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1.
Medicine (Baltimore) ; 99(4): e18822, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977875

RESUMO

Chronic sleep deprivation may worsen many medical and mental health conditions, causing difficulty in the ability to function at work. Job stress may be a factor that directly correlates with the poorer sleep quality of nurses from different departments in a general hospital. However, epidemiological evaluations of sleep problems among community nurses in China are scarce, and an association between sleep problems and occupational stress has not been investigated. This study investigated the association between nurses' job stress and sleep quality in a community hospital in China. This cross-sectional study was conducted from September to November 2017 and involved 180 nurses who had worked for more than 1 year in 12 community hospitals. The Job Stress Questionnaire was administered to evaluate occupational stress. The Pittsburgh Sleep Quality Index was used to evaluate sleep disorder status. Logistic regression was performed to investigate the association between job stress and sleep disorder among these community nurses in China. For the 155 nurses who completed the study, the job stress score was 58 ±â€Š18, and 72 nurses (46%) had a Pittsburgh Sleep Quality Index (PSQI > 7). The type of nurse contract and total job stress scores were related to sleep disturbances within the previous month. The job stress scores were negatively associated with sleep quality; in other words, the higher the job stress scores were, the worse the quality of sleep. The logistic regression analysis showed that the type of nurse contract and self-reported job stress were significant factors affecting sleep quality. Sleep disturbances in nurses were highly associated with job difficulty factor, doctor-patient relationships, psychosomatic state, environment or events, promotion or competition and total pressure scores. Sleep problems were prevalent among clinical nurses in community hospitals in China. Occupational stress negatively affects sleep quality in Chinese community nurses; the higher the stress is, the worse the sleep quality.


Assuntos
Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Ocupacional/psicologia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Estudos de Casos e Controles , China , Estudos Transversais , Hospitais Comunitários , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Estresse Ocupacional/epidemiologia , Prevalência , Pesquisa Qualitativa , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
2.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
3.
World Neurosurg ; 133: e76-e83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521757

RESUMO

OBJECTIVE: Spine fractures, including associated spinal cord injury, account for 3%-6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. METHODS: Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011-2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. RESULTS: A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. CONCLUSIONS: Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.


Assuntos
Transferência de Pacientes , Traumatismos da Coluna Vertebral/reabilitação , Atividades Cotidianas , Adulto , Idoso , Continuidade da Assistência ao Paciente , Feminino , Hospitais Comunitários , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/cirurgia , Centros de Atenção Terciária , Centros de Traumatologia , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
4.
Oral Dis ; 26(1): 234-237, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31621985

RESUMO

OBJECTIVE: To investigate associated risk factors for oral candidiasis in elderly patients hospitalized in a community-based acute-care hospital with no dental units. METHODS: Two hundred and twenty-eight elderly patients (male: 105, female: 123), who were hospitalized with several systemic diseases in a community-based acute-care hospital from May 2014 to October 2016, were retrospectively analysed by multiple logistic regression. RESULTS: Multiple logistic regression analysis shows that bacterial pneumonia has a statistically strong relationship with oral candidiasis (p = 0.000, OR: 5.173, 95% CI: 2.368-11.298). The order followed is poor oral hygiene (p = 0.001, OR: 6.095, 95% CI: 2.003-18.545) and severe dry mouth (p = 0.043, OR: 2.507, 95% CI: 1.031-6.098). Other correlated factors including diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care and use of inhalation steroids, were not statistically significant in this study. CONCLUSIONS: Bacterial pneumonia correlates with oral candidiasis.


Assuntos
Candidíase Bucal/complicações , Pneumonia Bacteriana/complicações , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição , Dentaduras , Diabetes Mellitus , Feminino , Hospitalização , Hospitais Comunitários , Humanos , Masculino , Desnutrição , Higiene Bucal , Estudos Retrospectivos , Fatores de Risco , Esteroides/administração & dosagem , Xerostomia/complicações
5.
J Oncol Pharm Pract ; 26(1): 60-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30924739

