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2.
Br J Community Nurs ; 24(Sup3): S6-S11, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30817187

RESUMEN

Patients with wounds pose an important healthcare challenge. Many of these wounds are managed in community care and can take weeks or months to resolve. Delays in wound healing can be perpetuated by clinicians who make poor treatment choices, fail to recognise complications and/or do not seek timely advice. Improving patient outcomes requires a proactive approach to care that includes accurate and timely assessment and re-assessment, treatment of the underlying cause using a multidisciplinary team approach and the use of evidence-based practice and clinical judgement to develop an appropriate treatment plan. A structured approach to care, such as the newly developed T.I.M.E. clinical decision support tool, has the potential to improve wound healing outcomes and reduce the burden of chronic wounds in community nursing services.


Asunto(s)
Enfermedad Crónica/terapia , Sistemas de Apoyo a Decisiones Clínicas , Prestación de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Hospitales Comunitarios/normas , Guías de Práctica Clínica como Asunto , Medicina Estatal/normas , Heridas y Traumatismos/terapia , Humanos , Resultado del Tratamiento , Reino Unido
3.
Br J Community Nurs ; 24(Sup3): S25-S27, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30817188

RESUMEN

Wound care in primary settings can be complex if patients are discharged early and have comorbidities. With community nurses often working alone, it is imperative that support is available to guide clinical decision making, for example, through both senior or specialist nurses, guidelines, protocols, wound care formularies, care pathways and care plans. Unfortunately some patients try to dictate their care when at home. Community nurses must continue with a professional approach, ensuring care is delivered in a safe and appropriate way. The patient may sometimes seek reassurance when they feel vulnerable; in these scenarios it is essential for the nurse to establish a trusting relationship, offering fully informed explanations of procedures and gaining patient consent. This report describes a gentleman whose whose personal anxieties led him to refuse care.


Asunto(s)
Hospitales Comunitarios/normas , Enfermeras de Salud Comunitaria/normas , Atención de Enfermería/normas , Guías de Práctica Clínica como Asunto , Heridas y Traumatismos/enfermería , Anciano , Humanos , Masculino , Resultado del Tratamiento
4.
Br J Community Nurs ; 24(Sup3): S14-S19, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30817189

RESUMEN

Diabetic foot ulceration is costly, both in terms of NHS expenditure and quality of life for the patient. This article reviews the guidelines for assessment and management of the diabetic foot ulcer and provides instruction on undertaking vascular and neurological assessments of the diabetic foot. Wound assessment, with an overview of the TEXAS and SINBAD wound classification systems, is also explored, as is the importance of the 1 working day referral for expert assessment for any new diabetic foot ulcer in order to reduce wound complications, length of hospital stay and, ultimately, amputation.


Asunto(s)
Enfermedad Crónica/terapia , Pie Diabético/terapia , Hospitales Comunitarios/normas , Guías de Práctica Clínica como Asunto , Medicina Estatal/normas , Adulto , Anciano , Anciano de 80 o más Años , Prestación de Atención de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reino Unido
5.
Transfus Apher Sci ; 58(2): 152-155, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30639177

RESUMEN

BACKGROUND: Treatment of multiple myeloma with daratumumab (DARA) is increasing fast. Unfortunately, this antibody also attaches to red blood cells (RBCs) and mimics an autoantibody's panreactivity during pre-transfusion testing, necessitating specialized techniques, (e.g. dithiothreitol (DTT)) for alloantibody detection. Many hospitals use a reference lab for such testing, increasing both cost and turn-around time (TAT). Herein, we compare the cost and TAT, pre and post-implementation of an in-house DTT protocol. METHODS: We designed a validation of our in-house DTT protocol from Nov to Dec 2017 with full implementation on January 1, 2018. We retrospectively reviewed all pre-transfusion tests on DARA patients from Feb 2016 to April 2018, pre and post-implementation of in-house DTT testing. Descriptive statistics were used for patient demographics and a Student t-test was used to compare cost and TATs (pre and post-implementation). RESULTS: We identified 49 patients on DARA treatment requiring transfusion. Samples from these patients were sent to the reference lab 104 times and were tested in-house 28 times. The average TAT for the reference lab was 19h25 m compared to our in-house TAT of 5h9m (an average time-savings of 14h16 m). We spent approximately $33,800 ($325 per test) for 104 reference lab samples versus $806.12 (˜$28.79 per test) for in-house testing of 28 samples. CONCLUSION: We provide an easily implementable DTT protocol for pre-transfusion testing community hospitals and beyond. As more monoclonal antibodies are developed and approved for clinical use, the lessons learned with DARA will expand to deal with interference from future targeted therapies.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Ditiotreitol/uso terapéutico , Servicios de Atención de Salud a Domicilio/normas , Hospitales Comunitarios/normas , Centros de Atención Terciaria/normas , Anticuerpos Monoclonales/farmacología , Análisis Costo-Beneficio , Ditiotreitol/farmacología , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos
6.
J ECT ; 35(1): 21-26, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29668495

