Health and Medical Administration Commons^™

Innovative Conservation Of Inhaled Medication Devices During The Covid-19 Pandemic Through A Canister Reassignment Process, Mandelin K. Cooper, L. Hayley Burgess, Karla Miller, Theresa Baltz, Julia Moody, Elizabeth Wiggins, Jeffrey Guy

HCA Healthcare Journal of Medicine

Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry, Ana Garces, Emily Macguire, Holly L. Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esama, Archana Patel

Community Health Sciences

Background: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.
Methods: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

Patient Experience Rounds (Per): Real-Time Feedback To Improve The Patient Experience And Quality Of Care, Amber Moore, Caroline Moore, Lydia Bunker, Barbara Sarnoff

Patient Experience Journal

While patient feedback is critical to improving the patient experience and clinical care, we are currently limited in our ability to collect feedback in real-time from hospitalized patients. This paper describes our experience and outcomes implementing Patient Experience Rounds (PER). Our model uses trained former patients or family members as volunteers to collect feedback in real-time. Through this feedback, we were able to identify areas for improvement, make adjustments in the moment, and provide targeted feedback to providers. A total of 321 patient encounters were recorded by eight PER advisors. Nursing staff received the highest percentage of positive comments. 49% …

Exploring Peer Mentoring In Pediatric Transition: Perspectives Of Different Stakeholders About Accompanying Patients In Gastroenterology, Guillaume Dumais-Lévesque, Marie-Pascale Pomey

Patient Experience Journal

The literature identifies several issues in the pediatric transition, such as the lack of coordination between pediatric and adult settings and young patients who are not exercising independence in the self-management of their disease. The objective of this study is to explore the potential for a pediatric transition program in gastroenterology, introducing an accompanying patient program to support the transition. A qualitative case study was conducted, including semi-structured focus groups and individual interviews with each group involved in the pediatric transition between two centres in Quebec. A thematic analysis of the collected data was performed using QDA Miner v5.1. In …

Predictors Of Birth Center Sustainability In The United States, Melanie Cabezas Phipps

Nursing ETDs

Pregnant women from all racial and socioeconomic communities deserve safe, personalized, and affordable ways to give birth. To meet all three needs, focus is increasing on birth centers, a midwifery model that provides family-centered care before, during, and after normal pregnancy, labor, and birth. However, many U.S. birth centers face significant obstacles to financial sustainability, particularly in rural areas. A better understanding of the factors that contribute to a birth center’s operational success is needed for practitioners and groups interested in establishing or maintaining a birth center, as well as to inform policymakers seeking to improve health care equity, outcomes, …

Optimizing Wellness In Academic Emergency Medicine, Kristen E. Nordenholz, Al'ai Alvarez, Michelle D. Lall, Christine Stehman, Cindy C. Bitter, Emily L. Hirsh, Rita Manfredi, Rosanna D. Sikora, Dave W. Lu, Leon D. Sanchez, Matthew L. Wong, Steven Bird, Andra L. Blomkalns

Journal of Wellness

Introduction

Academic Emergency Physicians (EPs) face additional unique challenges in optimizing wellness compared to community EPs.

Objective

Our objective was to explore specific individual and systems challenges that academic EPs encounter that affect their wellbeing and professional fulfillment in emergency medicine (EM).

Methods

An expert group of academic EPs convened in 2019 at the annual meeting of the Society of Academic Emergency Medicine to investigate the overall causes of burnout in healthcare providers, the effects of burnout on the healthcare system, specific causes of burnout in EM, and the distinct challenges facing academic emergency physicians.

Results

We outline specific causes …

Race, Ethnicity, And Insurance: The Association With Opioid Use In A Pediatric Hospital Setting, Louis Ehwerhemuepha, Candice D. Donaldson, Zeev N. Kain, Vivian Luong, Michelle A. Fortier, William Feaster, Michael Weiss, Daniel Tomaszewski, Sun Yang, Michael Phan, Brooke N. Jenkins

Psychology Faculty Articles and Research

Background

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.

Methods

Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children’s hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.

Results

There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric …

Implementation Of A Hospital Medicine Rotation And Curriculum For Internal Medicine Residents, Doris Lin, Chirayu Shah, Erica Lescinskas, Cory Ritter, Lindsey Gay

Faculty, Staff and Students Publications

INTRODUCTION: Hospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency.

METHODS: The RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of …

Parent Responses To Pediatric Pain: The Differential Effects Of Ethnicity On Opioid Consumption, Candice D. Donaldson, Brooke N. Jenkins, Michelle A. Fortier, Michael T. Phan, Daniel M. Tomaszewski, Sun Yang, Zeev N. Kain

Psychology Faculty Articles and Research

Objective

Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain.

Methods

Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy …

Acute Exacerbations Of Chronic Obstructive Pulmonary Disease: A Primer For Emergency Physicians, Randy Sorge, Peter Deblieux

School of Medicine Faculty Publications

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based …

Building A Culture Committed To Fall Prevention, Mary Uppinghouse, Queena Kim, Marissa Evans

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No abstract provided.

Effects Of Sedation Vacations And Sedation Level Quality Improvement Project, Gisele Bazan, Bo Ewing, Cynthia Grissman, April Marpa, August Montgomery, Tana Overman

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No abstract provided.

Process Improvement For Simethicone Use During Endoscopic Procedures, Airene D. Albutra, Mary Estelle De Vera, Sarah J. Wyrick

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No abstract provided.

Improving Ed Sepsis Bundle Compliance, Jen Selby

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No abstract provided.

Ppe Compliance And Knowledge Among Healthcare Staff, Beatrice Hagert, Nicole Krummel

Nursing DNP Projects

Abstract

Problem: One of the most important steps in infection prevention is the use of personal protective equipment (PPE) to protect patients and staff from infectious agents; yet, research indicates that PPE compliance remains suboptimal in many healthcare institutions.

Purpose: To identify the effect of a multidisciplinary education campaign on PPE compliance and knowledge among healthcare workers (HCWs) on a rehabilitation unit of a large, midwestern teaching hospital.

Methods: This project utilized pre-intervention observational audits and a survey to determine baseline PPE compliance and knowledge on the piloted units. A post-intervention survey was sent to HCW to assess for a …

Improving Quality Of Patient Care By Reducing The Prevalence Of Surgical Site Infections, Gina Dashiell, Luanna Hansen

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No abstract provided.

A Multicenter Mixed-Effects Model For Inference And Prediction Of 72-H Return Visits To The Emergency Department For Adult Patients With Trauma-Related Diagnoses, Ehsan Yaghmaei, Louis Ehwerhemuepha, William Feaster, David Gibbs, Cyril Rakovski

Mathematics, Physics, and Computer Science Faculty Articles and Research

Objective

Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits.

Methods

We analyzed 3.2 million ED encounters with at least one diagnosis under “injury, poisoning and certain other consequences of external causes” and “external causes of morbidity.” These encounters included patients 18 years or older from across 128 emergency room facilities in the …

Start Stop-Bang, Valerie D. Reeve

MSN Capstone Projects

Currently standard of care in the perioperative unit is not conducive when caring for patients with obstructive sleep apnea (OSA). OSA is highly prevalent and often undiagnosed. Screening patients with a STOP-Bang questionnaire is quick, effective, and cost efficient. OSA is linked to poor postoperative outcomes. Patients at high risk for OSA often encounter complications such as: additional airway management, respiratory complications, cardiovascular complications, and increased length of stay. Screening creates awareness and identification of patients at risk for postoperative complications.

Patient Experience In A Pediatric Emergency Department During Covid-19, Beth L. Emerson Md, Erika Setzer

Patient Experience Journal

The COVID-19 pandemic has changed many dynamics in healthcare in the United States. This study explores an increase in patient experience (PE) scores in a pediatric emergency department. Visits were analyzed before and after March 8, 2020, corresponding with the first local case of COVID-19. Changes in the patient population and characteristics of survey responders were analyzed. Overall, the number of daily visits decreased (113 vs 36/day) and survey response rate decreased (3.7 vs 2.8%, p = 0.03), but PE scores increased (87.21 to 93.73, p = 0.002). Comparatively, an increase in patients with higher acuity levels by Emergency Severity …

Reflections Of The Angiotensin Receptor Blocker Recall By The Fda And Repercussions On Healthcare, Michael Gillette, Addison Taylor, Djenita Butulija, Himabindu Kadiyala, Hani Jneid

Faculty, Staff and Students Publications

PURPOSE: Beginning in July of 2018, the FDA issued a voluntary recall regarding the presence of a contaminant found in the manufacturing of valsartan. What would ensue has become a largely unprecedented sequence of alarming events since the FDA began reporting public recalls, withdrawals and safety alerts on their website in 2016. Since then, the United States has been significantly impacted by drug recalls affecting angiotensin receptor blockers. This report arms clinicians with additional guidance and provides a framework for responding appropriately to future similar incidents and includes an overview of the angiotensin receptor blockers, and their effects and safety …

The Determinants Of Physical Activity, Self-Monitoring Of Blood Glucose, And Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes In Saudi Arabia: A Cross-Sectional Study Based On The Saudi Health Interview Survey (Shis), Mohammed Abdulrahman S. Alsuliman

Health Services Research Dissertations

The prevalence of diabetes and poor glycemic control in Saudi Arabia has increased that contributed to the growing number of deaths in Saudi Arabia. It is known that type 2 diabetes (T2DM) can be prevented but there is a lack information about the magnitude of the of diabetes at national level as well as the risk factors for physical activity (PA), self-monitoring of blood glucose (SMBG), and poor glycemic. Thus, through utilizing Health promotion model (HPM), the aims are to examine the personal factors, cognitive-perceptual, and behavioral determinants of three outcomes; physical activity, SMBG, and poor glycemic control. A secondary …

A 2-Hour Diabetes Self-Management Education Program For Patients With Low Socioeconomic Status Improves Short-Term Glycemic Control, Michael G. Jakoby Iv, Melissa Schleder, Vickie Luff, Cynthia Yergler, Albert Botchway, Cheryl Burns

Journal of Patient-Centered Research and Reviews

Diabetes self-management education (DSME) improves glycemic control, but patients with low socioeconomic status face institutional and personal barriers to receiving DSME. A retrospective single cohort study of a 2-hour group DSME program prioritizing accessibility and completion of a tightly focused curriculum was performed to determine if glycemic control improved and whether a longer, more comprehensive, prospective evaluation of the program is indicated. All patients who participated in the program from September 2017 to December 2018 were included in the analysis. The primary study endpoint was change in hemoglobin A1c (HbA1c) from baseline. A total of 58 out of 94 patients …

Clinical And Socioeconomic Predictors Of Palliative Care Utilization, Rohan Reddy Tummala, Andrew Manuel De Jesus, Natasha Danielle Tillett, Jeffrey Scott Nelson, Christine Marie Lamey

Longitudinal Scholar's Project

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service.

OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization.

METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), …

Mitigating Suicide Risk Post-Discharge From Inpatient Crisis Stabilization: Safety Planning Intervention, Leighia M. Mcghee

Dissertations

Abstract

Purpose: The purpose of this program evaluation is to evaluate the effectiveness of a newly implemented safety planning intervention (SPI) tool, comparing patient outcomes relating to suicide attempt rates, emergency department (ED) encounter rates, and inpatient rehospitalizations rates pre and post its integration to care in a suburban behavioral health hospital.

Methods: A descriptive cohort design utilizing a retrospective chart review was completed over six months, three months pre, and three months post implementation of the SPI program. A convenience sample of inpatient charts was reviewed to assess the rate of suicide attempts, ED encounters frequencies, and hospitalization rates …

The Other Epidemic, Bruce Deighton

HCA Healthcare Journal of Medicine

The epidemic level of opioid abuse in the U.S. population continues to present a major challenge to our society and to the medical profession. Medical education has a significant role in improving screening, diagnosis, appropriate treatment and management of opioid use disorder. Addressing the problem of overprescribing opioids through physician education, surveillance and opioid management has resulted in significant improvement, translating to fewer overdose deaths from prescription opioids. Graduate medical education can increase access to care by training more addiction medicine specialists, and training other physicians to prescribe buprenorphine and provide access to medically assisted care.

Dermatology Resident Training On Depression Screening: A Cross-Sectional Survey, Kaitlyn L Streight, Harry Dao, Soo Jung Kim

Faculty, Staff and Students Publications

Background

Many dermatologic diseases are implicated in the development of depression. Currently, there is no literature addressing the extent of dermatology residency training on depression screening.

Objective

Our study aimed to determine the extent of dermatology residency training on depression screening to potentially improve education in this area.

Methods

We designed a 12-question survey to assess the level of resident training and comfort in depression screening for patients with acne vulgaris, atopic dermatitis, psoriasis, hidradenitis suppurativa, and skin cancer. Fifty-six residents completed the survey, and data for each question was analysed in aggregate.

Results

Participants found depression screening most important …

Psjh Telehealth Covid-19 Repsonse, Todd Czartoski

Articles, Abstracts, and Reports

No abstract provided.

Observation Status Stays May Result In Financial Losses For Children’S Hospitals, David C. Synhorst

Research Days

No abstract provided.

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …