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Thomas V Kodankandath, Paul Wright, Paul M Power, Marcella De Geronimo, Richard B Libman, Thomas Kwiatkowski, Jeffrey M Katz
BACKGROUND AND OBJECTIVE: The transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Delays pose an obstacle to time-sensitive stroke treatments and, therefore, increase the likelihood of exclusion from endovascular stroke therapy. This study aims to evaluate the impact of the Stroke Rescue Program, with its goal of minimizing interfacility transfer delays and increasing the number of transport times completed within 60 minutes. METHODS: The Stroke Rescue Program was initiated to facilitate the rapid transfer of AIS patients from regional primary stroke centers (PSCs) to the network's CSC...
October 12, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Joyce Li, Stephanie Pryor, Ben Choi, Chris A Rees, Mamata V Senthil, Nicholas Tsarouhas, Sage R Myers, Michael C Monuteaux, Richard G Bachur
OBJECTIVES: The aim of this study was to determine the reasons for pediatric emergency department (ED) transfers and the professional characteristics of transferring providers. METHODS: We performed a multicenter, cross-sectional survey of ED medical providers transferring patients younger than 18 years to 1 of 4 tertiary care children's hospitals. Referring providers completed surveys detailing the primary reasons for transfer and their medical training. RESULTS: The survey data were collected for 25 months, during which 641 medical providers completed 890 surveys, with an overall response rate of 25%...
September 23, 2016: Pediatric Emergency Care
James H Hertzog, Thomas E Pearson, Marc A Priest, Ellen Spurrier, Ryan R Davies
Ventricular assist devices (VADs) for the mechanical support of cardiac failure are being used more frequently in children of increasingly younger age. These children have significant and multiple medical comorbidities, and their length of hospital stay has been increasing. As this population of hospitalized VAD-supported children increases, so does the possibility of their need for interfacility transport for specialized diagnostic or therapeutic procedures. Reports on such transports are limited to 3 children who underwent scheduled elective transfers...
September 2016: Air Medical Journal
Joseph Schili, Peter V R Tilney, Jacob T Gutsche, Jason Cohen
No abstract text is available yet for this article.
September 2016: Air Medical Journal
Kevin T Lynch, Rachael M Essig, Dustin M Long, Alison Wilson, Jorge Con
BACKGROUND: Secondary overtriage (SO) refers to the interfacility transfer of trauma patients who are rapidly discharged home without surgical intervention by the receiving institution. SO imposes a financial hardship on patients and strains trauma center resources. Most studies on SO have been conducted from the perspective of the receiving hospital, which is usually a level 1 trauma center. Having previously studied SO from the referring rural hospital's perspective, we sought to identify variables contributing to SO at the national level...
August 2016: Journal of Surgical Research
Michael Y Lin, William E Trick
Informatics tools are becoming integral to routine infection control activities. Informatics has the potential to improve infection control outcomes in surveillance, prevention, and connections with public health. Surveillance activities include fully or semiautomated surveillance of infections, surveillance of device use, and hospital/ward outbreak investigation. Prevention activities include awareness of multidrug-resistant organism carriage on admission, enhanced interfacility communication, identifying inappropriate infection precautions, reducing device use, and antimicrobial stewardship...
September 2016: Infectious Disease Clinics of North America
David Gomez, Barbara Haas, Kristian Larsen, Aziz S Alali, Russell D MacDonald, Jeffrey M Singh, Homer Tien, Theodore J Iwashyna, Gordon Rubenfeld, Avery B Nathens
BACKGROUND: More than half of severely injured patients are initially transported from the scene of injury to nontrauma centers (NTCs), with many requiring subsequent transfer to trauma center (TC) care. Definitive care in the setting of severe injury is time sensitive. However, transferring severely injured patients from an NTC is a complex process often fraught with delays. Selection of the receiving TC and the mode of interfacility transport both strongly influence total transfer time and are highly amenable to quality improvement initiatives...
October 2016: Journal of Trauma and Acute Care Surgery
Malik M Adil, Gabriel A Vidal, Lauren A Beslow
INTRODUCTION: Children with ischemic stroke (IS) and hemorrhagic stroke (HS) may require interfacility transfer for higher level of care. We compared the characteristics and clinical outcomes of transferred and nontransferred children with IS and HS. METHODS: Children aged 1-18 years admitted to hospitals in the United States from 2008 to 2011 with a primary discharge diagnosis of IS and HS were identified from the National Inpatient Sample database by ICD-9 codes...
July 21, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Matthew C Strehlow, Jennifer A Newberry, Corey B Bills, Hyeyoun Elise Min, Ann E Evensen, Lawrence Leeman, Elizabeth A Pirrotta, G V Ramana Rao, S V Mahadevan
OBJECTIVES: Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS). DESIGN: Prospective observational study. SETTING: Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014. PARTICIPANTS: This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport...
2016: BMJ Open
Andrew Thomas, Jeremiah Alt, Craig Gale, Sathya Vijayakumar, Reema Padia, Matthew Peters, Trevor Champagne, Jeremy D Meier
BACKGROUND: Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. METHODS: An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015...
October 2016: International Forum of Allergy & Rhinology
Nataniel H Lester-Coll, Henry S Park, Charles E Rutter, Christopher D Corso, Brandon R Mancini, Debra N Yeboa, Simon P Kim, Cary P Gross, James B Yu
OBJECTIVES: To identify factors associated with expectant management in a large cohort of men with low-risk prostate cancer based on cancer center type (community versus academic). Expectant management, consisting of active surveillance or observation for men with low-risk prostate cancer is an increasingly recognized management option given the morbidity and lack of a survival benefit associated with definitive treatment. However, the influence of cancer center type on treatment selection is uncertain...
July 5, 2016: Urology
Brian J Yun, M G Myriam Hunink, Anand M Prabhakar, Marilyn Heng, Shan W Liu, Rameez Qudsi, Ali S Raja
STUDY OBJECTIVE: Hip fractures cause significant morbidity and mortality. Determining the optimal diagnostic strategy for the subset of patients with potential occult hip fracture remains challenging. We determined the most cost-effective strategy for the diagnosis of occult hip fractures from the choices of performing only computed topography (CT), performing only magnetic resonance imaging (MRI), performing CT and if negative performing MRI (MRI selective strategy), or discharging the patient without advanced imaging...
June 10, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michael J Ward, Sunil Kripalani, Yuwei Zhu, Alan B Storrow, Thomas J Wang, Theodore Speroff, Daniel Munoz, Robert S Dittus, Frank E Harrell, Wesley H Self
Lack of health insurance is associated with interfacility transfer from emergency departments for several nonemergent conditions, but its association with transfers for ST-elevation myocardial infarction (STEMI), which requires timely definitive care for optimal outcomes, is unknown. Our objective was to determine whether insurance status is a predictor of interfacility transfer for emergency department visits with STEMI. We analyzed data from the 2006 to 2011 Nationwide Emergency Department Sample examining all emergency department visits for patients age 18 years and older with a diagnosis of STEMI and a disposition of interfacility transfer or hospitalization at the same institution...
August 1, 2016: American Journal of Cardiology
Gregory Hansen, Patrick J McDonald, Doug Martin, Jeff K Vallance
OBJECTIVES: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility transport to the trauma center. METHODS: Charts from a pediatric level I trauma center were reviewed for admissions between 2008 and 2013...
June 2, 2016: Pediatric Emergency Care
Michael E Valente, Judy A Sherif, Colleen G Azen, Phung K Pham, Calvin G Lowe
OBJECTIVE: The purpose of this study is to measure peak acceleration forces during interfacility transport; examine whether drops in cerebral oxygenation occurred; and test the associations between cerebral oxygenation, acceleration, and patient positioning. METHODS: A cerebral oximeter (INVOS-5100C; Somanetics, Minneapolis, MN) monitored regional saturation of oxygen (rSO2 [cerebral oxygenation]) in pediatric and neonatal patients (N = 24) transported between facilities by ground ambulance, helicopter, or fixed wing aircraft...
May 2016: Air Medical Journal
G Jesse Bender, Karen Kennally
OBJECTIVE: Post-war Kosovar health care systems have reduced gaps in maternal and newborn health care. Coordinated neonatal transport programs may further improve survival and morbidities. METHODS: Transport care paradigms were tested using in situ (Kosovo) and ex situ (the United States) mobile immersive simulation. Patient demographics and outcomes were measured at the tertiary referral center. RESULTS: Four paired physician and nurse transport teams performed 7 simulated interfacility transports across Kosovo...
May 2016: Air Medical Journal
Joseph M Mylotte
An antimicrobial stewardship program (ASP) has been recommended for long-term care facilities because of the increasing problem of antibiotic resistance in this setting to improve prescribing and decrease adverse events. Recommendations have been made for the components of such a program, but there is little evidence to support any specific methodology at the present time. The recommendations make minimal reference to metrics, an essential component of any ASP, to monitor the results of interventions. This article focuses on the role of antibiotic use metrics as part of an ASP for long-term care...
July 1, 2016: Journal of the American Medical Directors Association
Alyssa Karl, Tiffany Pham, Jeff D Yanosky, Jeffrey Lubin
STUDY OBJECTIVE: Some helicopter emergency medical services (HEMS) maintain an independent supply of blood for use during transport, although practice is variable and not well described. We aimed to characterize the blood-carrying practices by HEMS programs across the United States. METHODS: Online surveys were sent to the leadership of the 261 HEMS programs nationwide listed in the 2011 Atlas and Database of Air Medical Services (ADAMS) database. We examined blood-carrying practices in aggregate, including typical transport time, proportion of scene transports, and local population density...
May 23, 2016: Prehospital Emergency Care
Reda A Awali, Deepthi Kandipalli, Amina Pervaiz, Sandhya Narukonda, Urooj Qazi, Naveen Trehan, Teena Chopra
BACKGROUND: Preventing the transmission of Clostridium difficile infection (CDI) over the continuum of care presents an important challenge for infection control. METHODS: A prospective case-control study was conducted on patients admitted with CDI to a tertiary care hospital in Detroit between August 2012 and September 2013. Patients were then followed for 1 year by telephone interviews and the hospital administrative database. Cases, patients with interfacility transfers (IFTs), were patients admitted to our facility from another health care facility and discharged to long-term care (LTC) facilities...
September 1, 2016: American Journal of Infection Control
Jennifer L Rosenthal, Joan F Hilton, Ronald J Teufel, Patrick S Romano, Sunitha V Kaiser, Megumi J Okumura
BACKGROUND AND OBJECTIVE: The hospital-to-hospital transfer of pediatric patients is a common practice that is poorly understood. To better understand this practice, we examined a national database to profile pediatric interfacility transfers. METHODS: We used the 2012 Kids' Inpatient Database to examine characteristics of hospitalized pediatric patients (<21 years; excluding pregnancy diagnoses) with a transfer admission source. We performed descriptive statistics to compare patient characteristics, utilization, and hospital characteristics between those admitted by transfer versus routine admission...
June 2016: Hospital Pediatrics
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