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Ahmed A. Quality Metrics in Acute Stroke: Time to Own. Indian J Crit Care Med 2023; 27:786-787. [PMID: 37936796 PMCID: PMC10626240 DOI: 10.5005/jp-journals-10071-24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
How to cite this article: Ahmed A. Quality Metrics in Acute Stroke: Time to Own. Indian J Crit Care Med 2023;27(11):786-787.
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Affiliation(s)
- Asif Ahmed
- Department of Critical Care Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India
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Murray NM, Marshall S, Hoesch R, Hobbs K, Smith S, Roller D, Thomas K, Meier K, Puttgen A. Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy. Neurocrit Care 2023; 38:650-656. [PMID: 36324004 DOI: 10.1007/s12028-022-01632-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/07/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teleneurocritical care (TNCC) provides 24/7 virtual treatment of patients with neurological disease in the emergency department or intensive care unit. However, it is not known if TNCC is safe, effective, or associated with similar outcomes compared with in-person neurocritical care. We aim to determine the effect of daily inpatient consults from TNCC on the outcomes of patients with large vessel occlusive acute ischemic stroke treated by thrombectomy. METHODS A multicenter, retrospective cohort of consecutive patients ≥ 18 years old with acute ischemic stroke from a large vessel occlusion treated by thrombectomy were identified from 2018 to 2021 within a telehealth network of an integrated not-for-profit health care system in the United States. The primary end point was good functional outcome, i.e., modified Rankin Scale 0-3, at the time of hospital discharge in patients receiving in-person neurocritical care versus TNCC. RESULTS A total of 437 patients met inclusion criteria, 226 at the in-person hospital (median age 67, 53% women) and 211 at the two TNCC hospitals (median age 74, 49% women). The rate of successful endovascular therapy (modified Thrombolysis in Cerebral Infarction score 2b-3) was not different among hospitals. Good functional outcome at discharge was similar between in-person neurocritical care and TNCC (in-person 31.4% vs. TNCC 33.5%, odds ratio 0.88, 95% confidence interval 0.6-1.3; p = 0.64). Only National Institutes of Health stroke scale and age were multivariable predictors of outcome. There were no differences in mortality (9.3% vs. 13.2%, p = 0.19), intensive care unit length of stay (2.1 vs. 1.9 days, p = 0.39), or rate of symptomatic intracerebral hemorrhage (6.8% vs. 6.6%, p = 0.47) between in-person neurocritical care and TNCC. CONCLUSIONS Teleneurocritical care allows for equivalent favorable functional outcomes compared with in-person neurocritical care for patients with acute large vessel ischemic stroke receiving thrombectomy. The standardized protocols used by TNCC in this study, specifically the comprehensive 24/7 treatment of patients in the intensive care unit for the length of their stay, may be relevant for other health systems with limited in-person resources; however, additional study is required.
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Affiliation(s)
- Nick M Murray
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA.
| | - Scott Marshall
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Robert Hoesch
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Kyle Hobbs
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Shawn Smith
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Dean Roller
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Katherine Thomas
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Kevin Meier
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Adrian Puttgen
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
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Bolte TB, Swanson MB, Kaldjian AM, Mohr NM, McDanel J, Ahmed A. Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement. J Patient Saf 2022; 18:e1231-e1236. [PMID: 35858483 PMCID: PMC9722504 DOI: 10.1097/pts.0000000000001062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Sepsis is a common cause of death. The Centers for Medicare and Medicaid Services severe sepsis/septic shock (SEP-1) bundle is focused on improving sepsis outcomes, but it is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and reduced sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and nonreporting hospitals and to measure the association between sepsis QI processes, SEP-1 performance, and sepsis mortality. MATERIALS AND METHODS This study linked survey data on QI practices from Iowa hospitals to SEP-1 performance data and mortality. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with SEP-1 performance and observed-to-expected sepsis mortality ratios. RESULTS One hundred percent of Iowa's 118 hospitals completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%, P = 0.026) and using the case review process to develop sepsis care plans (87% versus 64%, P = 0.013). Sepsis QI practices were not associated with increased SEP-1 scores. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality (odds ratio, 0.37; 95% confidence interval, 0.14 to 0.96, P = 0.041), and presence of a sepsis committee was associated with lower hospital-specific mortality (observed-to-expected ratio, -0.11; 95% confidence interval, -0.20 to 0.01). CONCLUSIONS Hospitals reporting SEP-1 compliance conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.
