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Sangari A, Sood A, Stoff BK. What to do when you are curbsided by your patient's plus one. J Am Acad Dermatol 2024; 90:671-672. [PMID: 36029913 DOI: 10.1016/j.jaad.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Ayush Sangari
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Aditya Sood
- Department of Dermatology, Emory University School of Medicine, Druid Hills, Georgia.
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Druid Hills, Georgia; Emory Center for Ethics, Druid Hills, Georgia
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2
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Rutsky J, Schumacher D, Mallon D. Relevance, quick hits, and vibe: Features of meaningful teaching and learning during trainee consult interactions. J Hosp Med 2024; 19:24-30. [PMID: 38073059 PMCID: PMC10842903 DOI: 10.1002/jhm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Consults are increasingly frequent in inpatient pediatric services. Consult interactions between trainees provide a rich opportunity for teaching and learning. What constitutes meaningful teaching interactions with trainees has not been described. OBJECTIVE Explore how consulting fellows and residents define "meaningful teaching interactions" associated with inpatient consult interactions. METHODS Four focus groups were conducted with 21 pediatric trainees (11 subspecialty fellows and 10 residents) at one institution. Transcriptions were analyzed using thematic analysis to inductively create categories and themes. RESULTS Five factors define meaningful teaching interactions: (1) Relevance; (2) Quick Hits; (3) Vibe; (4) Face-to-face Interactions; and (5) Timing and Busyness. Meaningful content was described as relevant to current or future patient care. Residents valued content that would enable them to explain the reasoning behind recommendations and think through the next steps. Trainees highlighted brief clinical pearls as superior to longer teaching sessions. The "vibe" between resident and fellow was described as a prerequisite to meaningful teaching and included aspects of interest, receptivity, tone, and attitude. Face-to-face interactions were preferred by many trainees, from initial consults to seeing patients or co-rounding. Timing and workload reflected discordant schedules, including time of day and week, but setting a planned time for teaching was beneficial. CONCLUSION Relevant, bite-sized educational content combined with a good vibe and optimal timing creates a context in which consult fellows can foster meaningful teaching opportunities for residents.
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Affiliation(s)
- Jessica Rutsky
- Department of Pediatrics and Communicable Disease, Division of Pediatric Gastroenterology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor MI 48109, U.S.A
| | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
| | - Daniel Mallon
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center
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Freeman CW, O'Brien S, Levin D, Cook T. Striving to be of Value: Building a Virtual Radiology Consult Service for Patients. Curr Probl Diagn Radiol 2023; 52:519-521. [PMID: 37690967 PMCID: PMC10592057 DOI: 10.1067/j.cpradiol.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Direct interactions between patients and diagnostic radiologists are uncommon, but recent medicolegal developments in the United States may increase patient interest in communicating directly with radiologists. Patient participation rates in prior attempts at direct radiology consultation vary widely in the literature. Our objective was to design and build a virtual radiology consult service for a subset of patients undergoing lung cancer screening CTs to enable communication between patients and radiologists regarding imaging results and radiology recommendations. METHODS Patients scheduled for lung cancer screening CTs were identified using a custom scheduling system and offered via text message a free 15-minute consultation with a radiologist to discuss the results. RESULTS Of 38 patients texted, 10 (26.3%) responded. Nine (90%) scheduled a consultation, but 5 (55.5%) subsequently cancelled. Of the remaining four, 3 (75%) attended their appointments, with an overall 3/38 (7.9%) text-to-consult conversation rate. The 3 consults averaged 18 (±8.2) minutes. CONCLUSION The recruitment rate for our virtual service was between the low rate of a prior phone consult line study and the high rate in consults integrated into another physician visit. Further research is needed to identify patients most interested in a radiology consultation and optimize consultation modality by patient population.
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Affiliation(s)
- Colbey W Freeman
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA.
| | - Sophia O'Brien
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA
| | - Dayna Levin
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA
| | - Tessa Cook
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA
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Stanisce L, Ahmad N, Solomon DH, Kolia N, Garcia LD, Spalla TC, Gaughan JP, Koshkareva Y. Improving Outpatient Follow-Up Rates for New In-Hospital Consults. Laryngoscope 2023; 133:2540-2545. [PMID: 36511340 DOI: 10.1002/lary.30519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE(S) This investigation aimed to define the rate of outpatient follow-up after in-hospital consultation, identify factors associated with establishing care, and evaluate an alternative scheduling process to improve outpatient adherence. METHODS Two-phase, prospective study at an academic, tertiary-care institution from March 2020 to August 2022. First, all patients not previously known to our practice encountered via inpatient consult who warranted outpatient follow-up were prospectively captured. Logistic regression analysis was used to identify demographic, disease, and practice factors predictive of follow-up. Second, a randomized control trial was performed to validate the effects of pre-assigning appointments prior to discharge. RESULTS Six hundred subjects were included in the final study cohort; 500 in phase-one, and 100 randomized during phase-two. In the phase-one cohort, 54% (n = 272) were lost to follow-up. Multivariate analysis showed increased odds of outpatient follow-up when appointments were pre-assigned before discharge (odds ratio [OR]: 3.69 [95% confidence interval [CI]: 2.29-5.96], p < 0.001), the primary reason for hospitalization was ENT and consult-related (OR: 3.29 [1.92-5.64], p < 0.001), and the diagnosis was one of Oncology (OR: 1.93 [1.02-3.69], p = 0.045) or Pediatrics (OR: 3.36 [1.41-7.98], p = 0.006) subspecialties. During phase-two, subjects randomized for pre-assigned appointments had higher outpatient follow-up (82%) compared to the control group (20%) (p < 0.001). CONCLUSION Hospital-based consultations represent an important referral pathway for new patients. Disease characteristics may identify patients less likely to follow-up upon discharge. Appointment scheduling protocols, including pre-assigning appointments, are modifiable targets for improving adherence to care. Laryngoscope, 133:2540-2545, 2023.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadeem Kolia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Lucia D Garcia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
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Owen GS, Urban MJ, Calder AN, Husain IA, LoSavio PS, Revenaugh PC, Batra PS. Inpatient Otolaryngology Consultations and COVID-19: The Surge and Lasting Effects at an Urban, Academic Institution. Ear Nose Throat J 2023:1455613231182295. [PMID: 37329277 PMCID: PMC10290929 DOI: 10.1177/01455613231182295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
Objective: This study aims to examine the lasting effects of the coronavirus disease 2019 (COVID-19) pandemic on inpatient otolaryngology consultations. Methods: In a retrospective analysis, inpatient otolaryngology consultations at an urban, academic tertiary care center were reviewed over the course of 2 years (Jun 2019-Jun 2021). The consultations were categorized by time period based on the local data for COVID-19 hospitalizations and deaths as follows: pre-COVID (Jun 2019-Feb 2020), Surge 1 (Mar 2020-May 2020), Surge 2 (Oct 2020-Jan 2021), and Post Surge (Mar 2021-Jun 2021). Results: A total of 897 patients undergoing an inpatient otolaryngology consultation across all 4 time periods were included for analysis. The average consultations per day was 1.67 ± 0.24 in pre-COVID times, and dropped acutely to 0.86 ± 0.33 consultations per day during Surge 1. The consultation volume was not statistically different from pre-COVID levels during Surge 2 (1.33 ± 0.35) and Post Surge (1.60 ± 0.20). Reason for consultation and procedures performed did not vary significantly between pre-COVID times and Post Surge, except that consultation for postoperative complaint was less frequent in Post Surge (4.8% vs 1.0%, P = .02). More patients had been screened with rapid antigen COVID testing in Post Surge versus Surge 1 (20.1% vs 7.6%, P = .04). Conclusions: Inpatient otolaryngology consultation volumes, indications, and procedures performed at an urban, academic institution returned to pre-COVID levels after being significantly impacted during Surge 1.
