Community Hospital In Ontario Research Articles

A Feeding Adequacy Scale for Children With Bronchiolitis: Prospective Multicenter Study.

To determine the measurement properties of the Feeding Adequacy Scale (FAS) in young children hospitalized with bronchiolitis. Multicenter cohort study of infants hospitalized with bronchiolitis at children's and community hospitals in Ontario, Canada. Caregivers and nurses completed the FAS, a 10-cm visual analog scale anchored by "not feeding at all" (score 0) and "feeding as when healthy" (score 10). The main outcome measures were feasibility, reliability, validity, and responsiveness of the FAS. A total of 228 children were included with an average (SD) age of 6.3 (5.4) months. Completing the FAS was feasible for caregivers and nurses, with no floor or ceiling effects. Test-retest reliability was moderate for caregivers (intraclass correlation coefficient [ICC] 2,1 0.73; 95% confidence interval [CI] 0.63-0.80) and good for nurses (ICC 2,1 0.75; 95% CI 0.62-0.83). Interrater reliability between 1 caregiver and 1 nurse was moderate (ICC 1,1 0.55; 95% CI 0.45-0.64). For construct validity, the FAS was negatively associated with length of hospital stay and positively associated with both caregiver and nurse readiness for discharge scores (P values <.0001). The FAS demonstrated clinical improvement from the first FAS score at admission to the last FAS score at discharge, with significant differences between scores for both caregivers and nurses (P values for paired t test <.0001). These results provide evidence of the feasibility, reliability, validity, and responsiveness of caregiver-completed and nurse-completed FAS as a measure of feeding adequacy in children hospitalized with bronchiolitis.

Effectiveness of a Multi-component Delirium Prevention Program Implemented on General Medicine Hospital Units: an Interrupted Time Series Analysis

BackgroundDelirium is among the most prevalent harmful events in hospitals that is associated with an elevated risk for severe outcomes such as functional decline, falls, longer length of stay, and increased mortality.ObjectiveTo evaluate the impact of the implementation of a multi-component delirium program on the prevalence of delirium and the incidence of falls among patients staying on general medicine inpatient hospital units.DesignA pre-post intervention study using retrospective chart abstraction and interrupted time series analysis.CohortPatients were selected from adult patients that stayed at least 1 day on one of the five general medicine units in a large community hospital in Ontario, Canada. A total of 16 random samples of 50 patients per month for 8 consecutive months pre-intervention (October 2017 to May 2018) and 8 months post intervention (January 2019 to August 2019) were selected for a total of 800 patients. There were no exclusion criteria.InterventionThe delirium program included multiple components: education of staff and hospital leadership, twice per day bed-side screen for delirium, non-pharmacological and pharmacological prevention, and intervention strategies and a delirium consultation team.MeasurementDelirium prevalence was assessed using the evidence-based delirium chart abstraction method, CHART-del. Demographic data as well as fall incidence were also collected.ResultOur evaluation showed that the implementation of a multicomponent delirium program led to a reduction in delirium prevalence and fall incidences. The reduction in both delirium and falls was the largest for patients in the ages between 72 and 83 years old and varied across inpatient units.ConclusionA multi-component delirium program to improve the prevention, recognition, and management of delirium reduces the prevalence of delirium and fall incidence among patients in general medicine units.

Effectiveness of methicillin-resistant Staphylococcus aureus surveillance among exposed roommates in community hospitals: Conventional culture versus direct PCR