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Affiliation(s)
- Ty B. Bolte
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Morgan B. Swanson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Anna M. Kaldjian
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
- Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine
| | - Jennifer McDanel
- Clinical Quality, Safety & Performance Improvement, University of Iowa Hospitals and Clinics
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine
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Noshad M, Rose CC, Chen JH. Signal from the Noise: A Mixed Graphical and Quantitative Process Mining Approach to Evaluate Care Pathways Applied to Emergency Stroke Care. J Biomed Inform 2022; 127:104004. [DOI: 10.1016/j.jbi.2022.104004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Abstract
This article focuses on the inpatient evaluation and management of ischemic stroke and transient ischemic attack (TIA). We describe foundational principles including quality metrics, TIA, and stroke as emergencies, TIA/minor stroke management, and standard assessments before discussing tailored evaluation and management strategies by stroke type.
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Affiliation(s)
- Lauren Patrick
- Department of Neurology, Division of Neurovascular, University of California San Francisco, 505 Parnassus Avenue, M-830, San Francisco, CA 94143, USA; Weill Institute for Neuroscience, San Francisco, CA, USA
| | - Cathra Halabi
- Department of Neurology, Division of Neurovascular, University of California San Francisco, 505 Parnassus Avenue, M-830, San Francisco, CA 94143, USA; Weill Institute for Neuroscience, San Francisco, CA, USA.
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Li D, Zhang H, Lu X, Zhang L, Liu J. Practice of integrated treatment process for acute ischaemic stroke in hospital coordinated by emergency stroke nurses. Nurs Open 2021; 9:586-592. [PMID: 34741501 PMCID: PMC8685882 DOI: 10.1002/nop2.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Aims To explore the practice effect of establishing an integrated treatment process by stroke emergency nurses in general hospitals for acute ischaemic stroke (AIS). Design Compared the time spent in each link before and after the establishment of AIS integrated treatment. Methods Since March 2016, we set up a team of emergency stroke nurses (ESN), trained and assessed the knowledge of emergency stroke, and set up a post of ESN. Results The median time of admission‐judgement, admission‐establishment of venous access, admission‐cranial CT examination and admission‐intravenous thrombolytic therapy was statistically significantly shortened after the implementation of the integrated treatment process of AIS coordinated by stroke emergency nurses (p < .01). The new treatment process of AIS further shortens the time of each treatment link and promotes the timeliness.
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Affiliation(s)
- Dongmei Li
- Cerebrovascular center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hongjian Zhang
- Cerebrovascular center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaoying Lu
- Nursing Department, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lingjuan Zhang
- Nursing Department, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Cerebrovascular center, Changhai Hospital, Naval Medical University, Shanghai, China
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Bufalino VJ, Bleser WK, Singletary EA, Granger BB, O'Brien EC, Elkind MSV, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006780. [PMID: 32683982 DOI: 10.1161/circoutcomes.120.006780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population health interventions. In addition to adverse trends in stroke-related morbidity and mortality across the broader population, there are sociodemographic inequities in stroke risk. These challenges can be addressed by focusing on predicting and preventing modifiable upstream risk factors associated with stroke, but there is a need to develop a practical framework that health care organizations can use to accomplish this task across diverse settings. Accordingly, this article describes the efforts and vision of the multi-stakeholder Predict & Prevent Learning Collaborative of the Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. This article presents a framework of a potential upstream stroke prevention program with evidence-based implementation strategies for predicting, preventing, and managing stroke risk factors. It is meant to complement existing primary stroke prevention guidelines by identifying frontier strategies that can address gaps in knowledge or implementation. After considering a variety of upstream medical or behavioral risk factors, the group identified 2 risk factors with substantial direct links to stroke for focusing the framework: hypertension and atrial fibrillation. This article also highlights barriers to implementing program components into clinical practice and presents implementation strategies to overcome those barriers. A particular focus was identifying those strategies that could be implemented across many settings, especially lower-resource practices and community-based enterprises representing broad social, economic, and geographic diversity. The practical framework is designed to provide clinicians and health systems with effective upstream stroke prevention strategies that encourage scalability while allowing customization for their local context.
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Affiliation(s)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Elizabeth A Singletary
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Bradi B Granger
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Emily C O'Brien
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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Cheng EM, Wu AD, Wilson AM. Evaluating alerts: All alerts are not equally effective. Muscle Nerve 2020; 61:552-553. [DOI: 10.1002/mus.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Eric M. Cheng
- Department of NeurologyDavid Geffen School of Medicine, University of California Los Angeles California
| | - Allan D. Wu
- Department of NeurologyDavid Geffen School of Medicine, University of California Los Angeles California
| | - Andrew M. Wilson
- Department of NeurologyDavid Geffen School of Medicine, University of California Los Angeles California
- Department of NeurologyGreater Los Angeles Healthcare System Los Angeles California
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Ali SF, Fonarow G, Liang L, Xian Y, Smith EE, Bhatt DL, Schwamm L. Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care. Circ Cardiovasc Qual Outcomes 2019; 11:e003359. [PMID: 30354551 DOI: 10.1161/circoutcomes.116.003359] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background While many patients are transferred to specialized stroke centers for advanced acute ischemic stroke (AIS) care, few studies have characterized these patients. We sought to determine variation in the rates and differences in the baseline characteristics and clinical outcomes between AIS cases presenting directly to stroke centers' front door versus Transfer-Ins from another hospital. Methods and Results We analyzed 970 390 AIS cases in the Get With The Guidelines-Stroke registry from January 2010 to March 2014 to compare hospitals with high Transfer-In rates (≥15%) versus those with low Transfer-In rates (<5%) and to compare the front-door versus Transfer-In patients admitted to those hospitals with high Transfer-In rates (high Transfer-In hospitals). Of 970 390 patients discharged from 1646 hospitals, 87% initially presented via the emergency department versus 13% were a Transfer-In from another hospital. High Transfer-In hospitals had a median 31% Transfer-In rate among all stroke discharges, were larger, had higher annual AIS volume and intravenous tPA (tissue-type plasminogen activator) rates, and were more often Midwest teaching hospitals and stroke centers. Compared with front-door, Transfer-In patients were younger, more often white, had higher median National Institutes of Health Stroke Scale scores, less often hypertension and previous stroke/transient ischemic attack, and higher in-hospital mortality (7.9% versus 4.9%; standardized difference, 12.4%). After multivariable adjustment, Transfer-In patients had higher in-hospital mortality and discharge modified Rankin scale. Conclusions There is significant regional variability in the transfer of patients with AIS. Because Transfer-In patients seem to have worse short-term outcomes, these patients have the potential to negatively influence institutional mortality rates and should be accounted for explicitly in hospital risk-profiling measures.
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Affiliation(s)
- Syed F Ali
- University of Arkansas for Medical Sciences, Little Rock (S.F.A.)
| | | | - Li Liang
- Duke Clinical Research Institute, Durham, NC (L.L., Y.X.)
| | - Ying Xian
- Duke Clinical Research Institute, Durham, NC (L.L., Y.X.)
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, AB (E.E.S.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center (D.L.B.)
| | - Lee Schwamm
- Massachusetts General Hospital (L.S.), Harvard Medical School, Boston, MA
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Akwe J, Wallace JM. Using Stroke Order Sets to Improve Compliance With Quality Measures for Ischemic Stroke Admissions. Fed Pract 2018; 35:18-23. [PMID: 30766370 PMCID: PMC6368016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Creation of electronic health record order sets may improve adherence to The Joint Commission National Quality Measures for care of veterans with ischemic stroke.
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Affiliation(s)
- Joyce Akwe
- is the Chief of Hospital Medicine, and is a Performance Improvement Coordinator for Specialty Medicine, both at the Atlanta VA Health Care System in Georgia. Dr. Akwe is an Associate Professor of Medicine at the Emory University School of Medicine in Atlanta
| | - Joseph Michael Wallace
- is the Chief of Hospital Medicine, and is a Performance Improvement Coordinator for Specialty Medicine, both at the Atlanta VA Health Care System in Georgia. Dr. Akwe is an Associate Professor of Medicine at the Emory University School of Medicine in Atlanta
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Klein LM, Young D, Feng D, Lavezza A, Hiser S, Daley KN, Hoyer EH. Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project. Nurs Outlook 2018; 66:254-262. [DOI: 10.1016/j.outlook.2018.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
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Probasco JC, Lavezza A, Cassell A, Shakes T, Feurer A, Russell H, Sporney H, Burnett M, Maritim C, Urrutia V, Puttgen HA, Friedman M, Hoyer EH. Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients. Neurohospitalist 2017; 8:53-59. [PMID: 29623154 DOI: 10.1177/1941874417729981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although many hospitalized neuroscience patients have physical and occupational therapy (rehabilitation) needs, patients with none or minimal physical impairments frequently receive rehabilitation consultation, diverting from patients with greatest need. Methods A multidisciplinary team on the general and cerebrovascular neurology acute inpatient services mapped the rehabilitation consultation process, resulting in multiple implemented interventions including physician education on appropriate acute rehabilitation consultations, modification of multidisciplinary rounds, and discussion of patient rehabilitation needs throughout hospitalization. Nurses used the same functional impairment measurement tool used by physical and occupational therapists, the Activity Measure for Post-Acute Care Inpatient Short Forms (Basic Mobility and Activity domains). Results The rate for initial rehabilitation consults for patients with no limitations in mobility or activity during the 6-month baseline period was 12%, which was decreased to 7% and 10% during the 6-month intervention and sustain periods, respectively (P < .001). The baseline rate for patients with no limitations receiving both physical therapy and occupational therapy consultations was 62% and was decreased to 21% and 39% in the intervention and sustain periods, respectively (P < .001). Rehabilitation sessions per hospital day increased for patients with high functional impairments, from 0.52 at baseline to 0.64 in the intervention and 0.66 in the sustain periods (P = .02), which equated to 1 more rehabilitation visit per patient hospitalization. Conclusions A multifaceted intervention led to improved utilization of acute inpatient rehabilitation consultation while increasing the frequency of rehabilitation treatment for patients with highest functional impairment.
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Affiliation(s)
- John C Probasco
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andre Cassell
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Tenise Shakes
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Angie Feurer
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Holly Russell
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hilary Sporney
- Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Margie Burnett
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chepkorir Maritim
- Department of Quality Improvement, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Victor Urrutia
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - H Adrian Puttgen
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Anesthesia, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Ruland S, Biller J. Risk of warfarin-associated intracerebral haemorrhage after ischaemic stroke is low and unchanged during the 2000s. EVIDENCE-BASED MEDICINE 2015; 20:36. [PMID: 25510654 DOI: 10.1136/ebmed-2014-110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Sean Ruland
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - José Biller
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
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Abstract
Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.
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Affiliation(s)
- Raman Khanna
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tony Yen
- Chief Medical Information Officer, EvergreenHealth, Kirkland, WA, USA
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