma Rodriguez
161 Background: ASCO's Clinical Oncology Clinical Expert Statement on Cancer Survivorship Planning addressed the importance of using survivorship care plans (SCPs) to improve survivors' care. Evolving information technology strategies, such as web-based systems, offer real-time reporting tools to track providers' adherence for completion of SCPs. Our abstract reports on the creation of a web-based system to monitor survivors' care. METHODS: Ongoing audits of SCPs indicated broad variation in compliance rates with SCPs...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Alison Bradywood, Farrokh Farrokhi, Barbara Williams, Mark Kowalczyk, C Craig Blackmore
STUDY DESIGN: Quality improvement with before and after evaluation of the intervention. OBJECTIVE: To improve lumbar spine postoperative care and quality outcomes through a series of Lean quality improvement events designed to address root causes of error and variation. SUMMARY OF BACKGROUND DATA: Lumbar spine fusion procedures are common, but highly variable in process of care, outcomes, and cost. METHODS: We implemented a standardized lumbar spine fusion clinical care pathway through a series of Lean quality improvement events...
February 2017: Spine
Christopher Martin, Zeke J McKinney, Daniel Hoody, Lisa Fish
OBJECTIVE: We discuss the implementation and outcomes of a diabetic ketoacidosis (DKA) critical care pathway (CCP) at a 462-bed teaching hospital. METHODS: A multi-disciplinary team implemented a DKA CCP that was translated into 3 computerized physician order entry (CPOE) order sets corresponding to the phases of DKA care. Historical and postintervention data were obtained via automated queries of the electronic medical record (EMR) and further analyzed by manual chart review...
June 2016: Endocrine Practice
Lindsay Sonstein, Carlos Clark, Susan Seidensticker, Li Zeng, Gulshan Sharma
BACKGROUND: Clinical practice guidelines recommend 40-60 mg of prednisone equivalent for 10-14 days for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). However, the amount of corticosteroid prescribed varies widely in clinical practice. Using the electronic health record, we implemented an evidence-based order set to standardize treatment of patients hospitalized with acute exacerbations of COPD. METHODS: This is a pre- and post-intervention study on patients hospitalized between January 1, 2009 and September 30, 2012 with primary discharge diagnosis of COPD (International Classification of Diseases, 9(th) Revision code: 491...
November 2014: American Journal of Medicine
Joel Jerome, Jean C Solodiuk, Navil Sethna, Josh McHale, Charles Berde
BACKGROUND: Codeine is an unpredictable analgesic because of its variable pharmacokinetic, pharmacodynamic, and pharmacogenetic properties. This variability may lead to ineffective analgesia in some and respiratory depression in others. Despite this, codeine is still widely used. At a pediatric tertiary medical institution, codeine was prescribed despite efforts to inform prescribers of the potentially unpredictable analgesia and serious side effects. MEASURES: A retrospective/prospective metric was introduced to determine the frequency of codeine orders as compared with similar institutions using Pediatric Health Information Systems data...
July 2014: Journal of Pain and Symptom Management
Craig A Umscheid, Asaf Hanish, Jesse Chittams, Mark G Weiner, Todd E H Hecht
BACKGROUND: Venous thromboembolism (VTE) causes morbidity and mortality in hospitalized patients, and regulators and payors are encouraging the use of systems to prevent them. Here, we examine the effect of a computerized clinical decision support (CDS) intervention implemented across a multi-hospital academic health system on VTE prophylaxis and events. METHODS: The study included 223,062 inpatients admitted between April 2007 and May 2010, and used administrative and clinical data...
2012: BMC Medical Informatics and Decision Making
Shaker M Eid, Adel Boueiz, Suchitra Paranji, Christine Mativo, Regina Landis, Marwan S Abougergi
OBJECTIVE: In the hospital setting, several studies have reported proton pump inhibitor (PPI) overuse, a majority of which is continued after discharge. In addition to being expensive, PPIs are associated with an increased risk of infections, osteoporosis and serious drug interactions. We examined the trends and predictors of PPI guidelines non-compliance among academic and non-academic hospitalists in USA. METHODS AND PATIENTS: Oral PPI prescriptions initiated by 2 academic and 2 non-academic hospitalist groups were reviewed...
2010: Internal Medicine
M Schlueter, C James, A Dominguez, L Tsu, G Seymann
BACKGROUND: Published guidelines for the treatment of healthcare-associated pneumonia (HCAP) recommend initial broad-spectrum antibiotics with appropriate de-escalation based on culture results. Guideline recommendations are based on data from intubated patients, in whom cultures are easily obtained. The approach to antibiotic de-escalation for culture-negative patients has not been addressed. Consequently, there are no published reports that describe the current standard of practice...
October 2010: Infection
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