Mary's Medical Center Research Articles

Enhancing Heart Failure Diagnosis Accuracy and Distinguishing It From Other Pulmonary Conditions: A Retrospective Case Series Study Leveraging the HeartLogic Parameters.

Introduction Heart failure (HF) poses a substantial and escalating medical and economic challenge, marked by significant morbidity and mortality. It stands as the primary cause of hospital admissions among the elderly, contributing significantly to healthcare expenditures in developed nations. Evaluating cardiac and pulmonary function remains challenging, necessitating careful interpretation to mitigate misdiagnosis and inappropriate treatment. Remote monitoring has emerged as a preventive strategy to curb HF-related hospitalizations, emphasizing the importance of early detection of impending acute HF decompensation. Implantable cardiac defibrillators (ICDs) capture various parameters, including heart rhythm, pacing percentages, thoracic impedance, and physical activity. Objective In this study, we aim to investigate the effectiveness of HeartLogic (Boston Scientific, Marlborough, Massachusetts) parameters in accurately distinguishing HF patients from individuals with alternative diagnoses. Methods This cross-sectional study was conducted at Cabell Huntington Hospital, St. Mary's Medical Center in Huntington, West Virginia, between 2021 and 2022. The study involved a retrospective chart review of electronic medical records, approved by the institutional review board, encompassing patients aged >18 admitted with Heartlogic-capable devices. The analysis included demographic variables, admission and discharge diagnoses, length of hospital stays, health literacy index, and thoracic impedance. Results Of the initially included 26 patients, 19 met all inclusion criteria. The demographic profile highlighted a predominantly older population with a male preponderance and a notable incidence of congestive heart failure (CHF). Physiological changes, particularly in thoracic impedance and the HeartLogic Index, demonstrated significant alterations. Logistic regression analysis revealed that changes in health literacy index and thoracic impedance significantly contributed to predicting the change in CHF diagnosis. Conclusion This study, conducted in a rural setting, demonstrates the capability of the HeartLogic algorithm in predicting HF events, providing valuable insights into its utility in diverse clinical environments. The findings emphasize the potential of this technology to enhance diagnostic accuracy and improve patient outcomes.Despite inherent limitations, this analysis contributes unique perspectives, particularly in the context of a specific and underexplored rural population in West Virginia.

Age-Related Patterns of Traumatic Facial Fractures in the Appalachian Tri-state Area: A Five-Year Retrospective Study.

Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary's Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISSand hospital stay durations were similar across age groups.28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.

Judge rules against former employee

Case name: Draughn v. St. Mary's Medical Center Inc., No. 3:23‐0073 (S.D. W.Va. 10/10/23).

Judge rules against former employee

Case name: Draughn v. St. Mary's Medical Center Inc., No. 3:23‐0073 (S.D. W.Va. 10/10/23).

Judge rules against former employee

Case name: Draughn v. St. Mary's Medical Center Inc., No. 3:23‐0073 (S.D. W.Va. 10/10/23).

Judge rules against former employee

Case name: Draughn v. St. Mary's Medical Center Inc., No. 3:23‐0073 (S.D. W.Va. 10/10/23).

Social Determinants of Health Associated with Inpatient Admissions for Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, and Asthma

Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area.&#x0D; Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted ofunivariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0.&#x0D; Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p&lt;0.001) and diabetes (p&lt;0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p &lt;0.001).&#x0D; Conclusions: These findings indicate significant associations between multiple sociobehavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.

Socio-Demographic and Behavioral Predictors of Admission for Kidney Disease in an Urban Hospital in Northwest Indiana

Background: The CDC estimates more than 1 in 7 American adults have Chronic Kidney Disease (CKD) and nearly 800,000 live with End-Stage Renal Disease (ESRD); the majority of whom require dialysis. Current literature demands further exploration on how social determinants of health (SDOH) influence inpatient and emergency services utilization for CKD/ESRD-related exacerbations. This study examined socio-demographic and behavioral factors associated with hospital admission for CKD/ESRD. It is part of a three-phased Community-Based Participatory Research (CBPR) partnership between IUSM-NW and St. Mary Medical Center (SMMC) to examine and address relationships between SDOH, patient demographics, health behaviors, and health outcomes from January 2022-January 2025.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, health behavior, and health outcomes data obtained from adult inpatients between January 2021 and March 2023. CKD/ESRD was determined by admission diagnosis ICD-10 Code N18. Data analysis utilized SPSS 29.0 to produce frequencies, Chi-Square tests (p&lt;0.05), and a binary logistic regression (p&lt;0.05). This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).&#x0D; Results: This study included 10,953 inpatient admissions involving predominantly white (78.4%) and older adult (68 ± 21) patients. CKD/ESRD represented 96 admissions. The bivariate analysis found a significant association between CKD/ESRD admissions and age (p&lt;0.001), race (p&lt;0.001), sex (p=0.008), insurance type (p=0.030), and smoking tobacco use (p=0.004). After adjusting for all factors, being Asian (OR=12.172, p&lt;0.001), Black (OR=3.702; p&lt;0.001), female (OR=0.518; p=0.003), publicly insured (OR=2.76; p=0.014), and former smoking (OR=1.606; p=0.045) were significantly associated with CKD/ESRD admission.&#x0D; Conclusions: This study revealed several demographics, SDOH, and health behaviors associated with CKD/ESRD admission in an urban hospital. Uncovering predictors of CKD/ESRD admission enables focused interventions to decrease admissions. The next CBPR phases will apply advanced statistical analyses to further explore these relationships and codevelop interventions.

Association of Socio-Demographic Factors, Social Determinants of Health, and Weekly Physical Activity in an Urban Hospital in Northwest Indiana

Background: Engaging in regular physical activity has been proven to have beneficial health effects such as preventing chronic diseases and improving mental health. Recent studies have demonstrated correlations between socio-demographic factors and physical activity levels. This study determined the associations between socio-demographic factors, social determinants of health and the amount of weekly physical activity in patients occupying an urban underserved area.&#x0D; Methods: This study retrospectively analyzed a dataset generated by St. Mary Medical Center from EPIC™ with demographic characteristics and physical activity levels partitioned by time per week for adult inpatient visits from January 2021 to March 2023. Patients were stratified into physical activity levels based upon published guidelines: inactive (no physical activity), insufficiently active (&lt;150 minutes per week) or sufficiently active (≥150 minutes per week). Data analysis was conducted in SPSS 28.0 using tests of association including Kruskal Wallis H and multivariate ordinal regression model. This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).&#x0D; Results: The sample of individuals from the dataset who answered physical activity questions was comprised of 1498 patients. There was a statistically significant difference in physical activity level by age group (p&lt;0.001), sex (p&lt;0.05), insurance category (p&lt;0.001), and social connections risk score (p&lt;0.001); with race (p=0.057) and language (p=0.054) approaching significance. Multivariate analysis showed that age was the only significant factor when accounting for all variables, with higher age groups reporting lower proportions of physically active individuals.&#x0D; Conclusion: Determining how socio-demographic factors influence physical activity levels will direct efforts to form and implement new interventions in the Northwest Indiana urban area and support community health initiatives. This data makes it possible to inform practitioners of the demographics that are at risk of being insufficiently active and having them direct those patients to programs in place to help bridge the lapse.

Neurovascular Conditions and Associated Socio-Demographic and Behavioral Factors in an Urban Hospital in Northwest Indiana

Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p&lt;0.05), and multivariate analysis (binary logistic regression; p&lt;0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p&lt;0.001), veteran status (p&lt;0.001), insurance type (p&lt;0.037), and physical activity (p&lt;0.001). After adjusting for these factors in multivariate analysis, age group (p&lt; 0.003) and physical inactivity (p&lt;0.008) were significantly associated with admission for neurovascular conditions.&#x0D; Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.

Identifying Socio-Demographic and Behavioral Predictors of Prolonged Hospital Stay in an Urban Hospital in Northwest Indiana

Background: Hospital length of stay (LOS) is a crucial metric that impacts patient outcomes, healthcare resource utilization, and financial burden. In 2019 the CDC reported the average LOS in community hospitals was 5.4 days. Prolonged LOS is associated with an increased risk of hospital-acquired infections, decreased hospital bed availability limiting patient access to care, and cognitive impairment, particularly among the elderly. This indicates the importance of addressing LOS as a healthcare priority. This study examined the relationship between LOS and social determinants of health (SDOH), patient demographics, health behaviors, and health outcomes as part of a long-term Community Based Participatory Research partnership between IUSM-NW and St. Mary Medical Center (SMMC).&#x0D; Methods: This retrospective study analyzed EPIC™-generated data for adult inpatient visits at an urban hospital in Northwest Indiana from January 2021 to March 2023. Data analysis was performed using SPSS 28.0, consisting of descriptive statistics, bivariate analysis (One-way ANOVA, Independent T-tests, Kruskal Wallis H; p&lt;0.05), and Simple Linear Regression. This study was granted an exemption by the Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: The sample comprised of 10,916 predominantly white (77.7%) patients with a median age of 65 (IQR=22) and a median LOS of 4 days (IQR= 5). Bivariate analysis revealed LOS was significantly associated with age (p&lt;0.001), race (p&lt;0.033), sex (p&lt;0.012), insurance type (p&lt;0.001), physical inactivity (p&lt;0.001), and smoking tobacco (p&lt;0.001). After controlling for all factors in the multivariate analysis, age (p&lt;0.020), physical inactivity (p&lt;0.013), and insurance type (p&lt;0.013) retained their significance.&#x0D; Conclusions: These findings highlight the significance of demographic, behavioral, and social factors in relation to hospital LOS. Understanding these factors holds immense potential to guide the development of targeted interventions and healthcare strategies to optimize patient care and reduce LOS.

Social Determinants of Health and 30-Day Readmissions in an Urban Community Hospital in Northwest Indiana

Background: Hospital readmission within 30 days of discharge is a quality of care indicator with implications for healthcare systems, payers, and patients. The Hospital Readmission Reduction Program enacted in 2012 aimed to reduce preventable readmissions. Yet in 2018, there were 3.8 million adult 30-day readmissions with an average rate of 14% and estimated cost of $15,200 per readmission. This study examined the influence of social determinants of health (SDOH), demographics, and health behaviors on 30-day readmissions at an urban hospital in Northwest Indiana. This is part of a Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to address SDOH.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC in EPIC™ with SDOH, demographics, health behaviors, and health outcomes measures from inpatient admissions between January 2021 to March 2023. Data analysis consisted of descriptive, bivariate (Chi-Square; p&lt;0.05), and multivariate (binary logistic regression; p&lt;0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040).&#x0D; Results: The sample consisted of 7445 patients, majority 65 years and above (56.5%), white (77.47%), and publicly insured (76.83%). 30-day readmissions represented 10.5% of admissions. The bivariate analysis revealed statistically significant associations between 30-dayreadmissions and age (p&lt;0.001), language (p=0.008), insurance type (p&lt;0.001), veteran status (p=0.017), and smoking (p&lt;0.001). The multivariate analysis found that age (OR=1.008; p=0.004), being a non-English speaker (OR=1.866; p=0.009), public insurance (OR=2.096; p&lt;0.001), and former smoking (OR=1.243; p=0.011) remained significantly associated with 30-day readmission.&#x0D; Conclusions: Social and behavioral factors were associated with 30-day readmissions in an urban community hospital. Incorporating SDOH and behavioral interventions into hospital readmission reduction programs may reinforce these programs. The upcoming CBPR phase will conduct advanced analysis on these findings to uncover new relationships relevant to SMMC’s objectives.

Social Determinants of Health and Adverse Health Outcomes in an Urban Community Hospital in Northwest Indiana

Background: Social determinants of health (SDOH) are underlying contributing factors ofhealth inequities. Facility-based SDOH screenings inform targeted care, community resource referrals, and actions. St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana, was first acute care hospital in the state to pilot comprehensive SDOH screenings and referrals using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences(PRAPARE), a nationally recognized and validated tool. This study is part of a three-phased Community Based Participatory Research (CBPR) partnership between SMMC and IUSM-NWto examine and address SDOH from January 2021-January 2025. This study’s research questions are: What is the distribution of adverse health outcomes by demographics and by SDOH in SMMC’s inpatients?&#x0D; Methods: This descriptive study analyzed a limited dataset generated from EPIC™ by SMMC. It included demographics, behavioral, health outcomes, and SDOH measures for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 usingdescriptive statistics and tests of association (p&lt;0.05) including One-way ANOVA, Kruskal Wallis H, Chi-square, and Fisher’s Exact. This study was exempted by Indiana UniversityHuman Research Protection Program (IRB #14040).&#x0D; Results: The sample comprised 4370 patients, majority non-Hispanic (90.4%), White (75.7%), older adults (median age 65, IQR = 24), and publicly insured (76.3%). 30-day readmissions accounted for 9.1%. The top three discharge diagnoses were diseases of the circulatory system (20%), digestive system (12.4%), and injury (7.5%). Discharge diagnoses differed significantly (p&lt;.001) by family income, insurance type, stress presence, race, ethnicity, and sex. 30-day readmission was significantly associated with housing risk (p=.036) and insurance type (p&lt;.001).&#x0D; Conclusions: This study underscores the role of SDOH in influencing health outcomes and the importance of continuous SDOH screenings. This study will inform subsequent advanced analysis, the program evaluation, and the translation-to-action phase of the CBPR project.

Relationships Between Health Behaviors, Social Determinants of Health, and Patient Demographics in an Urban Northwest Indiana Hospital

Background: Social determinants of health (SDOH) contribute to over 50% of health outcomes and inequities. Healthcare institutions are increasingly implementing SDOH screenings and referrals. St. Mary Medical Center (SMMC) in Northwest Indiana was the first acute care hospital to implement a comprehensive SDOH pilot screening and referral program in Indiana using the validated Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE). This study is part of a three-phased Community-Based Participatory Research (CBPR) partnership between IUSM-NW and SMMC to examine and address SDOH within SMMC’s service area from January 2022-January 2025. This study’s research question is: What are the relationships between SDOH, behavioral, and demographic factors in SMMC’s inpatients?Methods: This descriptive study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral (tobacco use, alcohol use, physical activity), and health outcomes data for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 using descriptive statistics (i.e., frequencies and central tendency) and tests of association including Chi-square, Fisher’s Exact, Wilcoxon-Mann Whitney, and Kruskal Wallis H (p&lt;0.05). This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).Results: This study included 4370 inpatients, who were predominantly White (75.7%), older adults (65 ± 24), and publicly insured (76.3%). There were significant relationships between SDOH and tobacco use, alcohol use, and physical activity. Tobacco use was significantly associated with the majority of SDOH including insurance type (p&lt;.001), housing risk (p&lt;.001), financial resource risk (p&lt;.001), unmet transportation needs (p&lt;.001), and overall social risk (p=.012).Conclusions: Understanding how SDOH influence health behaviors will inform efforts to develop, implement, and evaluate multi-level interventions. The next phases of this CBPR will use advanced statistical techniques to further explore these relationships, evaluate SMMC’s pilot program, and co-develop SDOH interventions.

Improving Pneumococcal Vaccination Rates in an Inpatient Pediatric Diabetic Population.

Background: Diabetes is an immunocompromising condition, and diabetic children should receive the 23-valent pneumococcal polysaccharide (PPSV23) vaccine as part of their preventive care because of their increased risk for invasive pneumococcal disease. This recommendation is often not followed, however, and at our institution, we discovered that a factor limiting vaccine administration was lack of knowledge about the recommendation among residents.Methods: Our objective with this quality improvement initiative was to improve pneumococcal vaccination rates among the inpatient pediatric diabetic population to 70% in 6 months. Three education and awareness initiatives were conducted during the postintervention period of March 2021 to August 2021 at St. Mary Medical Center in Shreveport, Louisiana. All pediatric diabetic patients from age 2 to 18 years who were admitted to the inpatient general pediatrics or critical care services were included. The primary outcome was vaccination with PPSV23.Results: We studied 63 pediatric patients with a mean age of 12.7 years. The vaccination ordering rate during the 6 months prior to the implementation of the quality improvement initiatives was 41%. In the 6 months postintervention, the overall vaccination ordering rate improved to 81%. During data collection, however, we discovered that even though the residents were assessing for vaccine eligibility and ordering the vaccines, not all vaccines were administered prior to discharge. In the preintervention period, the overall vaccine administration rate was 27%, improving to 42% in the postintervention period.Conclusion: Simple interventions that included resident education, development of a smart phrase in the electronic medical record, and liaison with pharmacy led to an increase in the pneumococcal vaccination ordering rate for pediatric patients with diabetes. However, we did not anticipate that the vaccination ordering and administration rates would be different when we initiated the project and had therefore focused our interventions on resident education only. Our discovery of the difference between vaccination ordering and vaccination administration helped identify 2 other areas for improvement: nursing education and additional improvement of the electronic medical record.

"Atypical Case of Burkitt’s Lymphoma/Leukemia Presenting with Cranial Nerve Palsy"

Asma Jamil1*, Rajesh Gulati1, Ayesha Jamil2 and Abu Tahir M Taha3 Author Affiliations 1Riverside community hospital, Riverside, USA 2St.Mary medical center, Langhorn, USA 1Fresno state university, Fresno, USA Received: March 12, 2020 | Published: March 26, 2020 Corresponding author: Asma Jamil, Riverside community hospital, Riverside, CA, USA DOI: 10.26717/BJSTR.2020.26.004395

P.874 Aggression in psychiatric outpatients: Clinical and therapeutic variables from territorial faculty of the city of Milan

The objective of this study was to present the process of developing a rural surgery training track within an established residency program and review the current rural surgery training programs in the nation.This study reviews current rural surgery training opportunities at Accreditation Council for Graduate Medical Education accredited surgical residencies in the United States and presents the process of creating the University of Minnesota's rural surgery training track.This study was performed at the University of Minnesota, in Minneapolis, Minnesota, and at Essentia Health—Saint Mary's Medical Center, in Duluth, Minnesota.Accredited general surgery residencies were reviewed. The creation of a designated rural surgery training track added an additional rural-designated surgical resident during each postgraduation year and created a required postgraduation year 2 rural surgery rotation for all categorical surgical residents.Two hundred sixty-eight surgery residency programs were reviewed. Twenty-seven had required rural rotations, 10 offered only elective rural rotations, and 4 had dedicated National Resident Matching Program codes for rural training tracks. After review of national rural surgery training opportunities, the University of Minnesota's process of creating a designated rural surgery training program required attention to 5 main components: needs assessment and review of local opportunities, surgery residency review committee approval, funding, surgical education, and clinical/operative education.Increasing opportunities for surgical residents to train in rural settings may help with recruitment of medical students and retention of surgeons pursuing careers in rural surgery.

Improving Performance: A Multidisciplinary Approach to NICU Breast Milk Utilization

Improving Performance: A Multidisciplinary Approach to NICU Breast Milk Utilization Background: Breast milk utilization at our hospital is below the recognized standard based on CPQCC and VON, which can potentially lead to poor patient outcomes. Smart Aim: To increase the percentage of breast milk usage at discharge by 10% from baseline of 52.84% to 62.84% by December 2017 for infants <1500g and/or 22-31 and 6/7 weeks. Setting: At St Mary Medical Center, which is a 14 bed Community level 3 NICU with 300 admissions annually. …

Using Floor Champions to Improve Sepsis Quality Outcomes in Community Hospitals

Although dedicated sepsis nurses are beneficial to larger institutions, recruiting and/or economies of scale make the feasibility and affordability of this role much more challenging in smaller community hospitals. This article discusses an approach St. Mary Medical Center used to improve the overall bundle failure rate from 74% to 9% without a dedicated 24/7 sepsis nurse. Although dedicated sepsis nurses are beneficial to larger institutions, recruiting and/or economies of scale make the feasibility and affordability of this role much more challenging in smaller community hospitals. This article discusses an approach St. Mary Medical Center used to improve the overall bundle failure rate from 74% to 9% without a dedicated 24/7 sepsis nurse.

Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs

The objective of this study was to present the process of developing a rural surgery training track within an established residency program and review the current rural surgery training programs in the nation. This study reviews current rural surgery training opportunities at Accreditation Council for Graduate Medical Education accredited surgical residencies in the United States and presents the process of creating the University of Minnesota's rural surgery training track. This study was performed at the University of Minnesota, in Minneapolis, Minnesota, and at Essentia Health-Saint Mary's Medical Center, in Duluth, Minnesota. Accredited general surgery residencies were reviewed. The creation of a designated rural surgery training track added an additional rural-designated surgical resident during each postgraduation year and created a required postgraduation year 2 rural surgery rotation for all categorical surgical residents. Two hundred sixty-eight surgery residency programs were reviewed. Twenty-seven had required rural rotations, 10 offered only elective rural rotations, and 4 had dedicated National Resident Matching Program codes for rural training tracks. After review of national rural surgery training opportunities, the University of Minnesota's process of creating a designated rural surgery training program required attention to 5 main components: needs assessment and review of local opportunities, surgery residency review committee approval, funding, surgical education, and clinical/operative education. Increasing opportunities for surgical residents to train in rural settings may help with recruitment of medical students and retention of surgeons pursuing careers in rural surgery.