Average Census Research Articles

Using Large‐Scale Location Data to Examine Racial Diversity and Segregation in Church Attendees’ Home Neighborhoods

AbstractThe racial diversity of churches has been a longstanding topic of interest in the social science of religion. Studies have historically found low levels of racial diversity within churches—but some evidence suggests that diversification is increasing. However, past research has not addressed racial segregation in another significant setting: church attendees’ home neighborhoods. Our article illustrates how large‐scale location data collected from smartphones can estimate the average racial demographics of where church attendees live. Our findings show that church attendees in Omaha, Nebraska—especially those attending Evangelical Protestant, Roman Catholic, and Mainline Protestant churches—live in more homogenously white census blocks than the average census block in the city.

Marginalization Influences Access, Outcomes, and Discharge Destination Following Total Joint Arthroplasty in Canada’s Universal Healthcare System

BackgroundThe influence of socioeconomic status on outcomes following total joint arthroplasty (TJA) in the Canadian single-payer healthcare system is yet to be elucidated. The objective of the present study was to evaluate the impact of socioeconomic status on TJA outcomes. MethodsThis was a retrospective review of 7,304 consecutive TJA (4,456 knees and 2,848 hips) performed between January 1, 2001 and December 31, 2019. The primary independent variable was the average census marginalization index. The primary dependent variable was functional outcome scores. ResultsThe most marginalized patients in both the hip and knee cohorts had significantly worse preoperative and postoperative functional scores. Patients in the most marginalized quintile (V) showed a decreased odds of achieving a minimal important difference in functional scores at 1-year follow-up (odds ratio [OR] 0.44; 95% confidence interval [CI] [0.20, 0.97], P = .043). Patients in the knee cohort in the most marginalized quintiles (IV and V) had increased odds of being discharged to an inpatient facility with an OR of 2.07 (95% CI [1.06, 4.04], P = .033) and OR of 2.57 (95% CI [1.26, 5.22], P = .009), respectively. Patients in the hip cohort in V quintile (most marginalized) had increased odds of being discharged to an inpatient facility with an OR of 2.24 (95% CI [1.02, 4.96], P = .046). ConclusionDespite being a part of the Canadian universal single-payer healthcare system, the most marginalized patients had worse preoperative and postoperative function, and had increased odds of being discharged to another inpatient facility. Level of EvidenceIV.

Effectiveness of a Staphylococcus aureus mupirocin decolonization protocol in a neonatal intensive care unit

Background:Staphylococcus aureus infections are a significant cause of morbidity in neonatal intensive care units (NICUs), and they are typically preceded by nasal colonization. Mupirocin decolonization protocols as an infection prevention tool can halt S. aureus outbreaks and prevent infections. We examined the effect of a mupirocin treatment protocol on S. aureus incidence, prevalence, decolonization, and infections in a level IV NICU. Methods: We conducted a retrospective before-and-after observational study from June 1, 2018, to May 31, 2020. Beginning June 1, 2019, patients identified with either methicillin-sensitive or -resistant S. aureus (MSSA or MRSA) received mupirocin ointment to bilateral nares 3 times daily for 5 days. Patients with central lines or surgical incisions were treated every 30 days. All NICU patients were screened weekly unless positive for MRSA. We defined MSSA decolonization as 3 consecutive negative screens following mupirocin treatment. We calculated monthly S. aureus incidence as any new positive per 1,000 patient days and monthly prevalence as a percentage of the average daily number of patients with S. aureus per the average monthly census. Total number of infections were compared. Statistical significance was determined using a 2 sample proportions test and P < .05. Decolonization was calculated as percentage of occurrences among treated patients. Results: Overall, 190 patients received mupirocin; 142 patients received 1 course and 48 received 2 or more courses. There was no difference in incidence of MSSA (P = .09), but prevalence decreased from 18.8% to 14.4% (P < .05) (Fig. 1). Of 66 patients with MSSA, 35% were decolonized. An additional mupirocin treatment for 16 of these patients had a 50% decolonization rate. For MRSA, incidence decreased from 0.24 to 0.20 (P = .36) and prevalence decreased from 21.9% to 18.6% (P < .05) (Fig. 1). There was no statistical difference in the number of total S. aureus infections (P = .91) or when stratified by MSSA (P = .72) or MRSA (P = .82). In the postmupirocin population, there were 5 MRSA and 7 MSSA infections. Of the MSSA-infected patients, 6 remained colonized at the time of infection. Conclusions: Implementing a single mupirocin treatment course for S. aureus decolonization in NICU was only effective in one-third of patients and had no effect on infection occurrence. Changes in incidence and prevalence could be confounded by other infection prevention practices. Further study is needed to determine whether continued screening and additional mupirocin treatment could improve effectiveness of S. aureus decolonization programs.Disclosure: None

Effect of serious infectious threat response initiative (SITRI) during the coronavirus disease 2019 (COVID-19) pandemic at the Veterans Affairs North Texas Health Care System

Health care-associated infections (HAIs) increased worldwide as health care facilities struggled through the pandemic. We describe our methods in the implementation of a programmatic initiative called serious infectious threat response initiative (SITRI) that was conceptualized to support our staff, to facilitate day-to-day clinical operations related to COVID-19 and to shield our infection prevention and control program (IPC) from excessive COVID-19 work burden to the extent possible to retain routine prevention focused efforts. Post implementation, we sought to understand and quantify the workload and utility of SITRI, IPC burnout and HAI incidence during the implementation period. We correlated the number of weekly phone calls with inpatient COVID-19 census, assessed types of calls, staff feedback, IPC burnout, pre- and postpandemic HAI incidence, and the cost. There was significant correlation between SITRI calls and the weekly average COVID-19 census (P=.00026). IPC burnout evaluation indicated improvement in scores for exhaustion and reduced achievement and worsening in score for depersonalization. HAI incidence did not increase. SITRI's cost was $360,000. Staff solicited SITRI's support in tandem with the COVID-19 burden. Our HAI during the pandemic did not increase while SITRI was operational in contrast to what is published in literature.

Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator.

The lack of usable indicators and benchmarks for staffing of maternity units in health facilities has constrained planning and effective program implementation for emergency obstetric and newborn care (EmONC) globally. To identify potential indicator(s) and benchmarks for EmONC facility staffing that might be applicable in low resource settings, we undertook a scoping review before proceeding to develop a proposed set of indicators. Population: women attending health facilities for care around the time of delivery and their newborns. Concept: reports of mandated norms or actual staffing levels in health facilities. studies conducted in healthcare facilities of any type that undertake delivery and newborn care and those from any geographic setting in both public and private sector facilities. Searches were limited to material published since 2000 in English or French, using Pubmed and a purposive search of national Ministry of Health, non-governmental organization and UN agency websites for relevant documents. A template for data extraction was designed. Data extraction was undertaken from 59 papers and reports including 29 descriptive journal articles, 17 national Ministry of Health documents, 5 Health Care Professional Association (HCPA) documents, two each of journal policy recommendation and comparative studies, one UN Agency document and 3 systematic reviews. Calculation or modelling of staffing ratios was based on delivery, admission or inpatient numbers in 34 reports, with 15 using facility designation as the basis for staffing norms. Other ratios were based on bed numbers or population metrics. Taken together, the findings point to a need for staffing norms for delivery and newborn care that reflect numbers and competencies of staff physically present on each shift. A Core indicator is proposed, "Monthly mean delivery unit staffing ratio" calculated as number of annual births/365/monthly average shift staff census.

First lead, now no bed? The unintended impacts of lead abatement laws on eviction

Lead paint in old houses is the leading cause of lead poisoning in children under 6 today. To combat this problem, several states have passed lead abatement laws, forcing landlords to remove lead in the homes they rent if tenants have children under the age of 6. However, these laws have unintended consequences, causing landlords to evict tenants rather than abate lead. I use a difference-in-differences approach while employing various model specifications with various fixed effects and sets of controls to examine the impact of Ohio’s 2003 lead abatement law on eviction rates. Using newly collected data from the Eviction Lab at Princeton University, I find that the passage of Ohio’s lead abatement law sharply increased targeted evictions. Due to the law’s passage, the average census district in Ohio faced an increased eviction rate of roughly 0.457 points, corresponding to an additional 13.93 evictions a year. These impacts are highly statistically significant, sizeable, and economically meaningful, indicating that policy makers should incorporate distributional consequences when designing future lead abatement laws in order to avoid unintended consequences and ensure equitable outcomes.

Long-Term Impacts of a Targeted Intervention in the Emergency Department on Inpatient Prescribing Practices

Background: In 2009, researchers successfully implemented an intervention to decrease the inappropriate prescribing of multivitamin infusions (MVIs) in the emergency department (ED) for patients presenting with alcohol-related illnesses. Objective: The purposes of our study were to determine the impact of the 2009 intervention on hospital-wide prescribing practices of vitamin therapies for alcohol-related illnesses, and to evaluate its long-term sustainability. Methods: A retrospective observational cohort study was conducted at a 60,000-visit ED, 811-bed academically-affiliated tertiary referral hospital with an average census of 515 and 714 patients in 2009 and 2019, respectively. Patients were included if they presented to the ED from 2009 to 2019 with an alcohol-related illness as defined by ICD-9 and ICD-10 codes. The primary outcome was the change in the monthly average of MVIs ordered inpatient within the first four months compared to the last four months of the study period. Secondary outcomes included changes in the mean distribution (MD) per month of thiamine administrations in the ED and inpatient setting, and MVIs ordered in the ED. Results: The MD of MVIs ordered per month decreased by 3.5% (95% CI −5.3, −1.7) in the inpatient setting and decreased by 1.4% (95% CI −2.5, −.3) in the ED from the beginning to the end of our study period. Conclusions: This study suggests the effects of an intervention made in the ED sustained impact over a 10-year timeframe, and decreased the use of MVIs in both the ED and hospital-wide.

A Model for Integrating PNPs as Hospitalists

<h3>Category/Date</h3> Practice Innovation poster presented at NAPNAP's 43^rd National Conference on Pediatric Health Care, March 23^rd, 2022 <h3>Background</h3> Hospitalist services that include certified pediatric nurse practitioners (CPNPs) as providers experience decreased length of hospital stay, improved patient outcomes, provider retention and improved medical and nursing education. CPNPs are also cost-effective providers when practicing at the top of their scope of practice. Despite these benefits, barriers still exist due to lack of knowledge regarding the CPNP role, scope of practice, and fiscal benefit. The aim of this quality improvement project is to develop a care delivery model that integrates the use of CPNPs as hospitalist in a children's hospital, emphasizing their fiscal benefit. <h3>Method</h3> IRB review and project approval was obtained. The three most common diagnoses on the hospitalist service from October 2019-March 2020 were identified. Patients hospitalized for bronchiolitis, asthma exacerbation, or diabetes during this time frame (N = 172), were evaluated for length of stay (LOS). LOS was compared to a target LOS to identify potential cost savings by reducing LOS, inclusive of CPNPs. Hospitalist average daily census was collected from 2019-2021 to determine patient-to-provider ratios and assess for the need of additional providers. Regional salaries for both CPNPs and pediatric hospitalists were compared and adjusted revenue was calculated using Georgia Medicaid reimbursement rates for an initial inpatient encounter of mild severity. A new care delivery model was developed outlining how to implement the role of CPNPs into the hospitalist service. <h3>Results</h3> Total potential savings by reducing LOS for the top three diagnoses over a time frame of 5 months is $77,368. Hospitalist average daily census for 2019 was 21 patients. While a lower average census was experienced during 2020 and 2021, likely due to the COVID-19 pandemic, the hospitalist service would benefit from the addition of a third provider team utilizing pre-pandemic data. Despite Georgia Medicaid reimbursement differences amongst physicians and CPNPs, salary differences allow for CPNPs to generate $40,000-$80,000 more in annual revenue compared to physicians. <h3>Conclusion</h3> In conjunction with CPNPs' high level of education and training, their cost-effectiveness and ability to care for hospitalized children makes the addition of a CPNP-led hospitalist provider team the most fiscally beneficial solution for improving quality of care and patient outcomes. The new care delivery model will be presented to key collaborators within the institution for consideration of the inclusion of CPNPs on the hospitalist service.

