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1.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
2.
Am Surg ; 85(9): 1025-1027, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638518

RESUMO

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.


Assuntos
Centros Médicos Acadêmicos , Transplante de Fígado , Índice de Massa Corporal , Colestase/cirurgia , Fígado Gorduroso/cirurgia , Feminino , Sobrevivência de Enxerto , Hepatite C/cirurgia , Humanos , Tempo de Internação , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Mississippi , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias , Desenvolvimento de Programas , Reoperação
5.
Nephrol Nurs J ; 46(4): 423-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490052

RESUMO

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods. Keeping simplicity, nursing workload, and flexibility at the forefront of implementation, evaluation, and process revision, an overall adherence rate of 84.2% was achieved three months after implementation of the policy.


Assuntos
Derivação Arteriovenosa Cirúrgica/enfermagem , Equipamento de Proteção Individual , Diálise Renal , Centros Médicos Acadêmicos/organização & administração , Humanos , Política Organizacional , Sudeste dos Estados Unidos
7.
Int Heart J ; 60(5): 1022-1029, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484858

RESUMO

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Centros Médicos Acadêmicos , Síndrome Coronariana Aguda/diagnóstico por imagem , Lesão Renal Aguda/epidemiologia , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Japão , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Razão de Chances , Segurança do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos
8.
Ideggyogy Sz ; 72(7-8): 222-223, 2019 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31517453

RESUMO

Mátyás Bobest died in May, 2019, at the age of 79, following a disease tolerated with patience. He was the 1st nominated Chef of the independent Neurosurgical Department at the Markusovszky University Teaching Hospital, Szombathely in 1980, and under his leadership it worked for 23 years. He succeed to create a Neurosurgical Centre of West Hungary with his diligent and ambitious work. Beside his everyday surgical duties he paid attention to the continuing medical education and made research on the intervertebral disc degeneration.


Assuntos
Centros Médicos Acadêmicos/história , Departamentos Hospitalares/história , Liderança , Neurocirurgiões , Neurocirurgia/história , História do Século XX , História do Século XXI , Humanos , Hungria , Masculino
9.
Stud Health Technol Inform ; 264: 1767-1768, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438334

RESUMO

We observed the stay time of patients and staff in Gunma University Heavy Ion Medical Center. The stay time of patients with the prostatic cancer and the facing time with radiotherapy technicians in treatment rooms were significantly reduced as times goes by. This decreasing in time has an implication in scheduling algorithm development: for patients. RFID technology can be a potential method to track both staff and patients and thereby to assess the resource utilization efficiency.


Assuntos
Dispositivo de Identificação por Radiofrequência , Centros Médicos Acadêmicos , Íons Pesados , Humanos , Universidades
10.
Neurology ; 93(12): 538-549, 2019 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-31366723

RESUMO

Despite the fact that the percentages of women among physicians and neurologists have been rising, gender-related disparities in numerous metrics persist, notably in compensation, promotion, funding, recognition, leadership, publishing, and speaking. Simultaneously, women working in academia, including medicine, face high rates of sexual harassment. Leaders of all health care-related organizations must accept the moral and ethical imperative to expeditiously address both gender-related discrimination and harassment (inclusive of but not limited to sexual harassment) of women in medicine. At this unique time in history, there is an opportunity for leaders in neurology to strategically accelerate efforts to address workforce gender disparities and ensure harassment-free training and work environments. Leaders will have to plan an intentional path forward, using a systematic process, metrics, and strategies unique to their own organizations, to overcome barriers to an equitable and safe work environment for women. Moreover, leaders in 4 gatekeeper organizations-medical schools/academic medical centers, funding agencies, journals, and medical societies-must hold each other accountable for gender equity as their own success and financial return on investment is dependent on the efforts of those in the other categories. In short, the path forward is to focus on ethical principles and behavior when it comes to addressing workforce gender disparities for women in medicine.


Assuntos
Medicina , Neurologia , Centros Médicos Acadêmicos , Feminino , Humanos , Liderança , Faculdades de Medicina
12.
Stud Health Technol Inform ; 264: 1318-1322, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438139

RESUMO

In 2017, a US academic medical center switched to a commercial EHR system using the "specialist training the specialist" model, which combines peer-to-peer training, classroom based training, and web-based training. We conducted semi-structured interviews with physicians at multiple training levels to investigate the impact of this EHR switch and to explore the training experience of physicians and their perception of the training quality pre and post Go-Live. Our team used Grounded Theory methodology to classify the interview information. Themes that emerged from the interviews included stress and anxiety, the desire for more realistic training environments tailored to specialty needs, and concerns about the duration of time between training and implementation. In future implementations, we recommend more data-rich test patients and the demonstration of real-world workflows during training.


Assuntos
Medicina , Médicos , Centros Médicos Acadêmicos , Registros Eletrônicos de Saúde , Humanos , Fluxo de Trabalho
13.
Stud Health Technol Inform ; 264: 472-476, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437968

RESUMO

This study presents an approach for mining structured information from clinical narratives in Electronic Health Records (EHRs) by using Rich Text Formatted (RTF) records. RTF is adopted by many medical information management systems. There is rich structural information in these files which can be extracted and interpreted, yet such information is largely ignored. We investigate multiple types of EHR narratives in the Enterprise Data Warehouse from a multisite large healthcare chain consisting of both, an academic medical center and community hospitals. We focus on the RTF constructs related to tables and sections that are not available in plain text EHR narratives. We show how to parse these RTF constructs, analyze their prevalence and characteristics in the context of multiple types of EHR narratives. Our case study demonstrates the additional utility of the features derived from RTF constructs over plain text oriented NLP.


Assuntos
Registros Eletrônicos de Saúde , Narração , Centros Médicos Acadêmicos , Data Warehousing , Técnicas Histológicas
14.
Stud Health Technol Inform ; 264: 158-162, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437905

RESUMO

Emergency department (ED) overcrowding has been a pain point in hospitals across the globe. "Frequent flyers," who visited the ED at a much higher rate than average, account for almost one third of ED visits even though they represent only a small proportion of all ED patients. In this study, we used data-mining methods to cluster ED frequent flyers at a large academic medical center in the US. The objective was to identify distinct types of frequent flyers, and the common characteristics associated with each type. The results show that the frequent flyers at the ED have three subgroups each exhibiting distinct characteristics: (1) the elderly with chronic health conditions, (2) middle-aged males with unhealthy behavior, and (3) adult females who are generally healthy. These findings may inform targeted interventional strategies for patients of each subgroup, who likely have distinct reasons for visiting the ED frequently, to reduce ED overcrowding.


Assuntos
Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Análise por Conglomerados , Feminino , Humanos , Masculino , Dor
15.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
16.
Am Surg ; 85(6): 663-670, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267909

RESUMO

Ineffective communication between surgical trainees and attending surgeons is a significant contributor to patient harm. The aim of this study was to evaluate a tool to improve resident-to-attending communication regarding changes in patient clinical status. Ten critical patient events were compiled into a list of triggers for direct attending surgeon notification at a single academic institution. Residents and faculty were surveyed to assess communication before and after implementation of the list. Institution of the triggers list was associated with a nonstatistically significant increase in resident-to-attending notification regarding 7 of 10 critical patient events. There was no reported change in frequency of calls associated with the list's implementation. Most residents felt that the list improved patient care and increased their comfort with calling attending surgeons. Comments were generally positive; however, both groups expressed concern that the list could negatively impact resident autonomy and supervision. Implementing a list of triggers for attending notification of critical patient events subjectively improved resident-to-attending communication in an environment with high baseline levels of communication.


Assuntos
Internato e Residência/organização & administração , Corpo Clínico Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade , Inquéritos e Questionários , Centros Médicos Acadêmicos , Adulto , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Humanos , Comunicação Interdisciplinar , Relações Interprofissionais , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Ohio
17.
BMC Public Health ; 19(1): 885, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277616

RESUMO

BACKGROUND: The prevalence of food insecurity (FI) as "the limited or uncertain availability of enough food for an always active and healthy life" and diabetes as "the most common metabolic disease" are rising in Iran. The aim was to assess the FI, depression, and socioeconomic status as risk factors for type 2 diabetes (T2D). METHODS: This case-control study was conducted on 135 patients with T2D as cases (99 females, 36 males, mean age 46.83 years) and 135 subjects without diabetes (89 females, 46 males, mean age 45.93 years) as controls. They had been referred to clinics of Shiraz University of Medical Sciences, Shiraz, Iran. The prior major inclusion criterion for diabetes was fasting blood sugar (FBS) ≥126 mg/dl. General, demographic, and socioeconomic characteristics and FI status were assessed using the general and 18-items United States Department of Agriculture (USDA) household food security questionnaires, respectively. Chi-square, t-test, and uni-and multi-variate logistic regression tests and SPSS16 statistical software were used. RESULTS: The prevalence of FI was 66.7% in cases and 41.5% in controls. According to final analysis model, FI (Odds Ratio [OR] = 1.9, P = 0.016), depression (OR = 2.0, P = 0.018), body mass index (BMI) ≥ 25 kg/m2 (OR = 1.8, P = 0.025), number of children ≥4 (OR = 1.7, P = 0.046), and having children under 18 years. (OR = 2.1, P = 0.011) were significant independent risk factors for T2D. CONCLUSION: The prevalence of FI in patients with T2D was significantly higher compared to the controls. FI was an important risk factor for T2D, even after controlling for the potential confounders. Further studies are suggested.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Abastecimento de Alimentos/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Fatores de Risco , Fatores Socioeconômicos
18.
J Nurs Adm ; 49(7-8): 389-395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335521

RESUMO

OBJECTIVE: The purposes of this project were to identify innovations conceived from nurse faculty at a college of nursing and nurses in an academic medical center, examine their characteristics, and create a typology of nursing innovations. BACKGROUND: Innovation is a crucial component for progress in healthcare. Jobs to Be Done Theory suggests that to make progress in nursing, workers must be solution focused to answer problems. METHODS: This qualitative study used directed content analysis to evaluate survey responses of nurses in 1 university's academic and practice setting about solutions or innovations to achieve progress in their jobs. RESULTS: Fifty-seven examples of situations needing an innovative solution were coded and categorized by challenges to yield an 8 characteristic typology in nursing innovation. CONCLUSIONS: These findings serve as a guide for nurse executives to understand and leverage how innovations are conceptualized and translated in academia and practice.


Assuntos
Enfermeiras Administradoras , Inovação Organizacional , Resolução de Problemas , Centros Médicos Acadêmicos , Assistência à Saúde/métodos , Bacharelado em Enfermagem , Humanos , Pesquisa Qualitativa
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