RESUMO

PURPOSE: As immune checkpoint inhibitors continue to acquire new indications, it is important to understand the impact their use has on patients. This study adds to current literature by presenting an analysis of hospitalizations in this population. The primary objective was to assess the reasons for an emergency department visit or hospital admission in patients who receive immune checkpoint inhibitors. Secondary objectives included identifying the frequency of suspected or confirmed immune related adverse events, types of immune related adverse events, number of preventable admissions, duration of immunotherapy, and length of stay. METHODS: This study was a retrospective, multi-center, chart review of patients hospitalized after receiving an immune checkpoint inhibitor. The population included patients aged 18 and above who received at least one dose of an immune checkpoint inhibitor at a network facility and had a documented admission within one year following the initiation of immunotherapy. Descriptive statistics were performed along with inferential comparisons and a Poisson regression to determine if the immune checkpoint blocker or cancer type predicted admission or reason for admission. RESULTS: The 99 patients who met inclusion criteria had a total of 202 admissions. Of these patients, 56 (56.6%) had multiple admissions within the year following initiation of immunotherapy. The most common diagnoses on initial admissions were shortness of breath, pain, and pneumonia. A total of 104 admissions (51.5%) were considered potentially preventable. Suspected or confirmed immune related adverse events were identified in 15.6% of all admissions. There were no significant predictors of admissions or reason for admission. CONCLUSION: Reasons for admission in the study population were comparable to those identified in the general cancer population, with immune related adverse events being associated with a minority of both total and potentially preventable admissions.


Assuntos
Hospitalização/tendências , Hospitais Comunitários/tendências , Hospitais de Ensino/tendências , Fatores Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Imunoterapia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/imunologia , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Neoplasias/terapia , Estudos Retrospectivos
7.
J Nurs Adm ; 49(12): 624-627, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31725521

RESUMO

Magnet designation requires that nurses be actively involved in activities that lead to obtaining evidence through conducting research. Unfortunately, several barriers limit nurses' ability to engage in research activities, including insufficient resources. This article explains how a community-based hospital implemented a fellowship model to circumvent some of these barriers. Two fellowship positions are described, 1 in research and 1 in library sciences. The method, outcomes, and cost of the fellowship model are discussed.


Assuntos
Educação de Pós-Graduação em Enfermagem/organização & administração , Bolsas de Estudo/organização & administração , Hospitais Comunitários/organização & administração , Papel do Profissional de Enfermagem , Pesquisa em Enfermagem/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Sudeste dos Estados Unidos
8.
J Nurs Adm ; 49(12): 610-616, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31725059

RESUMO

Creating a nursing journal club is an initiative to promote nurses' use of best evidence in practice. A virtual nursing journal club (VNJC) was implemented in a Magnet-designated, midsize community hospital. The VNJC fostered nurses' reading nursing research studies and subsequent interaction with other nurses. The VNJC's formation, implementation, and evaluation are described. Quantitative and qualitative research critique items and an evaluation form are included that are essential to the site's ongoing processes.


Assuntos
Educação Continuada em Enfermagem/métodos , Disseminação de Informação/métodos , Bibliotecas Digitais/organização & administração , Informática em Enfermagem/organização & administração , Pesquisa em Enfermagem/educação , Recursos Humanos de Enfermagem no Hospital/educação , Publicações Periódicas como Assunto , Adulto , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
10.
Transplant Proc ; 51(9): 3040-3041, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627921

RESUMO

Progress in transplantation means the process of procuring both human organ and tissues has become a daily challenge. Considering that tissues are usually procured from organ donors who have suffered brain death or after controlled cardiac death, the tissue procurement is done mainly in major hospitals. With the aim of highlighting the potential role of regional hospitals in tissue donation, a prospective descriptive study was carried out of all the patients who died at the Regional Hospital of Inca in Mallorca (Spain) from January 2013 to August 2018. To ensure an early detection of all possible tissue donors, the hospital has implemented a computerized alert system that is activated immediately after a patient dies. This strategy has proven to be very useful as in the analyzed period, the hospital had an average of 280 donors per million population, which is one of the highest rates of cornea donation among the Spanish hospitals. Our data and experience show the important role of regional hospitals in tissue donation and the value of implementing screening programs and early selection of potential tissue donors.


Assuntos
Hospitais Comunitários , Doadores de Tecidos/provisão & distribução , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Feminino , Hospitais Comunitários/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Espanha
11.
Med Care ; 57(11): 913-920, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31609847

RESUMO

OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Pacientes Internados/psicologia , Erros Médicos/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
12.
Tidsskr Nor Laegeforen ; 139(13)2019 Sep 24.
Artigo em Norueguês | MEDLINE | ID: mdl-31556521

RESUMO

BACKGROUND: Low back pain is considered to be the most common single cause of sickness absence. In 2010, Sørlandet Hospital Arendal established an interdisciplinary treatment programme through the Faster Return-to-Work scheme, based on the relevant guidelines for patients with low back pain. In this study we present our experiences from six years of the treatment programme. MATERIAL AND METHOD: Patients who were referred to Sørlandet Hospital in Arendal in the period 2011-16 due to long-term symptoms of low back pain were offered interdisciplinary treatment. This included a one-to-one consultation with a doctor, four weeks of group-based low back school, and physiotherapist-led exercise as well as eight weeks of either physiotherapist-led exercise or home exercise. The degree of sick leave and functional level using scores on the Roland-Morris Disability Questionnaire (RMDQ) were reported at the outset and after 4 and 12 weeks. RESULTS: A total of 43 patients in employment completed the treatment programme. The average age was 41.9 years and 52 % were women. Altogether 57 % were on certified sick leave at the outset and the remainder were assessed as being at high risk of going on sick leave. A total of 7.5 % were placed on sick leave during the observation period, while 28.5 % of those on sick leave were declared completely fit. Altogether 52.7 % of the patients had a clinically significant reduction in RMDQ scores (> 3.5 points). INTERPRETATION: The interdisciplinary treatment programme appears to improve function and reduce sickness absent in patients with long-term low back pain. This study has a short follow-up time and no control group; the observations must therefore be interpreted with caution.


Assuntos
Dor Lombar/terapia , Manejo da Dor/métodos , Equipe de Assistência ao Paciente , Adulto , Avaliação da Deficiência , Terapia por Exercício , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Avaliação de Programas e Projetos de Saúde , Recuperação de Função Fisiológica , Encaminhamento e Consulta , Retorno ao Trabalho , Licença Médica , Inquéritos e Questionários , Resultado do Tratamento
13.
West J Emerg Med ; 20(5): 710-716, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31539326

RESUMO

INTRODUCTION: The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA). METHODS: This was a retrospective record review of 357,764 ED visits from January 1, 2011-December 31, 2016, of which 74% were at the AMC and 26% at the CH. We assessed the severity of ED visits by applying the previously validated Ballard algorithm, which classifies ED visits as non-emergent, intermediate, or emergent. Descriptive analyses were conducted to compare the characteristics of ED visits before and after the implementation of the ACA. We conducted multilevel logistic regression analysis to examine the odds of non-emergent compared to intermediate/emergent ED visits by the ACA implementation status controlling for patient demographic characteristics, insurance status, and multiple visits per patient. RESULTS: ED visits for patients with Medicaid or other governmental coverages increased in the post-ACA compared to pre-ACA period (Pre: 33.2 % vs Post: 38.3% at the AMC, and Pre: 29.7% vs Post: 35.1% at the CH). A statistically significant decrease in ED visits for uninsured patients was observed at the AMC and CH in the post-ACA period compared to the pre-ACA period (Pre: 12.1% vs Post: 6.4%, and Pre: 13.9% vs Post: 9.8%, respectively). Results from the regression analysis showed a significant decreased odds of non-emergent vs intermediate/emergent ED visits during the post-ACA period compared to the pre-ACA period at the AMC (odds ratio [OR] 0.68; confidence interval [CI], 0.66-0.70). However, an increased odds of non-emergent vs. intermediate/emergent ED visits was observed at the CH (OR 1.09; CI, 1.04-1.14). CONCLUSION: Similar to other Medicaid expansion states, ED utilization for uninsured patients decreased at both the AMC and the CH in the post-ACA period. While Medicaid visits for children < 18 years declined in the post-ACA period, it increased for ages 21 to 65 years of age. Contrary to our hypothesis, the severity of emergent ED visits increased in the post-ACA period but not at the CH.


