Screening for the high-need population using single institution versus state-wide admissions discharge transfer feed.

BACKGROUND: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admission, discharge, and transfer feed (ADT) in assessing equity in access to these programs. METHODS: This is a retrospective cross-sectional study. We included high-need patients at Vanderbilt University Medical Center (VUMC) 18 years or older, with at least three emergency visits (ED) or hospitalizations in Tennessee from January 1 to June 30, 2021, including at least one at VUMC. We used the Tennessee ADT database to identify high-need patients with at least one VUMC ED/hospitalization. Then, we compared this population with high-need patients identified using VUMC's Epic® EHR database. The primary outcome was the sensitivity of VUMC-only criteria for identifying high-need patients compared to the statewide ADT reference standard. RESULTS: We identified 2549 patients with at least one ED/hospitalization and assessed them as high-need based on the statewide ADT. Of those, 2100 had VUMC-only visits, and 449 had VUMC and non-VUMC visits. VUMC-only visit screening criteria showed high sensitivity (99.1%, 95% CI: 98.7 - 99.5%), showing that the high-needs patients admitted to VUMC infrequently access alternative systems. Results showed no meaningful difference in sensitivity when stratified by patient's race or insurance. CONCLUSIONS: ADT allows examination for potential selection bias when relying upon single-institution utilization. In VUMC's high-need patients, there's minimal selection bias when depending on same-site utilization. Further research must understand how biases vary by site and durability over time.

Quality of Clinical Notes: Lesson Learned from Elective Surgery Patients Admitted at University Teaching Hospital.

BACKGROUND: Informative relevant documentation regarding course of treatment minimizes errors, provides data for evidence based practice and legality. However, the clinical notes are often inadequate. This study aims to analyse quality of structured clinical notes in surgical patients. METHODS: This cross sectional study from Oct 1, 2015 in department of surgery included 100 clinical notes randomly selected by lottery. The entries in notes were predefined. There were 29 general entries (nine for identification, eleven for admission details, eight for treatment progress, and one for handwriting). Three additional entries were for discharge patients. The decision for entries was based on consensus meeting in surgery department. Microsoft excel was used for data entry and descriptive analysis. RESULTS: There were 100 clinical notes analysed, 62 non-discharge and 38 discharge patients. Four (out of 62) non-discharge had all 29 entries documented. Two (out of 38) in discharge had all 32 entries documented. The "date of entries, clinician name and designation" were mentioned in 12%, 13% and 10%, respectively. The progress on diet was recorded in 53%, investigations in 72% and intervention details in 73%. Handwriting was difficult to read in 21%. In 13 (out of 100) the identification information was incomplete. Discharge lacked details of home advice in 11%. CONCLUSIONS: The quality of clinical note of elective surgery patients needs improvement on documentation in all domains of identification, admission, progress and discharge.

Concordancia entre diagnósticos de ingreso y egreso y calidad de la historia clínica de urgencias / Correspondence between admission and discharge diagnostics and quality of emergency medical history

Introducción: la evaluación de la calidad de la historia clínica resulta un eficaz instrumento de control de la calidad del proceso asistencial. Objetivo: correlacionar la calidad de la anamnesis, del examen físico en el cuerpo de guardia, el horario de ingreso y la estadía hospitalaria, con los diagnósticos al ingreso y egreso. Métodos: se realizó un estudio descriptivo transversal en 292 historias clínicas de pacientes ingresados de urgencia en el Servicio de Medicina del Hospital Joaquin Albarrán durante seis meses. Se estableció la concordancia entre los diagnósticos al ingreso y egreso con la calidad de la anamnesis y el examen físico, estadía hospitalaria y horario de ingreso. Resultados: se encontró concordancia diagnóstica en 57,9 por ciento de los pacientes, en 74,1 por ciento de los que tuvieron anamnesis correcta y en el 61,6 por ciento con examen físico correcto. En el horario matutino ingresó el 75 por ciento de los casos con concordancia diagnóstica y el 76,6 por ciento sin concordancia ingresó en horario nocturno. La concordancia diagnóstica fue del 87,2 por ciento en los pacientes con estadía menor de 4 días. Discusión: la concordancia diagnóstica fue notablemente mayor en los pacientes que tuvieron una corta estadía, ello coincidió con una mayor calidad de la anamnesis y el examen físico; se corrobora la utilidad de la historia clínica como instrumento que permite precisar la calidad del proceso asistencial. Conclusión: la concordancia entre los diagnósticos al ingreso y egreso se asocia con una mayor calidad de la anamnesis y del examen físico en el cuerpo de guardia y con una estadía hospitalaria más corta, principalmente en pacientes ingresados en el horario matutino(AU)