Roommates of unrecognizednosocomial methicillin-resistant Staphylococcus aureus (MRSA) cases are at ahigher acquisition risk; however, optimal surveillance strategies are unknown. Using simulation, we analyzed surveillance testing and isolation strategies for MRSA among exposed hospital roommates. We compared isolating exposed roommates until conventional culture testing on day 6and a nasal polymerase chain reactiontest on day 3 (PCR3) with/without day 0 culture testing (Cult0). The model represents MRSA transmission in medium-sized hospitals using data and recommends best practices from the literature and Ontario community hospitals. Cult0 + PCR3 incurred a slightly lower number of MRSA colonizations and 38.9% lower annual cost in the base case compared to Cult0 + culture testing on day 6 because the reduced isolation cost compensated for the increased testing cost. The reduction in MRSA colonizations was due to a 54.5% drop in MRSA transmissions during isolation as PCR3 reduced the exposure of MRSA-free roommates to new MRSA carriers. Removing the day 0 culture test from Cult0 + PCR3 increased total cost, the number of MRSA colonization, and missed cases by $1,631, 4.3%, and 50.9%, respectively. Improvements were higher under aggressive MRSA transmission scenarios. Adopting direct nasal polymerase chain reaction testing for determining post-exposure MRSA status reduces transmission risk and costs. Day 0 culture would still be beneficial.

A PROPENSITY-MATCHED COHORT STUDY TO ASSESS THE EFFECTIVENESS OF A COMMUNITY HOSPITAL BASED HEART FUNCTION CLINIC

A PROPENSITY-MATCHED COHORT STUDY TO ASSESS THE EFFECTIVENESS OF A COMMUNITY HOSPITAL BASED HEART FUNCTION CLINIC

Impact of Diabetes on Inpatient Length of Stay in Adult Mental Health Services in a Community Hospital Setting: A Retrospective Cohort Study

ObjectiveOur aim in this study was to characterize the relationship between comorbid mental health diagnosis and diabetes type on inpatient length of stay (LOS). MethodsThis retrospective chart review study was conducted at a community hospital in Ontario, Canada. Individuals admitted to the inpatient mental health unit with a reported diagnosis of type 1 or type 2 diabetes were included in the analysis. Relevant data related to mental health conditions at admission and LOS were collected from the electronic health record. Analyses of variance and coviariance were used to determine the impact on LOS. ResultsA total of 249 encounters were included in the analyses. Overall, individuals with type 2 diabetes had a significantly longer LOS (mean, 14.70 days; standard deviation, 15.75 days) than individuals with type 1 diabetes (mean, 8.01 days; standard deviation, 7.27 days). Upon including sociodemographic factors, individuals older in age and with a most recent admission of <1 year also had a longer LOS. There was no significant relationship between the most responsible mental health diagnosis and LOS. ConclusionsIndividuals with type 2 diabetes may be more likely to have a longer LOS in inpatient mental health settings than those with type 1 diabetes. More dedicated support would be beneficial for this population. Future work should focus on in-depth exploration of the challenges that lead to the observed LOS.

Choosing Wisely: An idea worth sustaining.

To evaluate the sustainability potential of Choosing Wisely (CW) to address unnecessary medical care at Ontario community hospitals. Ontario community hospitals and their affiliated family health teams (FHTs). A mixed-methods study involving the administration of a validated sustainability survey to CW implementation teams followed by their participation in focus groups. Survey data were collected using an Excel file with an embedded, automated scoring system. We collated individual survey scores and generated aggregate team scores. We also performed descriptive statistics for quantitative data (frequencies, means). Qualitative data were triangulated with quantitative assessments to support data interpretations using the meta-matrix method. Fifteen CW implementation teams across four Ontario community hospitals and six affiliated primary care FHTs participated. CW priority areas investigated were de-prescribing of proton pump inhibitors (PPIs) and reducing Pre-Op testing and BUN/Urea lab testing. Survey results showed steady improvements in sustainability scores from baseline to final follow-up among most implementation teams: 10% increase for PPI de-prescribing (six FHTs) and 2% increase (three hospital teams); 18% increase in BUN/Urea lab testing (three hospital teams). Regardless of site or CW priority area, common facilitators were fit with existing processes and workflows, leadership support, and optimized team communication; common challenges were lack of awareness and buy-in, leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge for which they co-designed and implemented a plan to maximize the sustainability potential of their CW initiative. Evaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence implementation efforts and to realize positive outcomes for their health care services and patients.

RELIEF: A Digital Health Tool for the Remote Self-Reporting of Symptoms in Patients with Cancer to Address Palliative Care Needs and Minimize Emergency Department Visits.

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF—saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting.

The catch with urine: A justification for ultrasound-guided suprapubic tap in the NICU

A high index of suspicion is required for urinary tract infections (UTI) detection in the neonatal intensive care unit (1). Catching urine samples in sick children has been a longstanding clinical problem. In febrile children aged 2 to 36 months of life, the Canadian Paediatric Society recommends a bagged specimen for screening purposes only (2). Suspected infections based on bagged samples require follow-up by either clean catch, urethral catheterization, or suprapubic aspiration (SPA). Despite a higher contamination rate of 62.8% compared to 9.1% in catheter samples (3), in an Ontario community hospital audit, 65.7% of UTI diagnoses <3 years were based on bagged samples, in 73.9% without confirmation (4). Catheter samples in the neonatal intensive care unit may be difficult to obtain due to patient size, and results are often unreliable due to contamination. It is paramount to include a urine sample in addition to blood and spinal fluid for late-onset sepsis evaluations in infants >72 hours of life. Clinical signs are often nonspecific and unreliable in neonates (1), making UTIs arguably underdiagnosed. The inability to promptly obtain urine may delay antibiotics, or lead to antibiotics being started before obtaining a urine sample. Urine is rendered sterile by a single dose of an effective antibiotic.

Variations in Red Blood Cell and Frozen Plasma Transfusion Rates Across 60 Ontario Community Hospitals

Background: A restrictive transfusion strategy has been shown to be equivalent to a liberal transfusion strategy in terms of mortality and morbidity outcomes in major clinical trials.Liberal transfusions have been associated with higher mortality and morbidity, as well as longer lengths of stay in hospital based on observational data. Although patient blood management programs have reduced transfusion rates and improved patient outcomes, these programs have not been universally applied. Recent province wide audits of frozen plasma (FP) use in Ontario showed a high rate of inappropriate transfusions. Similarly, a recent red blood cell (RBC) audit in Ontario showed that approximately 25% of RBC units transfused were inappropriate.Objectives: The primary aim of this study was to compare transfusion rates of RBCs and FP across 60 Ontario community hospitals with more than 50 active treatment beds from 2012-2016. The secondary aims were to identify clinical and hospital factors, which may account for these differences.Methods:This study was a retrospective review of transfusion data from Ontario community hospitals between 2012-2016. RBC and FP transfusion data were acquired through the Canadian Blood Services data warehouse. Acute inpatient bed days and the annual average number of active treatment beds were obtained through the Ministry of Health and Long Term Care of Ontario. Annual transfusion rates were reported as FP and RBC units transfused per 100 acute inpatient days (AIPD), using descriptive statistics. Rates of blood component use were correlated with size of hospital using linear regression to determine whether size of hospital impacted on transfusion practices. Rates of RBC transfusion were correlated with rates of FP transfusion using linear regression. Finally, available data on local transfusion guidelines and pre-existing quality improvement mechanisms, such as pre-printed order sets, the presence of transfusion guidelines at each site were surveyed and reviewed to determine the impact of institutional culture on transfusion practices.Results: From 2012 to 2016, there were decreasing rates of RBC and FP use over time, with a wide range of variation amongst hospitals (Table 1). The average number of FP units transfused was 0.67, 0.62, 0.50, and 0.44 units per 100 AIPD for 2012-2013, 2013-2014, 2014-2015, and 2015-2016 respectively.The average number of RBC units transfused was 6.1, 6.0, 5.5, and 5.4 units per 100 AIPD for 2012-2013, 2013-2014, 2014-2015, and 2015-2016 respectively. Larger hospitals were associated with a significantly higher FP transfusion rate (p<0.05 for all years). However, there was no correlation between RBC transfusion rates and size of hospital. Of the 24 hospitals that responded to the survey, sites with transfusion quality improvement indicators (N=19) had statistically fewer units of FP transfused (p=0.04 for 2014-2015, p<0.01 for 2015-2016), and had a decrease in the units of FPs transfused from year to year. There was a statistically significant association between FP transfusion rates and RBC transfusion rates (p<0.01 for all years).Conclusion and significance: There may be cultural differences at different institutions contributing to the variations in transfusion rates across Ontario community hospitals. Characterization of transfusion practices and understanding of institutional culture surrounding blood component use will hopefully lead to quality improvement (QI) initiatives aimed at creating better guidelines, education, and transfusion order entry systems. These data will serve as a baseline to highlight sites and practices where QI initiatives may be most beneficial and potentially replicated in other provinces and states. [Display omitted] DisclosuresLin:Pfizer: Other: advisory board; Pfizer: Honoraria; Novartis: Research Funding; CSL Behring, Grifols: Other: unrestricted education grant.

