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Inpatient teaching unit

Norman Lance Downing, Joshua Rolnick, Sarah F Poole, Evan Hall, Alexander J Wessels, Paul Heidenreich, Lisa Shieh
BACKGROUND: Sepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions. OBJECTIVES: To determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis...
March 14, 2019: BMJ Quality & Safety
Rikinkumar S Patel, Shailesh Bobby Jain, Nagy A Youssef
OBJECTIVE: Main objectives of the study are to (1) describe the utilization of electroconvulsive treatment (ECT) for the treatment of manic episodes (ME) and (2) examine the effect of early inpatient use of ECT (within 7 days of admission) compared with delayed use on length of stay and cost of inpatient care. METHOD: The total sample of 14,005 inpatients with a principal diagnosis of bipolar disorder, ME (2012-2014), from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project were analyzed using univariate and logistic regressions...
March 13, 2019: Journal of ECT
Mark Mariathas, Rick Allan, Sanjay Ramamoorthy, Bartosz Olechowski, Jonathan Hinton, Martin Azor, Zoe Nicholas, Alison Calver, Simon Corbett, Michael Mahmoudi, John Rawlins, Iain Simpson, James Wilkinson, Chun Shing Kwok, Paul Cook, Mamas A Mamas, Nick Curzen
OBJECTIVE: To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital. DESIGN: Prospective, observational cohort study. SETTING: University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017. PARTICIPANTS: 20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason...
March 13, 2019: BMJ: British Medical Journal
Shiri Assis-Hassid, Barbara J Grosz, Eyal Zimlichman, Ronen Rozenblum, David W Bates
BACKGROUND: The majority of U.S hospitals have implemented electronic health records (EHRs). While the benefits of EHRs have been widely touted, little is known about their effects on inpatient care, including how well they meet workflow needs and support care. OBJECTIVE: Assess the extent to which EHRs support care team workflow during hospital morning rounds. DESIGN: We applied a mixed-method approach including observations of care teams during morning rounds, semi-structured interviews and an electronic survey of hospital inpatient clinicians...
2019: PloS One
Seohyuk Lee, Nicholas Czuzoj-Shulman, Haim Arie Abenhaim
Background Behcet's disease (BD) is a rare, multi-systemic inflammatory disorder for which only limited and contradictory data exists in the context of pregnancy. Our objective was to estimate the prevalence of BD in pregnancy and to evaluate maternal and fetal outcomes associated with pregnant women living with BD. Methods Using the 1999-2013 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States, we performed a population-based retrospective cohort study consisting of pregnancies that occurred during this time period...
February 15, 2019: Journal of Perinatal Medicine
Mayur Sharma, Beatrice Ugiliweneza, Enzo M Fortuny, Nicolas K Khattar, Noberto Andaluz, Robert F James, Brian J Williams, Maxwell Boakye, Dale Ding
OBJECTIVEThe development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).METHODSThe authors extracted data from the NIS database for the years 1998-2015 using the ICD-9/10 diagnostic and procedure codes...
February 1, 2019: Neurosurgical Focus
Mustafa Raoof, Syed Nabeel Zafar, Philip H G Ituarte, Robert S Krouse, Kurt Melstrom
BACKGROUND: Investigating methods to assess the quality of cancer surgery and then benchmarking hospitals on these quality indicators can lead to improvements in cancer care in the United States. We sought to determine the utility of lymph node count as a quality metric. METHODS: We performed a retrospective analysis of the California Cancer Registry database (2004-2011) merged with Office of Statewide Health Planning and Development inpatient database. Patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant therapy and resection were included...
April 2019: Journal of Surgical Research
Clifford C Sheckter, Jeffrey Jopling, Qian Ding, Amber W Trickey, Todd Wagner, Arden Morris, Mary Hawn
INTRODUCTION: Healthcare value is a national priority, and there are substantial efforts to reduce overuse of low-value testing. Residency training programs and teaching hospitals have been implicated in excessive testing. We evaluated the impact of surgery residents on the frequency of inpatient testing and investigated potential inter-resident variation. METHODS: Inpatient laboratory and imaging orders placed on general surgery services were extracted from an academic institution from 2014-2016 and linked to National Surgical Quality Improvement Program data...
January 17, 2019: Journal of the American College of Surgeons
João Paulo Vilela Rodrigues, Fabiana Angelo Marques, Ana Maria Rosa Freato Gonçalves, Marília Silveira de Almeida Campos, Tiago Marques Dos Reis, Manuela Roque Siani Morelo, Andrea Fontoura, Beatriz Maria Pereira Girolineto, Helen Palmira Miranda de Camargo Souza, Maurílio de Souza Cazarim, Lauro César da Silva Maduro, Leonardo Régis Leira Pereira
It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP...
2019: PloS One
Tânia Solange Bosi de Souza Magnago, Juliana Dal Ongaro, Patrícia Bittencourt Toscani Greco, Taís Carpes Lanes, Caroline Zottele, Naiane Glaciele Gonçalves, Rafaela Andolhe
OBJECTIVE: To evaluate the hospital infrastructure and the knowledge of the coordinators about the unit structure for hand hygiene. METHODS: Descriptive cross-sectional design study carried out in a teaching hospital in the South of Brazil, in the period between December 2016 and January 2017. Eighteen inpatient care units were evaluated, and 16 coordinators were interviewed. We used the questionnaire of the World Health Organization multimodal strategy on the structure of the units for hand hygiene...