Assuntos
Centros Médicos Acadêmicos/economia , Assistência à Saúde/economia , Serviço Hospitalar de Emergência/organização & administração , Hospitais Comunitários/economia , Patient Protection and Affordable Care Act/organização & administração , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Illinois , Lactente , Cobertura do Seguro , Masculino , Medicaid , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
14.
Medicine (Baltimore) ; 98(34): e16951, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441892

RESUMO

Teaching status/academic ranking may play a role in the variations in trauma center (TC) outcomes. Our study aimed to determine the relationship between TC teaching status and injury-adjusted, all-cause mortality in a national sampling.Retrospective review of the National Sample Program (NSP) from the National Trauma Data bank (NTDB). TCs were categorized based on teaching status. Adjusted mortality was determined by observed/expected (O/E) mortality ratios, derived using TRauma Injury Severity Score methodology from the Injury Severity Score and Revised Trauma Score. Chi-square and t test analyses were utilized with a statistical significance defined as P <.05.Of the 94 TCs in the NSP, 46 were university, 38 were community teaching, and 10 were community nonteaching. For the University TCs, 62.8% were American College of Surgeons (ACS) level 1 and 81.2% state level 1. Of the community teaching TCs, 39.0% was ACS level 1 and 35.1% was state level 1. Of the community nonteaching TCs, 0% was ACS level 1 and 11.1% was state level 1. University TCs had a significantly higher O/E mortality rate than community teaching (0.75 vs 0.71; P = .04). There were no differences in O/E between community teaching and nonteaching TCs (0.71 vs 0.70; P = .70).Community teaching and nonteaching TCs have lower injury-adjusted, all-cause mortality rates than University Centers. Future studies should further investigate key differences between University TCs and community teaching TC to evaluate possible quality and performance improvement measures.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Centros de Traumatologia/normas , Ferimentos e Lesões/mortalidade , Adulto , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Centros de Traumatologia/classificação , Estados Unidos
15.
Medicine (Baltimore) ; 98(32): e16370, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393346

RESUMO

Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P = .004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P = .011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.


Assuntos
Afro-Americanos , Doenças Cardiovasculares/etnologia , Dor no Peito/etnologia , Indicadores Básicos de Saúde , Hospitais Comunitários/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/mortalidade , Dor no Peito/etiologia , Dor no Peito/mortalidade , Eletrocardiografia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Readmissão do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/estatística & dados numéricos , Troponina/sangue
16.
West J Emerg Med ; 20(4): 626-632, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316702

RESUMO

Introduction: In many hospitals, off-hours emergency department (ED) radiographs are not read by a radiologist until the following morning and are instead interpreted by the emergency physician (EP) at the time of service. Studies have found conflicting results regarding the radiographic interpretation discrepancies between EPs and trained radiologists. The aim of this study was to identify the number of radiologic interpretation discrepancies between EPs and radiologists in a community ED setting. Methods: Using a pre-existing logbook of radiologic discrepancies as well as our institution's picture archiving and communication system, all off-hours interpretation discrepancies between January 2012 and January 2015 were reviewed and recorded in a de-identified fashion. We recorded the type of radiograph obtained for each patient. Discrepancy grades were recorded based on a pre-existing 1-4 scale defined in the institution's protocol logbook as Grade 1 (no further action needed); Grade 2 (call to the patient or pharmacy); Grade 3 (return to ED for further treatment, e.g., fracture not splinted); Grade 4 (return to ED for serious risk, e.g., pneumothorax, bowel obstruction). We also recorded the total number of radiographs formally interpreted by EPs during the prescribed time-frame to determine overall agreement between EPs and radiologists. Results: There were 1044 discrepancies out of 16,111 EP reads, indicating 93.5% agreement. Patients averaged 48.4 ± 25.0 years of age and 53.3% were female; 25.1% were over-calls by EPs. The majority of discrepancies were minor with 75.8% Grade 1 and 22.3% Grade 2. Only 1.7% were Grade 3, which required return to the ED for further treatment. A small number of discrepancies, 0.2%, were Grade 4. Grade 4 discrepancies accounted for two of the 16,111 total reads, equivalent to 0.01%. A slight disagreement in finding between EP and radiologist accounted for 8.3% of discrepancies. Conclusion: Results suggest that plain radiographic studies can be interpreted by EPs with a very low incidence of clinically significant discrepancies when compared to the radiologist interpretation. Due to rare though significant discrepancies, radiologist interpretation should be performed when available. Further studies are needed to determine the generalizability of this study to EDs with differing volume, patient population, acuity, and physician training.


Assuntos
Erros de Diagnóstico , Serviço Hospitalar de Emergência , Médicos , Radiografia , Radiologistas , Competência Clínica , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade
17.
West J Emerg Med ; 20(4): 654-665, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316707

RESUMO

Introduction: Canadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED. Methods: We implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis. Results: During the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA - 19.8 minutes (p<0.01), and LWBS - 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention. Conclusion: SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.


Assuntos
Protocolos Clínicos , Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Hospitais Comunitários , Hospitais Rurais , Humanos , Análise de Séries Temporais Interrompida , Terra Nova e Labrador , Triagem
18.
Urology ; 133: 34-39, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31310767

RESUMO

OBJECTIVE: To evaluate the sensitivity of ultrasound imaging in detecting upper urinary tract malignancy in patients with asymptomatic microscopic hematuria (AMH) in an outpatient community setting. MATERIALS AND METHODS: A list of all patients who received renal ultrasound for hematuria in our health care system between January 1, 1997 and July 1, 2015 was obtained, and electronic health records were retrospectively reviewed. Patients were excluded for age (<18 years), <3 years follow-up, prior upper tract malignancy, recent urinary tract catheterization, inpatient status, pregnancy, insufficient data, or gross hematuria. The initial ultrasound was considered positive if suspicious findings led to a subsequent diagnosis of an upper tract malignancy. False negatives were determined by electronic medical record follow-up for at least 3 years. RESULTS: Of the 2138 patients with AMH who met inclusion criteria, ultrasound imaging detected suspicious findings in 9 of 9 patients with renal cell carcinoma and 3 of 3 patients with upper tract urothelial cancer, indicating a sensitivity of 100% and 100%, respectively. Four additional malignancies were diagnosed more than 3 years after the initial evaluation for an incidence rate of 1.6 cases of upper tract malignancy per 10,000 person-years. CONCLUSION: The prevalence of upper urinary tract malignancy was low in patients with AMH. Ultrasonography is an appropriate modality for upper tract imaging in the initial evaluation of patients with AMH. Practice guidelines should be updated to reflect the high sensitivity of ultrasound and low risk of upper tract malignancy in patients with AMH.


Assuntos
Doenças Assintomáticas , Hematúria/etiologia , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Rim/diagnóstico por imagem , Neoplasias Ureterais/complicações , Neoplasias Ureterais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Ultrassonografia
19.
Medicine (Baltimore) ; 98(27): e16233, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277137

RESUMO

To assess the impact of multidisciplinary rounds (MDR) on 30-day readmissions and length of stay in hospitalized patients with a diagnosis of congestive heart failure in a community teaching hospital.Patients with primary admission diagnosis of congestive heart failure (CHF) were included. A before and after retrospective study was conducted once the intervention was implemented in 2014. The before and after study periods were each of 1-year duration and included 181 and 151 patients, respectively. Our multidisciplinary heart failure rounding team consisted of a staff cardiologist, case manager, pharmacist, social worker, and a nutritionist.The mean length of stay decreased from 5.7 days to 5 days, and 30-day readmissions decreased from 27.6% to 17.22% (P-value .026) after implementation of the multidisciplinary rounding. We observed a significant decrease of readmissions in ischemic cardiomyopathy (ICM) (from 33.61% to 14.01%; P-value .007) and heart failure with reduced ejection fraction (HFrEF) (from 31.34% to 16.05%; P-value .028) patients. There was an increase in the percentage of patients hospitalized with non-ischemic cardiomyopathy (NICM) and heart failure with preserved ejection fraction (HFpEF) and, in particular, women patients with heart failure.Implementation of MDR program on CHF patients resulted in significant decrease in both readmission rate and length of stay in our hospital.


Assuntos
Gerenciamento Clínico , Insuficiência Cardíaca/terapia , Hospitais Comunitários/estatística & dados numéricos , Estudos Interdisciplinares , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Idoso , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo
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