Cost Effective Virtual Intensive Care Unit Expanding Capabilities in Critical Access Hospitals.

Tele-consults provide access to specialized care for a specific question and single point in time. eICU models utilize remote monitoring and ordering but have significant financial burden. We developed a virtual intensive care unit (VICU) for daily input of an intensivist working with local physicians. The purpose was to expand the acute care ability of the critical access hospital (CAH). The study evaluates the impact on the CAH and system. The CAH developed an ICU team, led by a hospitalist, who staffed the intensive care unit (ICU). The CAH ICU team rounds daily via a secure video link to provide care in consultation with intensivists based at a university, tertiary care center (TC). A retrospective analysis was conducted 6 months before and after implementation (4/2018-3/2019). Fisher's exact test was used to compare pre- and post-intervention with significance at P < .04. After VICU implementation, there were 265 initial daily and 35 follow-up consults. Monthly transfers to a higher level of care decreased from 63 to 57 (P = .03). Transfers to TC increased from 49.6 to 62.0% (P = .001). Critical access hospital average monthly census and average monthly inpatient days increased (69 to 130 (P < .0001) and 158 to 319 (P < .0001), respectively). Critical access hospital physicians report increased comfort to admit ICU and non-ICU patients due to the program. The total startup cost was $5180. CAH hired 11 providers. There were no unanticipated deaths. VICU implementation resulted in new CAH jobs. The CAH experienced increased inpatient census and revenues (ICU and non-ICU) while decreasing patients transferred out of the system.

149 Examining the Relationship Between Markers of Emergency Department Crowding and Physician Wellbeing

Literature on emergency department (ED) crowding and boarding has primarily focused on adverse patient outcomes including increased patient mortality, and longer hospital length-of-stay. Few studies have explored relationships between ED crowding, boarding and physician wellbeing (burnout, professional satisfaction) despite evidence demonstrating that EM specialists are consistently among those with the highest rates of burnout. Therefore, we sought to evaluate the relationships between markers of ED crowding and boarding and physician wellbeing. Data for this prospective, observational study were collected from resident and attending emergency physicians employed at our Level-I, tertiary care referral center ED. Participants completed the 7- item Physician Well-Being Index (PWBI) twice weekly for three months following clinical shifts. The PWBI assesses physician distress across several dimensions using a score from 0 to 7 and has previously demonstrated validity with similar physician groups. For the same period, we collected markers of ED crowding and boarding: ED volume, numbers of arriving and boarding patients by shift, and average census by shift. Generalized Estimating Equations (GEE) analyses were performed to examine relationships between ED crowding and boarding markers and physician PWBI scores. Hierarchical regression models were constructed to control for the potentially confounding effects of the day of the week, shift type, and provider role (resident/attending). 42 emergency physicians (18 (43%) resident, 24 (57%) attending) participated in the study, providing 273 PWBI assessments. Data for 4, 318 ED patient encounters were summarized for the same period. Mean PWBI scores were 2.3 (SD 1.53, 95% CI: 2.1-2.5); no significant differences between the resident and attending groups were noted (2.0, ±1.50, 95% CI: 1.5-2.6 vs. 2.5, ±1.52, 95% CI: 1.9-3.0, respectively). After adjusting for the effects of day of week, shift type, and provider role, we did not observe statistically significant relationships between PWBI scores and count of arrivals in 24 hours (b=-0.089, SE=0.0593, CI: -0.206-0.027, p=0.133), patient arrivals by shift (b=-0.006, SE=0.013, CI: -0.031-0.02, p=0.667), average census by shift (b=0.004, SE=0.019, CI: 0.041-0.047, p=0.829), or average boarding census by shift (b=-0.161, SE=0.1051, CI: -0.367-0.045, p=0.127). In this study, ED crowding and boarding were not significantly related to physician wellbeing, as measured by the PWBI. Findings suggest further research is needed to validate the PWBI in capturing ED physician wellbeing during periods of ED crowding and boarding. Next steps are to explore the relationships between individual dimensions of wellbeing (fatigue, mental quality of life) and ED busyness, given the important impact of dimensions of burnout on care team wellbeing and patient outcomes.

Coronavirus in Wisconsin Nursing Homes: A Longitudinal Analysis of the First 10 Months of the Pandemic

Background: The COVID-19 pandemic has disproportionately affected nursing home residents, and emerging evidence suggests quality, location, resident demographics, and staffing levels may be related to COVID-19 incidence within facilities. We describe the distribution of COVID-19 cases in Wisconsin nursing homes from January 2020 to October 2020, the effect of rural versus urban locations on COVID-19 incidence, and the temporal changes in COVID-19 incidence. Methods: We constructed a database using the Center for Medicaid and Medicare Services’ (CMS) publicly available data. Variables obtained per facility included location, number of beds, ownership type, average census, 5-star ratings (overall, quality, health, staffing, and nurse staffing categories), number of COVID-19 cases, resident Medicaid/Medicare share, area deprivation index, and social vulnerability index. Nursing homes were divided into tertiles based on total COVID-19 cases for descriptive analysis (zero cases, 1–7 cases, &gt;7 cases). Demographic and clinical variables were reported as frequencies, mean (standard deviation) or median (interquartile range). We compared groups using the Pearson χ2 test and the Kruskal-Wallis test. COVID-19 incidence rates were calculated by dividing the number of COVID-19 cases by monthly occupied bed days and multiplied by 10,000. Results: From January 1, 2020, to November 1, 2020, in total, 3,133 SARS-CoV-2–confirmed cases were reported among 248 (70.5%) nursing homes. Urban location (P = .027), overall 5-star rating (P = .035), number of beds (p &lt; 0.001), and average count of residents per day (p &lt; 0.001) were associated with a greater number of COVID-19 cases. Temporal analysis showed that the highest incidence rates of COVID-19 in NHs were observed from January to May and in October 2020 (11.36 and 30.33 cases per 10,000 occupied-bed days, respectively). Urban NHs experienced higher incidence rates until September, then incidence rates among rural facilities surged (Fig.1A). In the first half of the year, NHs with lower quality scores (1-3 stars) had a higher COVID-19 incidence rate; however, in August this trend reversed, and facilities with higher quality scores (4-5 stars) showed the highest incidence rates (Fig.1B). Fig. 2 shows a temporal depiction of the shift from urban to rural settings. Conclusions: Higher COVID-19 incidence rates during the first 5 months of the pandemic were observed in urban, larger facilities with lower 5-star rating. By the end of the year, nursing homes in rural areas and those with higher quality ratings had the highest incidence rates.Funding: NoDisclosures: None

Evaluating West Virginia's Emergency Medicine Workforce: A Longitudinal Observational Study.

ObjectiveAlthough the urban emergency workforce is well studied, rural departments are less understood. This study seeks to further define the landscape of rural healthcare and expand on previous studies of the West Virginia (WV) workforce.MethodsDuring the second quarter of 2019, surveys were sent via email to medical directors’ professional IDs as anonymous survey links. Hard copies were also sent to directors at their hospital addresses. Responses were aggregated with hospitals stratified based on annual census and rural classification. Data was interpreted through descriptive analysis.ResultsSurveys were sent to 53 departments with a 55% response rate. Of the responding hospitals, 15 of 29 were identified as rural. The average state-wide annual hospital census was 29,500 visits with board-certified emergency medicine (EM)-trained physicians covering 67% of shifts. Rural departments have a smaller census and less specialized coverage. Full-time physicians are found to have the strongest ties to WV, with 65% attending medical school, residency, or growing up in the state.ConclusionBoard-certified EM-trained physicians provide some level of coverage in most emergency departments in WV but remain underrepresented in rural locations. This specialized coverage has increased by 20% in the last 15 years. Additionally, a majority of hospitals have access to basic consulting services (surgery and primary care); however, other specialists are rare in rural WV.

HOSPITAL STATISTICS AS A MEASURE OF EFFECTIVE MANAGEMENT OF HOSPITAL RESOURCES IN OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITAL, ILE-IFE, OSUN STATE, NIGERIA

This study examined the significance of hospital statistics in measuring effectiveness of hospital resources in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The study made use of secondary sources of data where the basic hospital statistics such as daily admissions, discharges, deaths, patients’ days, average census/ average daily bed occupied, patients’ average length of stay, percentage of occupancy, turnover interval and daily attendance. The study showed that major hindrances for effective statistics in the hospital lack of understanding of the fundamental usefulness of statistics in planning, research, training and budgeting for national sustainable development. This study identified low level of understanding of the significance of statistics. Based on the findings of this study, the following recommendations are suggested for policy implementation: This study identified low level of understanding of the significance of statistics, hence, there is need for more awareness creation on the importance of statistics among members of the hospital that are involved in the completion and submission of the various forms where hospital statistics are generated through seminars, conferences and workshops Health information officers and other units such as the laboratories and the nursing departments need to be re-educated on the need for timely submission of statistics generated in the various units and sections. The hospital management needs to formulate policies that will support accurate and complete statistics from the various units that can be used for effective planning and informed decision making. The hospital management should endeavour to motivate the units and department that submit their reports promptly for collation in the form of training and other incentive that will encourage the same spirit among the concerned units and department respectively.

Welfare Costs of Traditional Shopping

Using data on the number of visitors at the store level, this paper investigates the welfare costs of traditional shopping-trips for the U.S. census blocks. The investigation is based on an economic model, where individuals living in census blocks decide on which store to shop from based on the corresponding shopping-trip costs and idiosyncratic benefits. The implications of the model suggest that the welfare gains from removing shopping-trip costs in percentage terms can be measured for each census block as the weighted average of log distance measures between shopping stores and census blocks. The corresponding results show that the welfare gains from removing shopping-trip costs is about 4% for the average census block, with a range between 0.021% and 18% across census blocks that is further connected to their demographic or socioeconomic characteristics. Certain practical policy implications follow regarding how shopping-trip costs can be reduced to achieve higher welfare gains.

54. Microbiologic Characterization and Antibacterial Use in Hospitalized Adults with covid-19 Infection

BackgroundCoronavirus disease 2019 (CoVID-19) admissions, oft complicated by an uncertain trajectory, lent to treatment influenced by supposition. Respiratory bacterial co-infection frequently was invoked. The purpose of this study was to determine the respiratory pathogen distribution and antibiotic prescribing patterns in hospitalized patients with CoVID-19.MethodsPatients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ICD-10 code and/or positive polymerase chain reaction (PCR) hospitalized between March 1 and May 31, 2020 were included. Antibiotic utilization (patient days of therapy-pDOT) was collected for the institution during this period and two years prior. Respiratory microbiologic cultures were reviewed to examine the frequency of co-infection on presentation, categorized as within 3 calendar days from admission or afterward. The relationship of antibiotic utilization to positive cultures was also categorized.ResultsOf the 7,969 encounters, 829 were ICD-10 coded and/or confirmed SARS-CoV-2 PCR positive and 196 (23.6%) had positive respiratory cultures. 89.8% of patients had endotracheal samples, the rest were isolated from sputum or bronchoalveolar lavage (17.4% and 6.6%, respectively). Patients were more likely to isolate commensal respiratory flora (108 versus 78 patients within the first 3 days of presentation. Notable isolates such as Staphylococcus aureus and Pseudomonas aeruginosa, were more often isolated after 3 days of hospitalization. While the CoVID-19 average hospital census was only 14.7% of the total, antibiotic utilization, (pDOT/1000) was 2.3 times higher, 831.9 versus 368.3 across the institution. During similar periods in 2018 and 2019, days of therapy overall were lower. For CoVID-19 infected patients, the frequency of antibiotic initiation was 73.2%. The length of therapy was on average 8 days with a high rate of observed restarts.Table 1: Patient characteristics for CoVID-19 infected patients admitted during March 1 to May 31, 2020 Figure 1: Positive respiratory pathogen culture results for CoVID-19 encounters (March 1-May 31, 2020) Table 2: Prevalence and select types of antibiotics administered to CoVID-19 patients. (March 1-May 31, 2020) ConclusionBacterial co-infection in an acute viral process is generally low. In this examination of CoVID-19 infected patients, the rate of any positive respiratory culture was 23.6%. A disproportionate effect on the volume of antibiotics and total days of therapy prompted an interest in early stewardship efforts and education.Table 3: Antibiotic consumption (patient days of therapy) for CoVID-19 encounters (March 1-May 31, 2020) compared to total consumption during identical time periods in 2018, 2019, and 2020 Disclosures All Authors: No reported disclosures

Patterns and Growth of a Dedicated Pediatric Coagulation Consult Service in a Freestanding Children's Hospital

Introduction: At our freestanding pediatric hospital, a dedicated inpatient coagulation consult service has existed for 15 years. To our knowledge, this type of service is relatively unique in a pediatric hospital and provides an opportunity to objectively evaluate changes in coagulation consults in this patient population. Over the past decade, the increasing rate of thrombosis in hospitalized pediatric patients has been noted and more attention has been placed on preventing the occurrence of hospital-acquired venous thromboembolism. With concern over this increased incidence, more inpatients have been receiving prophylactic anticoagulation. Methods: This is a secondary use of existing clinical care data study, involving review of the patients receiving a consult from the inpatient coagulation consult service. Average daily census was documented via a clinical tracking system. Data collection ranged from May 2011 to May 2020. Since 2013, number of distinct new consults (not repeat patients), and indication for consult have also been documented. These data were analyzed for trends in average census number and indication for consult. Additionally, the service requesting the consult is also reported. Results: From May 2011 to May 2020, the average daily census for the coagulation consult service has increased from 4.5 to 34.4 patients. (Figure 1) The rate of consult request for prophylactic anticoagulation increased from 8 in 2013 to 82 in 2020, while thrombosis and bleeding referrals remained relatively stable. (Figure 2) Since 2013, the service with the most requests for prophylactic anticoagulation over the entire period was orthopedic surgery with 70, followed by the cardiovascular intensive care (31) and medical intensive care (28) units (ICU). There was an increase in the number of prophylactic anticoagulation consults from the ICUs over the course of the study. (Figure 3) In early 2020 a VTE risk stratification was instituted in the CVICU. Conclusions: In this single institution, retrospective study, we noted an increase in number of consults for the coagulation service overall, and a larger increase in requests for consults for prophylactic anticoagulation. Further studies should be done to determine whether this increase in use of prophylactic anticoagulation exists at other pediatric hospitals and the impact on subsequent VTE development. Disclosures Carpenter: CSL Behring: Research Funding; American Thrombosis and Hemostasis Network: Membership on an entity's Board of Directors or advisory committees; Genentech, Inc.: Honoraria; Kedrion: Honoraria; Novo Nordisk: Honoraria; Shire: Research Funding; Hemostasis &amp; Thrombosis Research Society: Membership on an entity's Board of Directors or advisory committees; American Academy of Pediatrics: Other: PREP Heme/Onc editorial board.

Evaluation of a state law on opioid-prescribing behaviour and the void affecting codeine-containing antitussive syrup

BackgroundGovernment opioid policies—such as the North Carolina Strengthen Opioid Misuse Prevention (STOP) Act—have aided in lowering the days’ supply of opioid prescriptions. However, what effect do these laws have on...

Determining Antibiotic Use in Long-Term Care Facilities Across Tennessee

Background: Antibiotic stewardship is an area of great concern in long-term care facilities nationwide. The CDC promotes 7 core elements of antimicrobial stewardship. Based on information obtained from the Infection Control Assessment and Response (ICAR) Program, the 2 core elements most infrequently achieved by LTCFs are tracking and reporting. Currently, minimal data are available on antibiotic use (AU) in LTCFs in Tennessee. To address both issues, the Tennessee Department of Health (TDH) developed a monthly antibiotic use (AU) point-prevalence (PP) survey to provide LTCFs with a free tool to both track and report their AU and to gather data on how LTCFs are using antibiotics. Methods: We used REDCap to create a questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. This self-administered survey was promoted through the TDH monthly antimicrobial stewardship and infection control (ASIC) call as well as at various conferences and speaking engagements across the state. Antimicrobial stewardship leads for each facility were targeted. Antibiotics were grouped into 4 classes according to their indications: C. difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs) and respiratory infections. We determined AU percentage by dividing the number of days of therapy for a drug by a facility’s average census. Individualized reports are provided to each participating facility on a quarterly basis. Results: Currently, 16 facilities have participated in the survey. Overall, 40.7% of antibiotics prescribed were in the common for SSTI category and 39.3% were common for respiratory infections. The top 33 most commonly prescribed antibiotics were amoxicillin (156 days of therapy [DOT]), nitrofurantoin (92 DOT), and levofloxacin (88 DOT). The average percentage of residents on antimicrobials on the day of survey was 12.3%; within this group, 57% of antibiotics were initiated in the LTCF, whereas 43% were present upon admission. Conclusions: Early results from the TDH AU PP survey revealed that drugs commonly used for SSTIs and respiratory infection were the most common antibiotic prescriptions and a potential area of focus for TDH’s antimicrobial stewardship efforts. None of the 3 most frequently prescribed antibiotics, however, fall under the SSTI indication, despite SSTI being the most commonly prescribed indication based on the survey’s evaluation metrics. This finding could be related to the larger number of antibiotics that fall under the SSTI indication. Preliminary data are being used to guide the direction of TDH’s future ASIC calls to better suit disease states, which have room for improvement.Funding: NoneDisclosures: None

Inhaled bronchodilator exposure in the management of bronchopulmonary dysplasia in hospitalized infants.

ObjectiveTo determine clinical, demographic, and hospital factors associated with inhaled bronchodilator (IB) use in infants with bronchopulmonary dysplasia (BPD) and specifically severe BPD.Study designRetrospective multicenter cohort study of 4986 infants born <32 weeks gestation with developing BPD at 28 days of life. We used the Pediatric Health Information System database to compare hospital experience and the demographic and clinical characteristics of infants exposed and not exposed to IBs.ResultsTwenty-five percent of BPD patients (1224/4986) and 48% of severe BPD patients (664/1390) received IBs. IB exposure was higher in infants with the tracheostomy, prolonged steroid and diuretic exposure, and longer duration of respiratory support. IB use varied markedly between hospitals (0–59%). Average annual BPD census was not associated with IB use.ConclusionBronchodilator exposure is common in BPD patients with substantial variability in its use. Hospital experience did not account for the between-hospital variation in practice.

COVID-19 exposures and infection control among home care agencies

Background and objectivesHome care agencies (HCAs) provide caregivers, who perform an important role in maintaining the health and well-being of older adults. However, during the COVID-19 pandemic, paid caregivers had the potential to inadvertently spread COVID-19. We sought to characterize the effects of COVID-19 on HCAs and examine HCAs’ infection prevention and control (IPC) policies. Research design and methodsThis was a qualitative analysis of data collected from a national survey of HCAs. Surveys were e-mailed to members of a national HCA association on March 18, 2020. Questions included queries on demographics, COVID-19 exposures, effects of COVID-19, and IPC protocols. Results1204 HCAs responded with an average census of 96.2 (5−2800) patients daily. Across 36 states, 238 HCAs reported COVID-19 cases or exposures among caregivers. HCAs experienced challenges related to changing patient needs (e.g. decreased caregiver requests), staffing shortages (e.g., fear of COVID-19, inability to train caregivers), and management issues (e.g., inability to obtain supplies). ICP protocols varied in how HCAs followed recommended guidelines, responded to COVID-19 exposures, performed infection surveillance, and implemented precautions. Additionally, HCAs had varying policies for caregiver PTO. ConclusionsHCAs experienced COVID-19 exposures and/or cases early in the pandemic. HCAs identified staffing and PPE shortages, and lack of IPC guidance as challenges. Although caregivers are providing essential care for millions of older adults, they have been largely absent from federal, state, and health system strategies for mitigating the spread of COVID-19. Future policies must include HCAs and their caregivers to optimize care for older adults.