January 10, 2019: Revista Gaúcha de Enfermagem
Benjamin P George, Thomas A Pieters, Christopher G Zammit, Adam G Kelly, Kevin N Sheth, Tarun Bhalla
OBJECTIVE: Stroke care in the US is increasingly regionalized. Many patients undergo interhospital transfer to access specialized, time-sensitive interventions such as mechanical thrombectomy. METHODS: Using a stratified survey design of the US Nationwide Inpatient Sample (2009-2014) we examined trends in interhospital transfers for ischemic stroke resulting in mechanical thrombectomy. International Classification of Disease-Ninth Revision (ICD-9) codes were used to identify stroke admissions and inpatient procedures within endovascular-capable hospitals...
January 7, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Rupak Desai, Upenkumar Patel, Hee Kong Fong, Ashish Sadolikar, Dipen Zalavadia, Sonu Gupta, Rajkumar Doshi, Rajesh Sachdeva, Gautam Kumar
OBJECTIVES: Intravascular ultrasonography (IVUS) and coronary atherectomy (CA) are useful modalities in managing calcified coronary lesions. Considering an inadequacy of data, we aimed to compare the outcomes with versus without IVUS assistance in percutaneous coronary interventions (PCIs) with CA. METHODS: From the National (Nationwide) Inpatient Sample data set for the years 2012 to 2014, we identified adult patients undergoing PCI and CA with or without IVUS assistance using International Classification of Diseases, Ninth Revision, Clinical Modification codes...
January 4, 2019: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Seungwon Yoon, Jennifer C Yoon, Ethan Winkler, Caterina Liu, Michael T Lawton
Background and Purpose- Aneurysmal subarachnoid hemorrhage (aSAH) has a high healthcare cost burden. Methods- We performed a cross-sectional analysis of the costs of clipping and coiling of aSAH using the National Inpatient Sample and Vizient databases. We conducted multiple regression analyses to estimate national costs and study associations between patient demographic, clinical, and hospital factors and treatment costs. Results- We identified 23 324 ruptured aneurysm patients in the National Inpatient Sample (2002-2013) and found mean inflation-adjusted costs for clipping increased 41...
December 3, 2018: Stroke; a Journal of Cerebral Circulation
Ana Recober, Payal B Patel, Dylan P Thibault, Andrew W Hill, Eric A Kaiser, Allison W Willis
BACKGROUND: Although migraine often starts in childhood or adolescence, hospital care for migraine in children is not well described. We examined patient and hospital characteristics associated with hospital care for migraine among children in the United States. METHODS: We queried the Kids' Inpatient Database (2003 to 2009) for hospitalizations of children aged 3-20. Sociodemographic and hospital characteristics were compared between hospitalizations for migraine and for other common medical conditions...
February 2019: Pediatric Neurology
Savannah Norman, Frank DeCicco, Jennifer Sampson, Ian M Fraser
OBJECTIVES: Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN: Quality improvement before-after unblinded trial. SETTING: 430-bed Canadian community teaching hospital. PARTICIPANTS: All admitted adult medical-surgical patients in a before-after 12-month interventional study...
December 14, 2018: BMJ Open
Ruchika Goel, Eshan U Patel, Jodie L White, Meera R Chappidi, Paul M Ness, Melissa M Cushing, Clifford M Takemoto, Beth H Shaz, Steven M Frank, Aaron A R Tobian
BACKGROUND: Demographic and hospital-level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized. METHODS: We conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally-representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes...
February 2019: Transfusion
Thomas S Metkus, Steven P Schulman, Joseph E Marine, Shaker M Eid
BACKGROUND: The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established. METHODS: To determine the current incidence of pericardial complications and the outcomes of patients undergoing TTP, we performed an analysis using the National Inpatient Sample (NIS), which is a US national database of hospital admissions. All patients who underwent TTP were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification codes...
December 10, 2018: Chest
Zubair Shah, Venkat Vuddanda, Aniket S Rali, Hema Pamulapati, Reza Masoomi, Kamal Gupta
AIM: The aim of this study is to report recent trends in the performance of endomyocardial biopsy (EMB) and its in-hospital complications (and their predictors) in the United States (US). METHOD: We analyzed Nationwide Inpatient Sample (NIS) database from years 2007 through 2014 to identify patients who underwent EMB. Once identified, the patients were subdivided into those with no history of heart transplant (HT) (cohort 1) and those with history of HT (cohort 2)...
December 5, 2018: Cardiology
Koray K Demir, Matthew P Cheng, Todd C Lee
INTRODUCTION AND OBJECTIVE: Diagnostic testing for Clostridioides difficile infection (CDI) by nucleic acid amplification test (NAAT) cannot distinguish between colonization and infection. A positive NAAT may therefore represent a false positive for infection, since diarrhea due to various aetiologies may occur in hospitalized patients. Our objective was to help answer the question: "does this medical inpatient with diarrhea have CDI?" DESIGN: We conducted a retrospective cohort study (n = 248) on the Clinical Teaching Units of the Royal Victoria Hospital (Montréal, Canada)...
2018: PloS One
Martha Quinn, Jane Forman, Molly Harrod, Suzanne Winter, Karen E Fowler, Sarah L Krein, Ashwin Gupta, Sanjay Saint, Hardeep Singh, Vineet Chopra
Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication. Methods We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis...
November 29, 2018: Diagnosis
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