RESUMEN

BACKGROUND: The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. OBJECTIVE: The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. METHODS: An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. RESULTS: Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. CONCLUSIONS: This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.


Asunto(s)
Terapia Electroconvulsiva/normas , Garantía de la Calidad de Atención de Salud/organización & administración , Actitud del Personal de Salud , Lista de Verificación , Adhesión a Directriz , Guías como Asunto , Hospitales Comunitarios/normas , Humanos , Auditoría Médica , Enfermeras y Enfermeros , Seguridad del Paciente , Estudios Retrospectivos , Revisiones Sistemáticas como Asunto
8.
Metas enferm ; 21(9): 57-62, nov. 2018. tab
Artículo en Español | IBECS | ID: ibc-172982

RESUMEN

Objetivo: describir el grado de cumplimentación del listado de verific ción de seguridad quirúrgica (LVSQ) en el servicio de quirófano de un hospital comarcal. Método: estudio descriptivo transversal llevado a cabo en el Hospital Santos Reyes de Aranda de Duero (Burgos) entre mayo de 2015 y mayo de 2016. Se realizó un muestreo aleatorio simple de 750 individuos sometidos a cirugía programada para la revisión de los LVSQ contenidos en sus historias clínicas. Se efectuó un análisis descriptivo con frecuencias absolutas y porcentajes de los ítems del listado categorizados por el momento del procedimiento quirúrgico (antes de la inducción anestésica, antes de la incisión cutánea y antes de la salida de quirófano) y por el profesional responsable de su cumplimentación (enfermera, anestesista y cirujano). Resultados: se estudiaron un total de 604 listados de verificaciónde seguridad quirúrgica. Se observó una mayor cumplimentación del LVSQ en los momentos anteriores a la inducción anestésica y a la incisión cutánea que antes de la salida de quirófano y siempre en aquellos ítems cumplimentados por enfermeras. La cumplimentación de las cuestiones propias de las enfermeras rondó el 88%, fue del 49% en el caso de los ítems propios de los anestesistas y del 46,9% en los asignados a cirujanos. Fue necesario corregir el consentimiento informado en el 4,3% de las intervenciones. Conclusiones: hay diferencias en la cumplimentación del LVSQ en función del momento quirúrgico y del profesional responsable. La formación del personal implicado, así como la implicación de los líderes institucionales, podría jugar un papel para conseguir una mayor adherencia en la cumplimentación


Objective: to describe the level of compliance with the Surgical Safety Checklist (SSCL) at the Operating Room in a regional hospital. Method: a descriptive cross-sectional study conducted at the Hospital Santos Reyes of Aranda de Duero (Burgos) between May, 2015 and May, 2016. Simple random sampling was conducted on 750 individuals undergoing scheduled surgery, in order to review the SSCLs included in their clinical records. Descriptive analysis was conducted with absolute frequencies and percentages of the list items, classified by time point during the surgical procedure (before anesthetic induction, before skin incision, and before leaving the operating room), and by professional responsible for completion (nurse, anesthetist and surgeon). Results: in total, 604 Surgical Safety Checklists were studied. Higher SSCL compliance was observed a the time point before anesthetic induction and skin incision, than before leaving the operating room, and always in those items completed by nurses. Completion of items by nurses reached about 88%; in the case of anesthetists, it was 49%, and 46.9% in those items assigned to surgeons. It was necessary to correct Informed Consents in 4.3% of interventions. Conclusions: there are differences in SSCL compliance according to the surgical time and the professional in charge. Training for the staff involved, as well as involvement by institution leaders, could play a role in order to achieve a higher adherence in terms of compliance


Asunto(s)
Hospitales Comunitarios/normas , Administración de la Seguridad/organización & administración , Lista de Verificación/métodos , España , Seguridad del Paciente/normas , Epidemiología Descriptiva , Estudios Transversales , Quirófanos/organización & administración
9.
Jt Comm J Qual Patient Saf ; 44(7): 389-400, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30008351

RESUMEN

BACKGROUND: Through an innovative affiliation, Duke University Health System (DUHS), a large and complex academic health system, and LifePoint Health® (LifePoint [LP]) collaborated to create a joint venture, DLP Healthcare (DLP) to measurably improve culture and quality and patient safety metrics in community hospitals across the United States. A structured approach to quality was developed in DLP hospitals and later refined and spread to all LP hospitals through the National Quality Program (NQP). METHODS: The NQP was designed to drive organizationwide performance improvement through use of a framework of leadership, performance improvement, and culture. A comprehensive quality assessment of each DLP and LP hospital led to the creation of a customized improvement plan that was specific to the performance level of individual hospitals and aligned with strategic organizational goals. The improvement process was data driven, managed with defined improvement methodologies and practices, and implemented in a culture that honors teamwork, mutual respect, accountability and provider well-being. RESULTS: Implementation of the NQP has led to significant improvements in patient safety metrics and in safety culture, which have now been sustained for more than seven years. Aggregate harm, as measured by administrative claims data-based harms per 1,000 inpatient-days, was reduced by 62.5% between January 2011 and December 2017, as compared to 2010 baseline data. CONCLUSION: The LP and Duke journey to achieve high reliability in community hospitals has yielded significant improvement in measures of patient safety and culture. The results are consistent with literature supporting the link between culture and overall performance.


Asunto(s)
Hospitales Comunitarios/organización & administración , Cultura Organizacional , Seguridad del Paciente/normas , Mejoramiento de la Calidad/organización & administración , Administración de la Seguridad/organización & administración , Accidentes por Caídas/prevención & control , Benchmarking/métodos , Benchmarking/normas , Hospitales Comunitarios/normas , Humanos , Enfermedad Iatrogénica/prevención & control , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Administración de la Seguridad/normas , Integración de Sistemas , Estados Unidos
10.
Acad Emerg Med ; 25(12): 1385-1395, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29947453

RESUMEN

BACKGROUND: Approximately 90% of pediatric emergency care is provided in community emergency departments (CEDs) that care for both adults and children. Paradoxically, the majority of pediatric emergency medicine knowledge generation, quality improvement work, and clinical training occurs in children's hospitals. There is a paucity of information of perceptions on pediatric care from CED providers. This information is needed to guide the development of strategies to improve CED pediatric readiness. OBJECTIVE: The objective was to explore interprofessional CED providers' perceptions of caring for pediatric patients. METHODS: A preparticipation survey collected data on demographics, experience, and comfort in caring for children. Emergency pediatric simulations were then utilized to prime interprofessional teams for debriefings. These discussions underwent qualitative analysis by three blinded authors who coded transcripts into themes through an inductive method derived from grounded theory. The other authors participated in confirmability and dependability checks. RESULTS: A total of 171 community hospital providers from six CEDs completed surveys (49% nurses, 22% physicians, 23% technicians). The majority were PALS trained (70%) and experienced fewer than five pediatric resuscitations in their careers (61%). Most self-reported comfort in caring for acutely ill and injured children. From the debriefings, three major challenge themes emerged: 1) knowledge and skill limitations attributed to infrequency of training and actual clinical events, 2) the emotional toll of caring for a sick child, and 3) acknowledgment of pediatric specific quality and safety deficits. Subthemes focused on causes and potential mitigating factors contributing to these challenges. A solution theme highlighted novel partnering opportunities with local children's hospitals. CONCLUSION: Interprofessional CED providers perceive that caring for pediatric patients is challenging due to case infrequency, the emotional toll of caring for sick children, and pediatric quality and safety deficits in their systems. These areas of focus can be used to generate specific strategies for improving CED pediatric readiness.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica/normas , Servicio de Urgencia en Hospital/normas , Hospitales Comunitarios/normas , Adulto , Niño , Conducta Cooperativa , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales Comunitarios/estadística & datos numéricos , Humanos , Masculino , Encuestas y Cuestionarios
11.
Ann Ig ; 30(4): 317-329, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29895049

RESUMEN

BACKGROUND: Intermediate Care Services have been developed to provide high-quality and sustainable care to the elderly patients with chronic diseases. Italian Community Hospitals, inspired by the British model, are an example of Intermediate Care. The aim of this study was: (1) to describe the healthcare needs met by the Community Hospitals of Emilia-Romagna, Northern Italy, by depicting the characteristics of hospitalized patients, and (2) to evaluate process and outcome indicators by conducting a comparative assessment of the quality of care. STUDY DESIGN: Observational retrospective cohort study. METHODS: The study population included patients living in Emilia-Romagna who were discharged during 2016 from the 14 Community Hospitals of the region. Data were retrieved from the Regional Informative System of Community Hospitals database; multi-morbidity profiles were identified through the Hospital Discharge Records Database and the Outpatient Pharmaceutical Database. In-hospital variation of the 5-level Modified Barthel Index and hospital readmissions within 3 months of discharge were retrieved for each patient. The presence of recurrent patterns of multi-morbidity, i.e., clinical conditions that tend to co-occur, was investigated using unsupervised cluster analysis. RESULTS: The study population included 2,121 patients. Mean age was 79.5 years, mean Community Hospital stay was 22.4 days (range 13.1 - 31.5 days) and 62.5% of the patients were females. The most common sources of admission were hospital (71.8%) and home (27.0%). Routine discharges were 60.0%, planned home discharges were 13.6%, and transfers to public or private hospitals were 10.8%. We identified two multi-morbidity clusters unevenly distributed across Community Hospitals. Mean number of co-occurring chronic conditions per patient was different in the two clusters (3.0 vs. 4.7, p < 0.004). Mean Modified Barthel Index at admission and discharge was 32.2 and 47.6, respectively. Mean difference of 15.3 between values at admission and discharge was statistically significant (p < 0.001). Three-month hospital readmissions occurred for 20.2% of patients. CONCLUSION: The development of Intermediate Care Services, and in particular Community Hospitals, requires guidelines and protocols to define who among the patients can benefit more from this type of care. It is necessary to assess the quality of care provided by these facilities through appropriate and internationally comparable measures, including patient experience indicators.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud , Hospitalización/estadística & datos numéricos , Hospitales Comunitarios/organización & administración , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Estudios de Cohortes , Prestación de Atención de Salud/normas , Femenino , Hospitales Comunitarios/normas , Hospitales Comunitarios/estadística & datos numéricos , Humanos , Italia , Tiempo de Internación/estadística & datos numéricos , Masculino , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud , Estudios Retrospectivos
12.
Am J Infect Control ; 46(11): 1224-1229, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29934205

RESUMEN

BACKGROUND: Hospital-acquired infections (HAIs) are a significant contributor to adverse patient outcomes and excess cost of inpatient care. Adjunct ultraviolet-C (UV-C) disinfection may be a viable strategy for reducing HAIs. This study aimed to measure the clinical, operational, and financial impact of a UV-C terminal disinfection intervention in a community hospital setting. METHODS: Using a pre-post study design, we compared the HAI rates of 5 multidrug-resistant bacteria (Acinetobacter baumannii, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Pseudomonas aeruginosa) from 6 culture sites before and after a 12-month facility-wide UV-C intervention. To measure impact of UV-C disinfection on hospital operations, mean inpatient emergency room wait time was calculated. Finally, we conducted a cost saving analysis to evaluate the financial benefits of the intervention. RESULTS: Overall, 245 HAIs among 13,177 inpatients were observed during a 12-month intervention period, with an incidence rate of 3.94 per 1,000 patient days. This observed HAIs incidence was 19.2% lower than the preintervention period (4.87 vs 3.94 per 1,000 patient days; P = .006). The intervention did not adversely impact emergency department admissions (297.9 vs 296.2 minutes; P = .18) and generated a direct cost savings of $1,219,878 over a 12-month period. CONCLUSIONS: The UV-C disinfection intervention was associated with a statistically significant facility-wide reduction of multidrug-resistant HAIs and generated substantial direct cost savings without adversely impacting hospital operations.


Asunto(s)
Infección Hospitalaria/prevención & control , Desinfección/métodos , Hospitales Comunitarios/normas , Control de Infecciones/métodos , Rayos Ultravioleta , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/efectos de los fármacos , Bacterias/efectos de la radiación , Infección Hospitalaria/epidemiología , Desinfección/economía , Farmacorresistencia Bacteriana Múltiple , Femenino , Hospitales Comunitarios/economía , Humanos , Control de Infecciones/economía , Masculino , Persona de Mediana Edad
13.
Glob Health Action ; 11(1): 1453333, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29621933

RESUMEN

BACKGROUND: Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing. OBJECTIVE: This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation. METHODS: A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation. RESULTS: A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system. CONCLUSION: The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken.


Asunto(s)
Hospitales Comunitarios/organización & administración , Partería/organización & administración , Adulto , Femenino , Grupos Focales , Recursos en Salud/provisión & distribución , Hospitales Comunitarios/normas , Humanos , Liderazgo , Masculino , Persona de Mediana Edad , Partería/normas , Investigación Cualitativa , Tanzanía
14.
Jt Comm J Qual Patient Saf ; 44(4): 219-226, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29579447

RESUMEN

A Patient Safety Huddle was developed at a community hospital (Providence Little Company of Mary Medical Center, San Pedro, California) through consultation with key stakeholders. The goal was to become a high reliability organization by improving communication across different departments, troubleshooting operational problems, focusing on safety and quality metrics, and reporting unusual occurrences. The Patient Safety Huddle involved executives in development and implementation, respect for employee time, ensuring accountability, and empowering frontline staff to foresee and deal with safety issues. The current template of the Patient Safety Huddle agenda and the Documentation Tools used to address patient safety issues are provided.


Asunto(s)
Hospitales Comunitarios/organización & administración , Cultura Organizacional , Seguridad del Paciente/normas , Calidad de la Atención de Salud/organización & administración , Concienciación , Comunicación , Conducta Cooperativa , Documentación , Hospitales Comunitarios/normas , Humanos , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados
15.
J Cardiothorac Vasc Anesth ; 32(2): 675-681, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29398380

RESUMEN

OBJECTIVE: Currently, there are no large-scale studies that compare differences in case duration of aortic valve replacements (AVRs). The primary objective of this study was to determine associations of hospital facility type, geographic location, case volume per year, and time of day with duration of valve replacement surgery. DESIGN: Retrospective. SETTING: Data from the National Anesthesia Clinical Outcomes Registry. PARTICIPANTS: National data from university and non-university hospitals. INTERVENTIONS: No interventions. MEASUREMENTS AND MAIN RESULTS: All AVRs from the National Anesthesia Clinical Outcomes Registry were identified from 2010 to 2014. Mean case duration for all AVRs was 360.8 ± 95.8 minutes and was presented based on facility type (university hospital, large community hospital, medium-sized community hospital, and other); US geographic region; time of day (cases performed after 5 pm and before 7 am v day shift); and case volume per year. A multivariable linear regression model was built to determine the association of various patient, procedural, and facility characteristics with case duration. University hospitals were associated with increased case duration for AVRs (p < 0.0001). CONCLUSIONS: With this large national database, the authors demonstrated that academic hospitals, time of day of the surgery, US region, and case volume per year for a facility are related to the case duration of AVRs.


Asunto(s)
Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/normas , Hospitales Comunitarios/normas , Hospitales Universitarios/normas , Tempo Operativo , Anciano , Bases de Datos Factuales/normas , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Capacidad de Camas en Hospitales/normas , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros/normas , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología
16.
Int J Gynecol Cancer ; 28(3): 581-585, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29466256

RESUMEN

OBJECTIVES: The purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion. METHODS: We retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates. RESULTS: There were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282). CONCLUSIONS: The results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.


Asunto(s)
Procedimientos Quirúrgicos de Citorreducción/métodos , Neoplasias de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos de Citorreducción/normas , Femenino , Procedimientos Quirúrgicos Ginecológicos/normas , Hospitales Comunitarios/organización & administración , Hospitales Comunitarios/normas , Humanos , Histerectomía/métodos , Persona de Mediana Edad , Atención Perioperativa/métodos , Atención Perioperativa/normas , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normas , Estudios Retrospectivos , Salpingooforectomía/métodos
17.
Am J Health Syst Pharm ; 75(3): 139-144, 2018 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-29371195

RESUMEN

PURPOSE: The creation of a clinical support role for a pharmacy technician within a primary care resource center is described. SUMMARY: In the Primary Care Resource Center (PCRC) Project, hospital-based care transition coordination hubs staffed by nurses and pharmacist teams were created in 6 independent community hospitals. At the largest site, patient volume for targeted diseases challenged the ability of the PCRC pharmacist to provide expected elements of care to targeted patients. Creation of a new pharmacy technician clinical support role was implemented as a cost-effective option to increase the pharmacist's efficiency. The pharmacist's work processes were reviewed and technical functions identified that could be assigned to a specially trained pharmacy technician under the direction of the PCRC pharmacist. Daily tasks performed by the pharmacy technician included maintenance of the patient roster and pending discharges, retrieval and documentation of pertinent laboratory and diagnostic test information from the patient's medical record, assembly of patient medication education materials, and identification of discrepancies between disparate systems' medication records. In the 6 months after establishing the PCRC pharmacy technician role, the pharmacist's completion of comprehensive medication reviews (CMRs) for target patients increased by 40.5% (p = 0.0223), driven largely by a 42.4% (p < 0.0001) decrease in the time to complete each chart review. CONCLUSION: The addition of a pharmacy technician to augment pharmacist care in a PCRC team extended the reach of the pharmacist and allowed more time for the pharmacist to engage patients. Technician support enabled the pharmacist to complete more CMRs and reduced the time required for chart reviews.


Asunto(s)
Recursos en Salud , Farmacéuticos , Servicio de Farmacia en Hospital/métodos , Técnicos de Farmacia , Atención Primaria de Salud/métodos , Rol Profesional , Recursos en Salud/normas , Hospitales Comunitarios/métodos , Hospitales Comunitarios/normas , Humanos , Transferencia de Pacientes/métodos , Transferencia de Pacientes/normas , Farmacéuticos/normas , Servicio de Farmacia en Hospital/normas , Técnicos de Farmacia/normas , Atención Primaria de Salud/normas
18.
Am J Health Syst Pharm ; 75(4): 199-211, 2018 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-29339374

RESUMEN

PURPOSE: Results of a study to evaluate the effectiveness of a recently introduced closed system drug-transfer device (CSTD) in reducing surface contamination during compounding and simulated administration of antineoplastic hazardous drugs (AHDs) are reported. METHODS: Wipe samples were collected from 6 predetermined surfaces in compounding and infusion areas of 13 U.S. cancer centers to establish preexisting levels of surface contamination by 2 marker AHDs (cyclophosphamide and fluorouracil). Stainless steel templates were placed over the 6 previously sampled surfaces, and the marker drugs were compounded and infused per a specific protocol using all components of the CSTD. Wipe samples were collected from the templates after completion of tasks and analyzed for both marker AHDs. RESULTS: Aggregated results of wipe sampling to detect preexisting contamination at the 13 study sites showed that overall, 66.7% of samples (104 of 156) had detectable levels of at least 1 marker AHD; subsequent testing after CSTD use per protocol found a sample contamination rate of 5.8% (9 of 156 samples). In the administration areas alone, the rate of preexisting contamination was 78% (61 of 78 samples); with use of the CSTD protocol, the contamination rate was 2.6%. Twenty-six participants rated the CSTD for ease of use, with 100% indicating that they were satisfied or extremely satisfied. CONCLUSION: A study involving a rigorous protocol and 13 cancer centers across the United States demonstrated that the CSTD reduced surface contamination by cyclophosphamide and fluorouracil during compounding and simulated administration. Participants reported that the CSTD was easy to use.


Asunto(s)
Antineoplásicos/toxicidad , Composición de Medicamentos/normas , Monitoreo del Ambiente/normas , Contaminación de Equipos/prevención & control , Servicio de Farmacia en Hospital/normas , Ciclofosfamida/toxicidad , Composición de Medicamentos/instrumentación , Composición de Medicamentos/métodos , Monitoreo del Ambiente/métodos , Fluorouracilo/toxicidad , Hospitales Comunitarios/métodos , Hospitales Comunitarios/normas , Humanos , Exposición Profesional/prevención & control , Exposición Profesional/normas , Servicio de Farmacia en Hospital/métodos
19.
Acad Emerg Med ; 25(2): 177-185, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28977717

RESUMEN

BACKGROUND: More than 30 million children are cared for across 5,000 U.S. emergency departments (EDs) each year. Most of these EDs are not facilities designed and operated solely for children. A Web-based survey provided a national and state-by-state assessment of pediatric readiness and noted a national average score was 69 on a 100-point scale. This survey noted wide variations in ED readiness with scores ranging from 61 in low-pediatric-volume EDs to 90 in the high-pediatric-volume EDs. Additionally, the mean score at the state level ranged from 57 (Wyoming) to 83 (Florida) and for individual EDs ranged from 22 to 100. The majority of prior efforts made to improve pediatric readiness have involved providing Web-based resources and online toolkits. This article reports on the first year of a program that aimed to improve pediatric readiness across community hospitals in our state through in situ simulation-based assessment facilitated by our academic medical center. The primary aim was to improve the pediatric readiness scores in the 10 participating hospitals. The secondary aim was to explore the correlation of simulation-based performance of hospital teams with pediatric readiness scores. METHODS: This interventional study measured the Pediatric Readiness Survey (PRS) prior to and after implementation of an improvement program. This program consisted of three components: 1) in situ simulations, 2) report-outs, and 3) access to online pediatric readiness resources and content experts. The simulations were conducted in situ (in the ED resuscitation bay) by multiprofessional teams of doctors, nurses, respiratory therapists, and technicians. Simulations and debriefings were facilitated by an expert team from a pediatric academic medical center. Three scenarios were conducted for all teams and include: a 6-month-old with respiratory failure, an 8-year-old with diabetic ketoacidosis (DKA), and a 6-month-old with supraventricular tachycardia (SVT). A performance score was calculated for each scenario. The improvement of PRS was compared before and after the simulation program. The correlation of the simulation performance of each hospital and the PRS was calculated. RESULTS: Forty-one multiprofessional teams from 10 EDs in Indiana participated in the study, five were of medium pediatric volume and five were medium- to high-volume EDs. The PRS significantly improved from the first to the second on-site verification assessment (58.4 ± 4.8 to 74.7 ± 2.9, p = 0.009). Total adherence scores to scenario guidelines were 54.7, 56.4, and 62.4% in the respiratory failure, DKA, and SVT scenarios, respectively. We found no correlation between simulation performance and PRS scores. Medium ED pediatric volume significantly predicted higher PRS scores compared to medium-high pediatric ED volume (ß = 8.7; confidence interval = 0.72-16.8, p = 0.034). CONCLUSIONS: Our collaborative improvement program that involved simulation was associated with improvement in pediatric readiness scores in 10 EDs participating statewide. Future work will focus on further expanding of the network and establishing a national model for pediatric readiness improvement.


Asunto(s)
Servicio de Urgencia en Hospital/normas , Mejoramiento de la Calidad , Entrenamiento Simulado/normas , Lista de Verificación , Niño , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales Comunitarios/organización & administración , Hospitales Comunitarios/normas , Humanos , Lactante , Pediatría/normas , Entrenamiento Simulado/organización & administración , Encuestas y Cuestionarios
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