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Affiliation(s)
- Grant S. Owen
- Rush Medical College, Rush University, Chicago, IL, USA
| | - Matthew J. Urban
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Inna A. Husain
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Phillip S. LoSavio
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter C. Revenaugh
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pete S. Batra
- Department of Otorhinolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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Vestesson EM, De Corte KLA, Crellin E, Ledger J, Bakhai M, Clarke GM. Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study. JMIR Public Health Surveill 2023; 9:e44944. [PMID: 37129943 DOI: 10.2196/44944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). OBJECTIVE This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. METHODS We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. RESULTS Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. CONCLUSIONS The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Affiliation(s)
- Emma Maria Vestesson
- The Health Foundation, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Jean Ledger
- National Health Service England, London, United Kingdom
| | - Minal Bakhai
- National Health Service England, London, United Kingdom
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Sakanovic A, Hadden WJ, Guglani S, Afkham A, Liddy C, Keely E, Meulenkamp B. The effect of e Consult on the provision of orthopaedic services in Nunavut. Int J Circumpolar Health 2022; 81:2151551. [PMID: 36451521 PMCID: PMC9718551 DOI: 10.1080/22423982.2022.2151551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To assess the effect of eConsultation in providing Orthopaedic Surgery specialist service to patients in Nunavut. A cross-sectional study of 161 Orthopaedic Surgery consultations received from primary care providers (PCPs) in Nunavut via the Champlain Building Access to Specialist service through eConsult (BASETM) service over the 2-year period from January 2017 to December 2018. Data captured were: reason for consultation, impact of advice on referral, perceived value to the PCPs and time spent. eConsult avoided unnecessary in-person consultation 62% of the time while catching 5% of the referrals that would have otherwise been missed. PCP referral behaviour was modified 48% of the time. 94% of eConsults were rated as valuable to PCPs in their practice and 100% of eConsults resulted in actionable advice. Further, eConsults took an average of 15.4 minutes of specialist time to complete, and the mean time from referral to response was 1.4 days. eConsultation spares unnecessary consultation to Orthopaedic Surgery, catches important referrals that would have otherwise been missed, decreases wait time, and may reduce cost in remote healthcare systems such as Nunavut.
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Affiliation(s)
- Alenko Sakanovic
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - William J Hadden
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Amir Afkham
- Enabling Technologies, The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Department of Medicine University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brad Meulenkamp
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,CONTACT Brad Meulenkamp Faculty of Medicine, University of Ottawa; 1053 Carling Ave. Suite J129, OttawaK1Y 4E9, ON, Canada
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Janbakhsh M, Ratliff P, Ross J, Cottingham L, Tobin M, Busch H. Evaluating Outcomes of a Pharmacist-Driven Pain Management Consult Service. J Pain Palliat Care Pharmacother 2022; 36:145-151. [PMID: 35675066 DOI: 10.1080/15360288.2022.2084208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The opioid crisis continues to place a significant burden on American families and the healthcare system. To date, there is an evolving body of evidence demonstrating that pharmacists can positively impact patient care in the pain management specialty. The purpose of this study is to evaluate 24-hour average pain scores before and after a clinical pharmacist completes a physician-ordered pain consult in a community hospital setting. For the primary outcome, there was a statistically significant reduction in pain scores 48 hours post consult (6.5 vs. 5.2; p < 0.001; Table 3) and 24 hours prior to discharge (6.1 vs. 4.5; p < 0.001; Table 3) when compared to pain scores 24 hours prior to consult. Additionally, there was a statistically significant reduction in the number of morphine milligram equivalents (MMEs) at 48 hours post consult (149.4 vs. 133.8; p < 0.001; Table 4) and 24 hours prior to discharge (136.5 vs. 100.6; p < 0.001; Table 4) when compared to 24 hours prior to consult. This pharmacist-driven pain consult service demonstrated a statistically significant reduction in pain scores while simultaneously reducing MME utilization and the number of opioids ordered, using a multimodal evidence-driven approach to pain management in a community hospital.
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Affiliation(s)
- Michael Janbakhsh
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Patrick Ratliff
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - James Ross
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Lauren Cottingham
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Morgan Tobin
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
| | - Haley Busch
- Department of Pharmacy, Saint Joseph Hospital, Lexington, Kentucky, USA
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9
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Neuhaus K, Ho ES, Low N, Forrest CR. Analysis of Plastic Surgery Consultations in a High-Volume Paediatric Emergency Department: A Quality Improvement Initiative. Plast Surg (Oakv) 2021; 29:272-279. [PMID: 34760844 DOI: 10.1177/2292550320969652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Consult services influence emergency department (ED) workflow. Prolonged ED length of stay (LOS) correlates with ED overcrowding and as a consequence decreased quality of care and satisfaction of health team professionals. To improve management of paediatric ED patients requiring plastic and reconstructive surgery (PRS) expertise, current processes were analyzed. Methods Patient characteristics and metrics of PRS consultations in our paediatric ED were collected over a 3-month period. Data analysis was followed by feedback education intervention to ED and PRS staff. Data collection was then resumed and results were compared to the pre-intervention period. Results One hundred ninety-eight PRS consultations were reviewed, mean patient age was 6.3 years. Most common (52%) diagnoses were burns and hand trauma; 81% of PRS referrals were deemed appropriate; 25% of PRS consults were requested after hour with no differences in patient characteristics compared to regular hours; 60% of consultations involved interventions in the ED. Time between ED registration and PRS consultation request (116.5 minutes), quality of procedural sedation (52% rated inadequate), and overall ED LOS (289.2 minutes) were identified as main areas of concern and addressed during feedback education intervention. Emergency department LOS and quality of sedation did not improve in the post-intervention period. Conclusion The study provides detailed insights in the characteristics of PRS consultation in the paediatric ED population. Despite high referral appropriateness and education feedback intervention, significant inefficiencies were identified that call for further collaborative efforts to optimize quality of care for paediatric ED patients and improve satisfaction of involved healthcare professionals.