Factors that influence community hospital involvement in clinical trials: A qualitative descriptive study.

The successful conduct of randomized clinical trials (RCTs) is often impeded by recruitment difficulties. Community hospitals see large volumes of patients but rarely participate in trials. The objective of this study was to explore how research stakeholders identify and understand the contextual, organizational, research, and individual-level factors that influence the engagement of community hospitals in Ontario to participate in RCTs as partner sites. In this descriptive, qualitative study, semi-structured interviews were conducted with a purposeful sample of 18 individuals who are familiar with the processes associated with engaging community hospitals for research or recruiting participants from these sites into trials. Demographic data were summarized using descriptive statistics. The principles of conventional content analysis were used to code, categorize and synthesize the interview data. Informed by participants' descriptions, the results were organized within three unique stages that describe the process of recruitment within community hospitals: (a) community hospital engagement; (b) initiation of the project in the community hospitals; and (c) recruiting patients. The key barriers were the invisibility of the community hospitals to research investigators and the lack of research infrastructure in most of the community hospitals. Increased communication and sharing of resources between academic centers and community hospitals facilitated recruitment across all three stages. Our results illustrated a willingness of community hospitals to participate in RCTs, but a lack of capacity for research. Additional efforts by trial coordinating sites are required to recruit community hospitals, but their inclusion improves the generalizability of trial results.

Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting

BackgroundStudies have shown that the incidence of postoperative delirium, the hospital length of stay and time to surgery are reduced when older adults with a hip fracture are cared for by a multidisciplinary team providing comprehensive geriatric assessments. Most of these studies have been conducted in academic centres. We sought to determine if implementation of an orthogeriatric collaborative care model would improve key quality of care metrics in a community hospital setting.MethodsThis retrospective pre- and postintervention single-site study was conducted in a community hospital in Ontario, Canada. We included consecutive patients aged 65 years or older who were admitted for a hip fracture between June 2015 and June 2017. In the intervention period, a new postoperative order set included a referral to a geriatrician for comprehensive geriatric assessment, with direct implementation of recommendations. Primary outcomes were the incidence of postoperative delirium and length of stay. Secondary outcomes included Health Quality Ontario’s quality standards for hip fracture.ResultsA total of 212 consecutive patients (95 in the preintervention group and 117 in the postintervention group) were included in the study. The incidence of postoperative delirium (26.3% v. 26.5%, p = 0.98) and length of stay (interquartile range 4–10 v. 5–10 d, p = 0.32) were similar in the preintervention and postintervention groups. There were improvements (p < 0.001) in the rates of asssessment of mental status, falls and bone health; identification of delirium prevention strategies; prescription of vitamin D or calcium or both; and recommendations for antiresorptive therapy. Despite systemic implementation of the orthogeriatric model, only 74.4% of patients in the postintervention group were seen by a geriatric medicine consultant.ConclusionAlthough the implementation of an orthogeriatric collaborative care model for older adults with a hip fracture did not reduce the incidence of postoperative delirium or length of stay, there were improvements in the rates at which several other key quality standards for hip fracture care were met. Earlier proactive, comprehensive geriatric assessment in a community hospital setting will be the target for further quality improvement initiatives.