Introduction: evaluation of the quality of medical records is an effective instrument for controlling the quality of the care process. Objective: correlate the quality of the clinical history, physical examination in the emergency room, hours of admission and hospital stay, with diagnoses at admission and discharge. Methods: a cross-sectional descriptive study was conducted in 292 medical records of patients admitted to emergency room in the Department of Medicine at Joaquín Albarrán Hospital for six months. The concordance between the diagnoses at admission and discharge with the quality of the anamnesis and physical examination, hospital stay, and admission hours was established. Results: diagnostic correlation was found in 57.9 percent of patients, 74.1 percent of those who had correct anamnesis and 61.6 percent had proper physical examination. 75 percent of cases with diagnostic correlation entered in the morning hours and 76.6 percent with no correlation entered at night. Diagnostic correlation was 87.2 percent in patients stay less than 4 days. Discussion: the diagnostic correlation was significantly higher in patients who had a short stay, this coincided with a higher quality of anamnesis and physical examination; the usefulness of clinical history as an instrument which allows to determine the quality of the care process is confirmed. Conclusion: the correlation between diagnoses at admission and discharge is associated with higher quality of anamnesis and physical examination in the emergency room and a shorter hospital stay, mainly in patients admitted during the morning hours(AU)

Practical challenges related to point of care testing.

Point of care testing (POCT) refers to laboratory testing that occurs near to the patient, often at the patient bedside. POCT can be advantageous in situations requiring rapid turnaround time of test results for clinical decision making. There are many challenges associated with POCT, mainly related to quality assurance. POCT is performed by clinical staff rather than laboratory trained individuals which can lead to errors resulting from a lack of understanding of the importance of quality control and quality assurance practices. POCT is usually more expensive than testing performed in the central laboratory and requires a significant amount of support from the laboratory to ensure the quality testing and meet accreditation requirements. Here, specific challenges related to POCT compliance with accreditation standards are discussed along with strategies that can be used to overcome these challenges. These areas include: documentation of POCT orders, charting of POCT results as well as training and certification of individuals performing POCT. Factors to consider when implementing connectivity between POCT instruments and the electronic medical record are also discussed in detail and include: uni-directional versus bidirectional communication, linking patient demographic information with POCT software, the importance of positive patient identification and considering where to chart POCT results in the electronic medical record.

Diagnósticos clínicos al ingreso y al egreso de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos / Clinical diagnoses in admission and in discharge of patients admitted to Internal Medicine, Geriatrics and Infection wards

A partir de asumir que una coincidencia entre el diagnóstico inicial al ingreso y el definitivo al egreso, refleja alta calidad en el cumplimiento de ese paso esencial del método clínico, se revisaron los resultados de dos series de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos, para precisar factores asociados con dicha correspondencia. Se constató total coincidencia en más de las dos terceras partes de los casos, con porcentajes elevados en los más jóvenes, los que tuvieron menor estadía y los que ingresaron en el horario de las guardias. Se destacan los altos valores para enfermedades respiratorias e infecciosas y más bajos para diagnósticos menos precisos, como anemias, síntomas y signos mal definidos y para los ingresados en Geriatría. Se hacen consideraciones sobre el error diagnóstico y la trascendencia de estos resultados para los pacientes y la organización de la atención hospitalaria(AU)

The assumption that there is a coincidence between the initial diagnosis at admission and the definite at discharge reflects a high quality in fulfillment of this essential step of clinical method. Results from two series of patients admitted in Internal Medicine, Geriatrics and infectiuos diseases departments were reviewed to specify exactly the factors associated with such correspondence. Authors verified the total coincidence in more than the two third of cases with high percentages in younger, which had a minor stage and those admitted in the medical duty times. Emphasized are the higher values for the respiratory and infectious diseases and lower for fewer accurate diagnoses including anemias, ill-defined symptoms and signs and for those admitted in Geriatrics department. We took into account on the diagnostic error and the importance of these results for patients and the organization of hospital care(AU)

Diagnósticos clínicos al ingreso y al egreso de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos / Clinical diagnoses in admission and in discharge of patients admitted to Internal Medicine, Geriatrics and Infection wards

A partir de asumir que una coincidencia entre el diagnóstico inicial al ingreso y el definitivo al egreso, refleja alta calidad en el cumplimiento de ese paso esencial del método clínico, se revisaron los resultados de dos series de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos, para precisar factores asociados con dicha correspondencia. Se constató total coincidencia en más de las dos terceras partes de los casos, con porcentajes elevados en los más jóvenes, los que tuvieron menor estadía y los que ingresaron en el horario de las guardias. Se destacan los altos valores para enfermedades respiratorias e infecciosas y más bajos para diagnósticos menos precisos, como anemias, síntomas y signos mal definidos y para los ingresados en Geriatría. Se hacen consideraciones sobre el error diagnóstico y la trascendencia de estos resultados para los pacientes y la organización de la atención hospitalaria

The assumption that there is a coincidence between the initial diagnosis at admission and the definite at discharge reflects a high quality in fulfillment of this essential step of clinical method. Results from two series of patients admitted in Internal Medicine, Geriatrics and infectiuos diseases departments were reviewed to specify exactly the factors associated with such correspondence. Authors verified the total coincidence in more than the two third of cases with high percentages in younger, which had a minor stage and those admitted in the medical duty times. Emphasized are the higher values for the respiratory and infectious diseases and lower for fewer accurate diagnoses including anemias, ill-defined symptoms and signs and for those admitted in Geriatrics department. We took into account on the diagnostic error and the importance of these results for patients and the organization of hospital care