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Affiliation(s)
- Kathrin Neuhaus
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital, Zurich, Switzerland
| | - Emily S Ho
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Nelson Low
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
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Griebe KM, Hencken LN, Efta J, Patel N, Stine JJ, Bott B, El-Khoury C, MacDonald NC. An electronic tool for health systems to assess and communicate discharge medication access. Am J Health Syst Pharm 2021; 79:477-485. [PMID: 34636856 DOI: 10.1093/ajhp/zxab390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The purpose of this study was to describe how the discharge medication cost inquiry (DMCI) consult order and workflow were created and used to communicate transition of care needs and medication access barriers before discharge. SUMMARY Health-system pharmacists collaborated with the information technology department to develop the DMCI consult order and workflow. This institutional review board-approved retrospective case study evaluated use of the DMCI consult order throughout the health system. Outcomes that could not be retrieved electronically were collected for every third patient encounter using manual chart review. The DMCI consult order was used at each hospital in the health system. Physicians placed the most DMCI consult orders; however, pharmacists at the large academic tertiary hospital utilized the DMCI consult order the most. The DMCI consult order was sent most frequently for anticoagulants. Although most medications were covered by insurance, the tool and workflow identified barriers to medication access. Almost 90% of the patients with a DMCI consult order had at least one prescription generated on discharge. CONCLUSION The DMCI consult order is a novel electronic tool to aid in communicating discharge medication needs. When incorporated into care transition planning, the DMCI consult order and workflow provide a model to ensure patients have access to medications. It can also be used to document and evaluate the role of pharmacy in transitions of care in the health system.
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Affiliation(s)
- Kristin M Griebe
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Laura N Hencken
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Jessica Efta
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Nisha Patel
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - John J Stine
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Brandon Bott
- Community Care Services, Ambulatory Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Caren El-Khoury
- Community Care Services, Ambulatory Pharmacy, Henry Ford Health System, Detroit, MI, USA
| | - Nancy C MacDonald
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
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Dharmarajan H, Belsky MA, Anderson JL, Sridharan S. Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach. Ann Otol Rhinol Laryngol 2021; 131:12-26. [PMID: 33779296 PMCID: PMC8010376 DOI: 10.1177/00034894211005937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To analyze trends in otolaryngology consultations and provide algorithms to
guide management during the COVID-19 pandemic. Methods: A retrospective cohort study at a single institution tertiary care hospital.
A total of 95 otolaryngology consultations were performed from March 1, 2020
to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019
to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data
collected included patient demographics, COVID-19 status, reason for
consult, location of consult, type of consult, procedures performed, need
for surgical intervention, length of hospital stay and recommended follow
up. Results: Patient populations in the pre-COVID-era and COVID-era were similar in terms
of their distribution of demographics and chief complaints. Craniofacial
trauma was the most common reason for consultation in both periods, followed
by vocal fold and airway-related consults. We saw a 21.5% decrease in the
rate of consults seen per month during the COVID-era compared to the
6 months prior. Review of trends in the consult workflow allowed for
development of several algorithms to safely approach otolaryngology consults
during the COVID-19 pandemic. Conclusions: Otolaryngology consultations provide valuable services to inpatients and
patients in the emergency department ranging from evaluation of routine
symptoms to critical airways. Systematic otolaryngology consult service
modifications are required in order to reduce risk of exposure to healthcare
providers while providing comprehensive patient care.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Anderson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Reza JA, Steve Eubanks W, de la Fuente SG. Clinical and Financial Implications of Consulting Physicians in the Management of Surgical Patients. Am Surg 2020; 88:578-586. [PMID: 33291943 DOI: 10.1177/0003134820952439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study was designed to evaluate the immediate consequences that the number of consulting physicians has on length of stay (LOS), in-hospital mortality, 30-day readmission rates, direct health care costs, and contribution margins. METHODS A retrospective review of administrative databases for the years 2013 and 2014 was performed at the Florida Hospital Adventist Healthcare System. RESULTS 11 274 patients were included in the analysis. Total and variable costs increased by $1347 and $592, respectively, with each consulting physician service per patient. The contribution margin decreased by $354 per patient/consulting physician. Each consulting physician increased LOS by .72 days and increased odds ratio of mortality and 30-day readmission by 5% and 3%, respectively. CONCLUSIONS Our research suggests that each consulting physician added to the care of an individual surgical patient negatively affected LOS, readmission rates, in-hospital mortality, and costs.
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Affiliation(s)
- Joseph A Reza
- Department of Surgery, AdventHealth Orlando, FL, USA
| | - W Steve Eubanks
- Department of Surgery, AdventHealth Orlando, FL, USA.,University of Central Florida, Orlando, FL, USA
| | - Sebastian G de la Fuente
- Department of Surgery, AdventHealth Orlando, FL, USA.,University of Central Florida, Orlando, FL, USA
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13
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Abstract
OBJECTIVE Patient care delivered by residents is an educational opportunity to foster autonomy. These services, however, may not be billed without direct faculty supervision. This quality improvement project analyzes descriptive data, procedures, and billing from an academic otolaryngology-head and neck surgery department's inpatient consult service. METHODS This prospective cohort study collected descriptive and billing data on all consults over 30 consecutive days. Data collected described bedside procedures and operative interventions. Encounters were Current Procedural Terminology coded and equivalent work relative value unit (wRVU) calculated. Codes submitted for billing were reviewed to identify opportunities for inpatient billing improvement. RESULTS Ninety-eight new consults were included, and 105 bedside procedures were performed. Flexible laryngoscopy (n = 27), I&D (incision and drainage; n = 11), and suturing (n = 11) were the most performed bedside procedures. Operative intervention was required in 15 encounters. The inpatient consult team provided the equivalent of 391.39 wRVU. Seventy-three percent of operative compared to 3% of bedside procedures were submitted for billing. DISCUSSION The productivity of our team approximated 61.8% of a full-time general otolaryngologist but with decreased billing submissions. Balance between resident autonomy, education, quality patient care, and the ability to capture service revenue is complex. Strategies other institutions have used to capture missed billing opportunities have included a hospitalist model, mid-level providers, and resident billing. IMPLICATIONS FOR PRACTICE This study characterizes an academic inpatient consult service. Results describe a case for improving the structure of the inpatient consult service, caution that studies collecting data via department billing may underrepresent services, and suggest alternative service structures to overcome identified billing limitations.
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Affiliation(s)
- Jonathan Chiao
- Department of Otolaryngology-Head & Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jayme R Dowdall
- Department of Otolaryngology-Head & Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Samuel K Pate
- Department of Otolaryngology-Head & Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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14
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Abstract
Establishing good rapport with patients is important during the initial consult, especially in aesthetic medicine. While experienced physicians develop expertise in cultivating a positive patient experience, younger physicians may benefit from some guidance. We describe the L.E.A.P (Listen, Educate and Empower, Align, Perform) method which may help guide young physicians through a successful cosmetic consult. In addition we will review the B.L.A.S.T (Believe, Listen, Apologize, Satisfy, Thank) method for dealing with unhappy patients.
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Affiliation(s)
| | | | - Michael S Kaminer
- SkinCare Physicians, Chestnut Hill, MA, USA.,Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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15
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Gilani S, Bommakanti K, Friedman L. Electronic Consults in Otolaryngology: A Pilot Study to Evaluate the Use, Content, and Outcomes in an Academic Health System. Ann Otol Rhinol Laryngol 2019; 129:170-174. [PMID: 31625409 DOI: 10.1177/0003489419882726] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To categorize the primary reasons for electronic consults (eConsults) to otolaryngology from primary care physicians (PCPs). To determine how many patients avoided subsequent in-person otolaryngology office visits. METHODS This is a retrospective analysis of a pilot study that took place between 2016 and 2017 regarding eConsults to adult otolaryngology placed by primary care physicians at the University of California, San Diego (UCSD) Medical Center. The complaints were categorized as related to the following: ear, nose, throat or neck. Initial recommendations were classified as (1) providing education only (no intervention), (2) suggesting medical therapy provided by the PCP, or (3) suggesting surgical intervention. Univariate statistics and multinomial logistic regression were used to analyze the association of problem type with the need for follow-up in the otolaryngology offices. The data was analyzed for differences in patient age and gender. RESULTS The study population included 64 patients (average age 54.6 years, 60.9% male). Within this group, 41% of consults were for ear complaints, 15% for nose complaints, 28% had throat-related complaints, and 16% had neck-related complaints. In-person follow-up was not required for 82.8% of the consults. Overall, 76.9% of ear, 100% of nose, 88.9% of throat, and 70.0% of neck complaints did not require in-person visits. CONCLUSIONS eConsults to otolaryngology were primarily for ear concerns. Of the eConsults, 82.4% did not require in-person follow-up. We therefore conclude that the use of eConsults prevented substantial office visits that would not otherwise be necessary. Efforts should be made to promote the widespread use of eConsults, which may to the more efficient use of resources.
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Affiliation(s)
- Sapideh Gilani
- Department of Surgery, Division of Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Krishna Bommakanti
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Lawrence Friedman
- Department of Internal Medicine, University of California San Diego, San Diego, CA, USA
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16
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Jones TM, Drew RH, Wilson DT, Sarubbi C, Anderson DJ. Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center. Am J Health Syst Pharm 2019; 74:1997-2003. [PMID: 29167141 DOI: 10.2146/ajhp170113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The impact of automatic infectious diseases (ID) consultation for inpatients with fungemia at a large academic medical center was studied. METHODS In this single-center, retrospective study, the time to appropriate antifungal therapy before and after implementing a policy requiring automatic ID consultation for the management of fungemia for all patients with an inpatient positive blood culture for fungus was examined. The rates of ID consultation; the likelihood of receiving appropriate antifungal therapy; central venous catheter (CVC) removal rates; performance of ophthalmologic examinations; infection-related length of stay (LOS); rates of all-cause inhospital mortality, death, or transfer to an intensive care unit within 7 days of first culture; and inpatient cost of antifungals were also evaluated. RESULTS A total of 173 unique episodes (94 and 79 in the control and intervention groups, respectively) were included. Candida species were the most frequently cultured organisms, isolated from over 90% of patients in both groups. No differences were observed between the control and intervention groups in time to appropriate therapy, infection-related LOS, or time to CVC removal. However, patients in the intervention group were more likely than those in the control group to receive appropriate antifungal therapy (p = 0.0392), undergo ophthalmologic examination (p = 0.003), have their CVC removed (p = 0.0038), and receive ID consultation (p = 0.0123). Inpatient antifungal costs were significantly higher in the intervention group (p = 0.0177). CONCLUSION While automatic ID consultation for inpatients with fungemia did not affect the time to administration of appropriate therapy, improvement was observed for several process indicators, including rates of appropriate antifungal therapy selection, time to removal of CVCs, and performance of ophthalmologic examinations.
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Affiliation(s)
- Travis M Jones
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC .,Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC
| | - Richard H Drew
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC.,Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC
| | - Dustin T Wilson
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC.,Department of Pharmacy, Duke University Medical Center, Durham, NC
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17
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Abstract
Medical management of chronic health concerns relies heavily on behavioral change, most specifically medication adherence. Yet approximately 50% of patients with chronic illnesses are not thought to take their medications as prescribed. Moreover, it is recognized that lifestyle and behavioral changes can reduce the need for medication. It is well documented that patient outcomes and their success in achieving behavioral change is improved with engagement and support from a medical care team. As the inpatient lifestyle medicine service was being conceptualized at Loma Linda University Health (LLUH), it became apparent that an outpatient service would be necessary for follow-up care of the patients and support the lifestyle medicine treatments initiated in the hospital. Additionally, an outpatient clinic would be available to the patient population at Loma Linda and potentially prevent hospitalizations, morbidity, and mortality with proactive lifestyle medicine treatment. The initial outpatient clinic opened in February 2017 and was soon expanded to meet patient demand. Currently, the LLUH Lifestyle Medicine Outpatient Clinic is available 5 days a week, utilizing 5 physicians.
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Affiliation(s)
| | - Brenda Rea
- Loma Linda University, Loma Linda, California
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18
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Eugene AR, Eugene B. An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers. F1000Res 2018; 7:677. [PMID: 30271581 PMCID: PMC6143933 DOI: 10.12688/f1000research.14970.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
Background: Adverse drug reactions (ADRs) are a major cause of hospital admissions, prolonged hospital stays, morbidity, and drug-related mortality. In this study, we sought to identify the most frequently reported medications and associated side effects in adolescent-aged patients in an effort to prioritize clinical pharmacology consultation efforts for hospitals seeking to improve patient safety. Methods: Quarterly reported data were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 and ending in the third quarter of 2017. We then used the GeneCards database to map the pharmacogenomic biomarkers associated with the most reported FAERS drugs. Data homogenization and statistics analysis were all conducted in R for statistical programming. Results: We identified risperidone (10.64%) as the compound with the most reported ADRs from all reported cases. Males represented 90.1% of reported risperidone cases with gynecomastia being the most reported ADR. Ibuprofen OR=188 (95% CI, 105.00 – 335.00) and quetiapine fumarate OR=116 (95% CI, 48.40 – 278.00) were associated with the highest odds of completed suicide in teenagers. Ondansetron hydrochloride OR=7.12 (95% CI, 1.59 – 31.9) resulted in the highest odds of pneumothorax. Lastly, olanzapine (8.96%) represented the compound with the most reported drug-drug interactions cases, while valproic acid OR=221 (95% CI, 93.900 – 522.00) was associated with the highest odds of drug-drug interactions. Conclusion: Despite any data limitations, physicians prescribing risperidone in males should be aware of the high rates of adverse drug events and an alternative psychotropic should be considered in male patients. Further, patients with a history of pneumothorax or genetically predisposed to pneumothorax should be considered for an alternative antiemetic to ondansetron hydrochloride, due to increased odds associated with the drug and adverse event.
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Affiliation(s)
- Andy R Eugene
- Department of Pharmacogenomics, Bernard J. Dunn School of Pharmacy, Inova Center for Personalized Health, Shenandoah University, Fairfax, VA, 22031, USA.,Neurophysiology Unit, Department of Psychiatry, Medical University of Lublin, Aleje Racławickie 1, 20-059 Lublin, Poland
| | - Beata Eugene
- Marie-Curie Sklodowska University, Lublin, Poland
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Cramer T, Wilson A, Rea B. Lifestyle Medicine Inpatient Consultation Services at Loma Linda University Health: A Novel Approach in a Tertiary Care Center. Am J Lifestyle Med 2018; 12:227-229. [PMID: 30283255 DOI: 10.1177/1559827618754860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As a nation facing primary care provider shortages, an expanding chronic disease burden, and rising health care costs, lifestyle medicine interventions have become critical for patient care and management. The current fee-for-service health care system in the United States is designed for delivering acute care but has made it challenging to deliver and be reimbursed sufficiently for lifestyle interventions that can help prevent and treat chronic disease. Loma Linda University Health began to address these concerns through the creation of an inpatient consultation service for the neurology rehabilitation stroke team. Initiation of the consultation service took 2 years of planning, testing, and resource development. Currently, the consultation service operates one half-day per week in the rehabilitation hospital utilizing 1 attending physician and 2 residents. Visiting residents and medical students are also permitted to rotate with the new service. In coordination with billing experts, a standard number of 21.2 to 25.4 RVUs (relative value units) has been established for the half-day service. As the service continues to expand, future considerations include adding consultation availability to other departments and increasing the consultation workforce.
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Affiliation(s)
| | | | - Brenda Rea
- Loma Linda University, Loma Linda, California
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20
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Ray KN, Drnach M, Mehrotra A, Suresh S, Docimo SG. Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance. Acad Pediatr 2018; 18:409-417. [PMID: 29277463 PMCID: PMC5936662 DOI: 10.1016/j.acap.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/16/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE One barrier to timely access to outpatient pediatric subspecialty care is the complexity of scheduling processes. We evaluated the impact of implementing electronically transmitted referrals on subspecialty visit attendance. METHODS Through collaboration with stakeholders, an electronically transmitted referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume. Electronically transmitted referrals then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after implementation. RESULTS From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9% to 20.0%; P < .001). Relative to control practices, pilot practices experienced an 8.6% improvement (P = .001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8% to 14.7% (P < .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking. CONCLUSIONS While electronically transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.
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Mehta AK, Wilks S, Cheng MJ, Baker K, Berger A. Nurses' Interest in Independently Initiating End-of-Life Conversations and Palliative Care Consultations in a Suburban, Community Hospital. Am J Hosp Palliat Care 2017; 35:398-403. [PMID: 28413929 DOI: 10.1177/1049909117704403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients who receive early palliative care consults have clinical courses and outcomes more consistent with their goals. Nurses have been shown to be advocates for early palliative care involvement and are able to lead advanced care planning discussions. OBJECTIVE The purpose of this study was to assess whether after a brief educational session, nurses at a suburban, community hospital could demonstrate knowledge of palliative care principles, would want to independently initiate end-of-life conversations with patients and families, and would want to place specialty palliative care consults. DESIGN Four 1 hour presentations were made at 4 nursing leadership council meetings from November through December 2015. Anonymous pre- and post-presentation surveys were distributed and collected in person. Setting/Participant: Nonprofit, suburban, community hospital in Maryland. Participants were full-time or part-time hospital employees participating in a nursing leadership council who attended the presentation. MEASUREMENTS We compared responses from pre- and post-presentation surveys. RESULTS Fifty nurses (19 departments) completed pre-presentation surveys (100% response rate) and 49 nurses completed post-presentation surveys (98% response rate). The average score on 7 index questions increased from 71% to 90%. After the presentations, 86% strongly agreed or agreed that nurses should be able to independently order a palliative care consult and 88% strongly agreed or agreed with feeling comfortable initiating an end-of-life conversation. CONCLUSION Brief educational sessions can teach palliative care principles to nurses. Most participants of the study would want to be able to directly consult palliative care and would feel comfortable initiating end-of-life conversations after this educational session.
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Affiliation(s)
- Ambereen K Mehta
- 1 Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia Health System, Charlottesville, VA, USA.,2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven Wilks
- 3 Palliative Care Service, Johns Hopkins Suburban Hospital, Bethesda, MD, USA
| | - M Jennifer Cheng
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Karen Baker
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ann Berger
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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22
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O'Neil T, Lyndale P, Szakatis K, Fitzgerald T. The Value of a Brief Thought for the Day Reflection on an Academic Consult Service. Am J Hosp Palliat Care 2016; 34:869-873. [PMID: 27448669 DOI: 10.1177/1049909116660518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Work in hospice and palliative medicine can be stressful. A variety of methods have been used to mitigate workplace stress including mindfulness mediation, reflective writing, and physical activity. An intervention implemented at our institution is a "Thought for the Day," a short reflection on a piece of poetry, music, or religious writing. Although this practice may be commonplace in the field of hospice and palliative medicine, no literature has been published about its perceived utility by team members with various competing demands on their time. OBJECTIVE This study's objective was to obtain a better understanding about the perception and utility of a Thought for the Day held by clinicians rounding on an academic palliative medicine consult service. METHODS A survey, containing qualitative and quantitative elements was sent to faculty, staff, and learners who participated in a Thought for the Day over the 18 months between March 2013 and October 2014. Twenty-eight responses were returned and analyzed. RESULTS Most participants (23 of the 28) felt that the Thought for the Day was an important use of their time on the academic consult service. Differences were seen by gender and team role. Additionally, it was reported that the Thought for the Day improved the participants' perception of teamwork. CONCLUSION The use of a Thought for the Day reflection may be beneficial and constructive even for a busy academic consult service.
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Affiliation(s)
- Thomas O'Neil
- 1 Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patricia Lyndale
- 2 Hospital Chaplain, Department of Spiritual Care, University of Michigan Medical Center, Ann Arbor, MI, USA
| | | | - Tom Fitzgerald
- 4 Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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23
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Bursle EC, Playford EG, Looke DFM. Infectious diseases consultations at an Australian tertiary hospital: a review of 11,511 inpatient consultations. Intern Med J 2015; 44:998-1004. [PMID: 25051906 DOI: 10.1111/imj.12536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/15/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infectious diseases (ID) clinicians provide an important service within tertiary hospitals. However, as a largely consultation-based service, their value can be difficult to evaluate. AIMS A review of 13.5 years of consultations was undertaken to define the scope of the service and any changes over time. METHODS ID consultations at the Princess Alexandra Hospital are tracked on a database, recording information including the requesting team, indication for and outcome of the consult. Incident formal inpatient consultations between July 1999 and December 2012 were reviewed retrospectively. Phone consultations, repeat consultations and ID admissions were excluded. RESULTS Eleven thousand five hundred and eleven consultations were identified, with annual consultations increasing significantly during this period. Overall, formal consultations were performed on 1.3% of admissions. Consultations were most commonly requested by orthopaedics (14.3%) and general medicine (11.4%). The two most common syndromes triggering a consult were bloodstream infection (13.9%) and complicated soft tissue infection (7.8%). The final diagnosis was most frequently osteomyelitis (7.9%). Staphylococcus aureus (19.4%) and Pseudomonas aeruginosa (8.3%) were the most commonly identified pathogens. CONCLUSION The demand for ID consultations has increased over time and there are likely to be many drivers of this increase. Information derived from this audit can enhance the ID service by guiding service delivery, trainee education and informing funding or accreditation applications.
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Affiliation(s)
- E C Bursle
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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