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

To determine acceptability of medical cannabis research in critically ill patients. Q-methodology survey. Convenience sample of healthcare providers and the general public were recruited at an acute care community hospital in Ontario, Canada. In the first phase, 63 respondents provided 197 unique viewpoints in response to a topic statement about medical cannabis use in critically ill patients. Twenty-five viewpoints were selected for the q-sample. In the second phase, 99 respondents ranked these viewpoints according to an a priori quasi normal distribution ranging from +4 (most agree) to -4 (least agree). Factor analysis was combined with comments provided by survey respondents to label and describe the extracted factors. The factor labels were hoping and caring (factor 1), pragmatic progress (factor 2), and cautious/conservative and protectionist (factor 3). Factor 1 describes a viewpoint of unequivocal support for medical cannabis research in this population with few caveats. Factor 2 describes a viewpoint of cautious support with a need to monitor for unintended adverse effects. Factor 3 describes a viewpoint of ensuring that current analgosedation techniques are optimized before exposing patients to another potentially harmful drug. Using a q-methodology design, we were able to sample and describe the viewpoints that exist about medical cannabis research in critically ill patients. Three factors emerged that seemed to adequately describe the relative ranking of q-statements by the majority of respondents. Combining the distinguishing statements along with respondent comments allowed us to determine that the majority support medical cannabis research in critically ill patients.

Estimation of unregistered patients who left without being seen: At an urban mid-sized Canadian community emergency department.

To determine whether changes to the appearance of an emergency department (ED) waiting room influenced the number of patients who left without being seen (LWBS). Retrospective analysis using National Ambulatory Care Reporting System data collected at the time of patient registration. The ED of Belleville General Hospital, a mid-sized secondary care community hospital in Ontario with a catchment population of 125 000. All unscheduled patients registering at the hospital to be seen in the ED from July 1 to December 31, 2016 (control period), and from July 1 to December 31, 2017 (study period). The volume of patients registering by Canadian Triage and Acuity Scale (CTAS) level to be seen in the ED during the study period compared with the volume of patients registering during the control period, and the number of LWBS during the 2 time periods. The average number of patients registered per month was significantly greater in the study period than in the control period (t 10 = -5.53, P < .01). A total increase of 1881 registrations was recorded in the study period, or 10.47% (increase per month ranged from 9.59% to 11.66%). The proportion of patients with less acute triage scores decreased in the study period; however, the differences in CTAS levels between the 2 years was not statistically significant (χ 2 = 1.05, P = .90). The number of LWBS according to CTAS level was lower in all categories in the study period, including those in the less acute levels, decreasing from 60 in CTAS 5 in 2016 to 45 in 2017, and 585 in CTAS 4 in 2016 to 330 in 2017. Overall, the distribution of LWBS by CTAS level was significantly different between the control and study periods (P < .01). The number of patients registering is influenced by the apparent high or low occupancy of the waiting area at the time of registration.

Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario.

Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital's medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.

The Management of an Early COVID-19 Case with Severe Acute Respiratory Distress Syndrome in a Community Hospital in Ontario, Canada

We reported an early COVID-19 case in a young patient in a Canadian community intensive care unit (ICU) with severe acute respiratory syndrome (ARDS). We discussed the management according to the recently published Surviving Sepsis Guidelines on COVID-19. This will provide critical care physicians important and timely information on the management of severe COVID-19 using a real case when critical care physicians are facing a surge in COVID-19 cases.

Trends in elective and ruptured abdominal aortic aneurysm repair by practice setting in Ontario, Canada, from 2003 to 2016: a population-based time-series analysis.

Recent years have seen centralization of vascular surgery services in Ontario. We sought to examine the trends in overall and approach-specific elective and ruptured abdominal aortic aneurysm repair by hospital type (teaching v. community). We conducted a population-based time-series analysis of elective and ruptured abdominal aortic aneurysm repairs in Ontario, Canada, from 2003 to 2016. Quarterly cumulative incidences of repairs per 100 000 Ontarians aged 40 years and older were calculated. We fit exponential smoothing models to the data stratified by approach and hospital type to examine repair trends. We identified 19 219 elective and 2722 ruptured repairs between 2003 and 2016. The cumulative incidences of overall elective repair and elective open surgical repair decreased by 1.15% (p = 0.008) and 67% (p < 0.001), respectively, in teaching hospitals and by 23% (p < 0.001) and 60% (p < 0.001), respectively, in community hospitals. The cumulative incidence of elective endovascular repair increased 667% in teaching hospitals (p < 0.001). Elective endovascular repair began in community centres after 2010 and increased to 0.98/100 000 (p < 0.001), resulting in a rebound in overall elective repair in the community. Overall ruptured repairs and ruptured open repairs decreased by 84% (p < 0.001) and 88% (p = 0.002), respectively, at community hospitals. Ruptured endovascular repairs at community hospitals increased from no procedures before 2006 to 0.03/100 000 in 2016 (p = 0.005). There has been substantial uptake of endovascular aortic repair in teaching and community hospitals in Ontario, and community hospital uptake of endovascular repair has begun decentralization of abdominal aortic aneurysm repair. Increased experience and training in endovascular repair and reduced specialized care requirements will probably lead to continued decentralization.

Variations in RBC and frozen plasma utilization rates across 62 Ontario community hospitals.

Recent province-wide audits of frozen plasma (FP) and RBC use in Ontario showed a high rate of inappropriate transfusions. This was a retrospective, ecological study to determine variations in RBC and FP utilization rates across Ontario community hospitals between 2012 and 2017. Annual utilization rates were reported using descriptive statistics. Rates of blood component use were correlated with size of hospital, presence of specialized programs, and quality improvement (QI) initiatives, using Poisson regression. RBC and FP utilization rates decreased from 2012 to 2017 (p = 0.03 for FP; p < 0.01 for RBC). There was a 10-fold difference in RBC and FP transfusion rates between the highest and lowest users. Smaller hospitals (p < 0.05) and sites with any QI initiative (p = 0.006) were associated with lower FP utilization rates. Hospitals without cancer programs (p = 0.02) and sites with RBC guidelines (p = 0.05) or with technologists who prospectively screened transfusion orders (p = 0.01) had lower RBC transfusion rates. RBC utilization rates decreased further after the implementation of RBC guidelines (p = 0.02) and order sets (p = 0.005). There was a positive correlation between FP and RBC transfusion rates for each fiscal year (p < 0.005 for all years). RBC and FP utilization showed wide variation across community hospitals in Ontario. Overall, transfusion rates decreased over time. A further decrease was observed at sites with QI initiatives, supporting their implementation in reducing utilization. These data will serve as a baseline to highlight sites and practices where QI initiatives may be most beneficial and replicated in other jurisdictions.

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

Evaluating the Relationship Between Hospital Antibiotic Use and Antibiotic Resistance in Common Nosocomial Pathogens.

OBJECTIVE The relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada. METHODS We conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days). RESULTS With resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility for Pseudomonas aeruginosa (-0.162% per DDD/1,000 PD; P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly for Escherichia coli (0.173% per DDD/1,000 PD; P=.005), Klebsiella spp (0.124% per DDD/1,000 PD; P=.004), Enterobacter spp (0.194% per DDD/1,000 PD; P=.003), and Enterococcus spp (0.309% per DDD/1,000 PD; P=.001), and nonsignificantly for Staphylococcus aureus (0.012% per DDD/1,000 PD; P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD; P<.001). CONCLUSIONS We found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns. Infect Control Hosp Epidemiol 2017;38:1457-1463.

Design and Implementation of a Trauma Care Bundle at a Community Hospital

The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack...