Post-intervention Time Periods Research Articles

Reduced Time to Admit Emergency Department Patients to Inpatient Beds Using Outflow Barrier Analysis and Process Improvement

Objective: Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient flow investigation to discover and solve outflow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced. Methods: In June 2022, a team using Lean Healthcare methodologies identified flow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers’ magnitudes of burden by the frequency of involvement in delays. During October–December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, defined as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed t-test comparing pre- to post-intervention time periods, January 1–September 30, 2022 (273 days) to January 1–September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability. Results: Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the outflow of admitted ED patients wherein 18 delays were identified. The EVS-clinical care collaboration failures explained 61% (11/18) of delays. Technology contributed to 78% (14/18) of delays primarily because staff’s technology did not display needed information, a condition we coined “digital blindness.” Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) significantly decreased (96.4 to 87.1 minutes, P = 0.04), even while daily ED encounter volume significantly increased (110.7 to 117.3 encounters per day, P < 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, P = 0.01; 95% confidence interval −22.7, −2.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coefficient [−12.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention’s sustainability over nine months. Conclusion: After systemwide patient flow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures significantly reduced ED admitted patient boarding.

Rollout of a statewide Australian telestroke network including virtual reality training is associated with improved hyperacute stroke workflow metrics and thrombolysis rate

BackgroundTelestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.AimsThe overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.MethodsThis study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.ResultsA total of 2,683 patients were included (April 2013–December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56–118] to 54 min [40–76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68–114] vs. 68.5 min [54–90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3–31 sessions per site).ConclusionsDelivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative

BackgroundAlbumin continues to be used routinely by cardiac anaesthesiologists perioperatively despite lack of evidence for improved outcomes. The Multicenter Perioperative Outcomes Group (MPOG) data ranked our institution as one of...

Reducing central line-associated bloodstream infection with a dedicated CLABSI prevention registered nurse role

Following a 200% increase in the central line-associated bloodstream infection (CLABSI) standardized infection ratio in a private teaching hospital between 2019 and 2020, a program with the utilization of a CLABSI Prevention Registered Nurse was implemented to reduce CLABSIs through a variety of focused prevention efforts and education. The CLABSI P-RN project consisted of a dedicated team of RNs that performed interventions that included an audit of all central lines daily, real-time education and remediation, bi-weekly educational handouts, and assistance with 2-person dressing changes. Audit data were utilized to identify trends in gaps in compliance with the CLABSI bundle (ie, daily bathing, dressing integrity). The CLABSI rate/1,000 central line days were tracked in preintervention, intervention, and postintervention time periods. During the intervention, the CLABSI rate decreased from 1.4 during the preintervention time period, to 0.4 during the intervention time period (P-value .04). Additionally, daily bathing compliance improved from 84.3% during the preintervention time period, to 90.8% during the intervention time period (P-value .004). The implementation of the CLABSI P-RN was beneficial in reducing CLABSIs. An expert-trained role dedicated to central line management reduces CLABSI occurrences, reduces health care costs, and improves patient outcomes.

Catheter-associated urinary tract infection (CAUTI) reduction in a neuroscience intensive care unit: A multidisciplinary approach

Utilizing a multidisciplinary approach to identify catheter-associated urinary tract infection (CAUTI) risks in Neuroscience intensive care patients admitted for aneurysmal subarachnoid hemorrhage, our CAUTI rate decreased from 5.903 per 1,000 catheter days (June 2020-June 2021) to 0.371 per 1,000 catheter days in our postintervention time period (July 2021-March 2023). A review of our clinical treatment guideline to optimize the timing of indwelling urinary catheters and medication management related to bowel regimens has resulted in a sustained CAUTI reduction, particularly in postaneurysmal subarachnoid hemorrhage patients in the Neuroscience intensive care unit.

Synthetic Control Analysis of the Short-Term Impact of New York State’s Bail Elimination Act on Aggregate Crime

We conduct an empirical evaluation of the short-term impact of New York’s bail reform on crime. New York State’s Bail Elimination Act went into effect on January 1, 2020, eliminating money bail and pretrial detention for nearly all misdemeanor and nonviolent felony defendants. Our analysis of effects on aggregate crime rates after the reform informs the understanding of bail reform and general deterrence, rather than specific deterrence via re-arrest rates of the detained/released population. We conduct a synthetic control analysis for a comparative case study of the impact of bail reform. We focus on synthetic control analysis of post-intervention changes in crime for assault, theft, burglary, robbery, and drug crimes, constructing a dataset from publicly reported crime data of 27 large municipalities. Due to the short time frame before the onset of COVID-19 and its far-reaching effects, we restrict attention to a short post-intervention time period. Nonetheless, evaluation of short-term impacts may still inform hypotheses of general deterrence of bail reform policy. Our findings, including placebo checks and other robustness checks, show that for assault, theft, and drug crimes, there is no significant impact of bail reform on aggregate crime. For robbery, we find a statistically significant increase; for burglary, the synthetic control is more variable and our analysis is deemed less conclusive. Since our study assesses the short-term impacts, further work studying long-term impacts of bail reform and on specific deterrence remains necessary. Supplementary materials for this article are available online.

Optimizing Neurology Inpatient Documentation: A Pilot Study of a Novel Discharge Documentation EHR Tool.

Clinical documentation of patient acuity is a major determinant of payer reimbursement. This project aimed to improve case mix index (CMI) by incorporating a novel electronic health record (EHR) discharge documentation tool into the inpatient general neurology service at the University of California, Los Angeles (UCLA) Medical Center. We used data from Vizient AMC Hospital: Risk Model Summary for Clinical Data Base (CBD) 2017 to create a discharge diagnosis documentation tool consisting of dropdown menus to better capture relevant secondary diagnoses and comorbidities. After implementation of this tool, we compared pre- (July 2017-June 2019) and post-intervention (July 2019-June 2021) time periods on mean expected length of stay (LOS) and mean CMI with two sample T-tests and the percentage of encounters classified as having Major Complications/Comorbidities (MCC), with Complication/Comorbidity (CC), and without CC/MCC with tests of proportions. Mean CMI increased significantly from 1.2 pre-intervention to 1.4 post-intervention implementation (P < .01). There was a pattern of increased MCC percentages for "Bacterial infections," "Other Disorders of Nervous System", "Multiple Sclerosis," and "Nervous System Neoplasms" diagnosis related groups post-intervention. This pilot study describes the creation of an innovative EHR discharge diagnosis documentation tool in collaboration with neurology healthcare providers, the clinical documentation improvement team, and neuro-informaticists. This novel discharge diagnosis documentation tool demonstrates promise in increasing CMI, shifting diagnosis related groups to a greater proportion of those with MCC, and improving the quality of clinical documentation.

139 Reducing Physical Therapy Consults for Patients with High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Differences Analysis

OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (&gt; 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC &gt; 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p &lt; 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.

Evaluation of a Multifaceted Protocol in Reducing Unnecessary Telemetry Monitoring across a Large Healthcare System.

Telemetry is frequently overused in hospitals. The goal of this study was to evaluate a telemetry protocol aimed at decreasing inappropriate telemetry utilization across four different hospitals within a large healthcare system by modifying the electronic telemetry order to incorporate the 2017 American Heart Association practice guidelines on the appropriate use of telemetry and using an electronic nursing screening task form to safely discontinue telemetry. We performed a retrospective analysis of telemetry utilization before and after we implemented a protocol across four hospitals within a large healthcare system. We compared the average number of days of telemetry monitoring and hospital length of stay during the preintervention period with the 6-month postintervention period. There were a total of 23,774 encounters evaluated. There was a statistically and clinically significant 24% decrease in telemetry duration between pre- and postintervention time periods (P < 0.0001). The mean (standard error) telemetry duration was 4.11 (0.17) and 2.36 (0.13) days in pre- and postintervention periods, respectively. The results of our study demonstrate a statistically significant decrease in overall duration of telemetry monitoring by nearly 1.75 days across each of the four hospitals with the implementation of a multifaceted telemetry protocol that included hardwiring the American Heart Association practice guidelines into the electronic order and using a nursing-driven discontinuation protocol.

Antimicrobial Stewardship in Total Joint Arthroplasty: Outcomes of a Collaborative Program Implementation.

Antimicrobial stewardship has been cited as a crucial component of orthopaedic surgical care; however, limited high-quality data exist to guide antibiotic use across the total joint arthroplasty continuum. Antimicrobial stewardship program (ASP) implementation and evaluation is needed in this space. We pursued a prospective, sequential cohort study of an interprofessional ASP for total joint arthroplasty (TJA) formed in late 2017 at the study institution. Twelve total evidence-based recommendations for protocol change were issued, with 11 accepted and implemented across three project phases spanning March 2018 to December 2019. The primary study outcome was the rate of optimal preoperative intravenous antibiotic selection as assessed for Baseline versus Postintervention time periods. Secondary outcomes included individual antibiotic utilization rates. Descriptive statistics were pursued for institutional surgical site infection (SSI) and postoperative acute kidney injury (AKI) rates across the affected time frame. A cost-benefit analysis of the ASP was estimated from the institutional perspective. The rate of optimal preoperative antibiotic selection increased from 64.9% in the Baseline Period (February 2018, n = 57) to 95.4% in the Postimplementation period (June 2018 to December 2019, n = 1,220) (P < 0.001). The rates of second-line preoperative antibiotics and total perioperative antibiotic exposures decreased. Total SSI and AKI rates in primary elective TJA seemed to decrease from calendar year 2018 to 2019 (deep SSI 1.00% to 0.22%, superficial SSI 0.66% to 0.00%, and AKI 1.97% to 1.03%). The institution realized an estimated $197,050 cost savings per 1000 TJA procedures. A comprehensive ASP for TJA was associated with an increased use of optimal preoperative antibiotic selection, decreased total antibiotic exposures, and cost savings, without apparent detriment to SSI or AKI rates.

Creating respectful workplaces for nurses in regional acute care settings: A quasi-experimental design.

To examine self-reported exposure and experiences of negative workplace behaviour and ways of coping of nursing staff before and after educational workshops. A Quasi-experimental design. Data were collected pre- /postworkshops using a structured questionnaire. Nurses (N= 230) from 12 units in four regional acute care hospitals were invited to complete a pre-intervention survey. Educational workshops were then implemented by the organization at two of the hospitals, after which, follow-up surveys were undertaken. There were 74 responses in the pre-intervention and 56 responses in the postintervention time period. There were 111 participants who attended the educational intervention, 20% (n= 22) completed the follow-up survey. Participants were more likely exposed to work-related bullying acts and they used problem-focused coping strategies and sought social support as a way of coping when exposed to the negative behaviours. Overall, there was a decrease in both bullying and incivility experienced by participants; however, our findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention. Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

#23 Clinical Outcomes with Rapid Gram-Positive Blood Culture Identification in an Academic Pediatric Hospital

Abstract Background BACKGROUND Delays in initiating appropriate antibiotics increases mortality, length of stay, and overall admissions costs in patients with bloodstream infections. Adult studies using rapid diagnostic tests such as the GenMark’s e-Plex Blood Culture Identification (BCID) Panels coupled with Antimicrobial Stewardship Program (ASP) interventions have led to reductions in each of these metrics. Similar data assessing use in the pediatric population are generally lacking. The primary aim of this study was to assess the impact of the GenMark Blood Culture Identification Gram Positive panel (BCID-GP panel) on the time to optimal antimicrobial therapy (OAT) in pediatric patients with positive blood cultures growing gram-positive bacteria (GPB). Method METHOD A 2-year Quality Improvement study of admitted pediatric patients was carried out at UPMC Children’s Hospital of Pittsburgh (CHP) between June 25, 2019 and June 26, 2021. Pre-intervention data (6/25/19 – 6/25/20) was collected retrospectively from the CHP Electronic Medical Record (EMR). During the post-intervention time-period (6/26/20 - 6/26/21), BCID-GP panel was run daily from 6AM to 10 PM on blood cultures with Gram stains revealing GPB. Results were provided to the ASP who generated recommendations and communicated them to the patient’s primary team after reviewing the EMR using a pre-determined algorithm. Statistical analyses were performed using Wilcoxon rank sum test and Chi-squared tests. Results RESULTS 317 and 265 blood cultures with GPB were evaluated in the pre- and post-intervention groups, with median ages of 2.26 and 3.2 years in the 2 groups, respectively. Overall panel accuracy was 97% with gene accuracy of 100%. Percent compliance with ASP recommendations within 12 hours was 89%. The median time to OAT was 48 (range of 0-175), and 33.1 hours (range 0-165) in the pre- and post-intervention groups, respectively (p &amp;lt;0.001). The median time to OAT for patients with MSSA decreased from 65 to 30.5 hours (p &amp;lt;0.001), and 37 to 20 hours (p 0.048) for those with MRSA. Antibacterial therapy was avoided in 42.2% of patients in the post-intervention group when results were interpreted as contaminants, compared with 23.4% in the pre-intervention group with this assessment (p = 0.008). Length of stay and 30-day mortality was similar between groups, 6.1 days vs 6.9 days (p = 0.23) and 3.5% vs 3.4%, (p = 1.00) respectively. Conclusion CONCLUSION Use of BCID-GP panel significantly decreased the time to OAT and avoided initiation of antibiotics in incidences of contamination in our study population. This was also true for positive blood cultures due to MSSA and MRSA. However, significant differences in the length of stay or 30-day mortality were not identified between groups. We did find the overall accuracy, defined as the percentage of BCID panels detected targets confirmed by conventional laboratory culture and gene accuracy, defined as the percent of BCID panels with results detected confirmed by conventional laboratory susceptibility methods, of the panel mirrored with previously published data. We also found ASP recommendations based on the BCID-GP were followed 89% of the time within 12 hours of them being made.

An analysis of missed injuries at a level 1 trauma center with a tertiary survey protocol

BackgroundTertiary surveys can help identify missed injuries, but how and when to conduct them remains uncertain. This study aimed to evaluate the outcomes of a policy requiring tertiary survey completion within 24 h post-admission. MethodsA retrospective review was performed with a pre-intervention time-period of 8/1/2019-1/31/2020, where tertiary surveys were performed prior to discharge (n = 762). During the post-intervention time-period of 8/1/2020-1/31/21 tertiary surveys were performed within 24 h of admission (n = 651). ResultsMissed injury (1.6% [n = 12] vs. 1.5% [n = 10]; p = 0.953) and mortality rates (3.1% vs. 3.7%, p = 0.579) were similar between the pre- and post-intervention groups. Tertiary survey completion rates were higher (86.8% vs. 80.2%; p = 0.001) and exams performed earlier (1[1-1] vs. 1 [1–2] day, p < 0.001) in the post-intervention group. For those with missed injuries, time to injury identification and number of injuries identified on tertiary survey was unchanged. ConclusionRequiring tertiary surveys within 24 h of admission can help identify and correct missed injuries, but standardization of the tertiary survey process and documentation may be as important as the timing.

Management of cancer‐associated thrombosis with thrombocytopenia: Impact of the ISTH guidance statement

BackgroundOptimal management of cancer‐associated thrombosis (CAT) in patients with thrombocytopenia remains difficult given competing risks of recurrent thrombosis and increased bleeding. We determine the impact of the ISTH Scientific and Standardization Committee (SCC) guidance on CAT management and thrombocytopenia on platelet transfusion, bleeding, and recurrent thrombosis. MethodsA retrospective review was performed of patients with CAT and thrombocytopenia who required anticoagulation for VTE for 11 months before and after implementation of the ISTH SCC guidance. Medical records were reviewed to identify the type of VTE event, number of platelet transfusions, incidence of bleeding, and VTE recurrence within pre‐ and postintervention time periods. ResultsA total of 41 and 80 cases were included in the preintervention and postintervention periods, respectively. The preintervention group showed a trend toward less acute VTE events (39% vs 55%; P= .05). The postintervention period had an increased per‐patient platelet transfusion (median, 2.5 vs 4; P= .05). Nonmajor bleeding was increased in the postintervention group (2% vs 16%; P= 0.03) and included all six (8%) major hemorrhages (P= .09). There was numerically less recurrent thrombosis in the postintervention group (20% vs 8%; P= .07), which was not significantly different when accounting for acuity of VTE. Management adherence was strong, at 91%, in the postintervention group. ConclusionThe ISTH guidance on management of cancer‐associated thrombosis in patients with thrombocytopenia was successfully implemented in an academic medical center. There was no significant difference in bleeding or recurrent thrombosis outcomes after adjusting for acuity of VTE.

Sustained radiation reduction following initial quality improvement intervention in a paediatric cardiac catheterisation laboratory.

As part of a quality improvement project beginning in October 2011, our centre introduced changes to reduce radiation exposure during paediatric cardiac catheterisations. This led to significant initial decreases in radiation to patients. Starting in April 2016, we sought to determine whether these initial reductions were sustained. After a 30-day trial period, we implemented (1) weight-based reductions in preset frame rates for fluoroscopy and angiography, (2) increased use of collimators and safety shields, (3) utilisation of stored fluoroscopy and virtual magnification, and (4) hiring of a devoted radiation technician. We collected patient weight (kg), total fluoroscopy time (min), and procedure radiation dosage (cGy-cm2) for cardiac catheterisations between October, 2011 and September, 2019. A total of 1889 procedures were evaluated (196 pre-intervention, 303 in the post-intervention time period, and 1400 in the long-term group). Fluoroscopy times (18.3 ± 13.6 pre; 19.8 ± 14.1 post; 17.11 ± 15.06 long-term, p = 0.782) were not significantly different between the three groups. Patient mean radiation dose per kilogram decreased significantly after the initial quality improvement intervention (39.7% reduction, p = 0.039) and was sustained over the long term (p = 0.043). Provider radiation exposure was also significantly decreased from the onset of this project through the long-term period (overall decrease of 73%, p < 0.01) despite several changes in the interventional cardiologists who made up the team over this time period. Introduction of technical and clinical practice changes can result in a significant reduction in radiation exposure for patients and providers in a paediatric cardiac catheterisation laboratory. These reductions can be maintained over the long term.

The effect of geographic rounding on hospitalist work experience: A mixed-methods study

Objectives To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as “geographic rounding,” and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. Methods The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. Results Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p<0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p<0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p<0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p=0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. Conclusion Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.

Community pharmacist counseling improves adherence and asthma control: a nationwide study

BackgroundPharmaceutical counseling (PC) interventions have been shown to improve adherence to controller medication and asthma control. However, the real-life impact of these PC interventions in difficult-to-control asthma patients remains unclear. We aimed to assess the effectiveness of PC interventions in real life using nationwide claims data.MethodsDemographics and drugs use of patients who received ICS in 2017 with or without pharmaceutical counseling were retrieved from a Belgian claims database. Asthma-related drug use from 1 year before first ICS dispensing in 2017 (reference period) was compared with 1 year after. Outcomes were usage of inhaled corticosteroids (ICS) in defined daily doses (DDD), proportion of users of short-acting beta-agonist (SABA), antibiotics, oral corticosteroids (OCS), asthma biologicals and controller-to-total (CTT) ratio.ResultsThe study population consisted of difficult-to-control asthma patients aged 5–40 years with at least the first interview within 90 days after first ICS dispensing (n = 1350). ICS usage increased significantly in the year after PC intervention compared with the reference period (+ 43.3 DDD/patient, p < 0.05). A nominal decrease was observed in the proportion of SABA (48.0 to 46.2%) and antibiotics (54.5 to 52.7%) after PC intervention compared with the reference period. CTT ratio significantly increased from 0.671 to 0.749 (p < 0.05). The proportion of biological users was nominally lower in the intervention group compared with a control group (n = 50,477) in the post-intervention time period (0.22% versus 0.30%).ConclusionsThis first nationwide study among difficult-to-control asthma patients suggests that community pharmacist counseling is effective in real life to improve controller adherence and asthma control.

Systemization of a pharmacy technician career ladder in a multi-hospital system

PurposeHospital consolidation into larger, systemized health systems has enabled system-wide standardization of promotion processes, including pharmacy technician career ladders. However, whether system standardization affects the job satisfaction or outcomes of pharmacy technicians is unknown. The purpose of this project was to assess pharmacy technician perceptions and outcomes after systemization of a pharmacy technician career ladder. MethodsPharmacy technician satisfaction scores and outcomes (promotion and turnover rates) were assessed in an eight-hospital health system before and after systemization of a pharmacy technician career ladder. ResultsTwo hundred and forty-nine pharmacy technicians were employed during the pre-intervention (n = 104) and post-intervention (n = 145) time periods. One hundred and twenty-three of 145 (84.83%) pharmacy technicians completed a job satisfaction survey after implementation of the system-wide technician career ladder. Overall satisfaction for the career ladder averaged 3.8 ± 0.61 or between neutral to positive satisfaction. There was no difference in total satisfaction regardless of teaching (3.8 ± 0.59) or community hospital (3.8 ± 0.63) location (p = 0.53) or stratifying by Pharmacy Technician status. A total of 50 pharmacy technicians were hired during the study period, either during the pre-implementation (n = 36) or post-implementation (n = 14) time periods. Time to the first promotion averaged 1.73 ± 1.00 years in the pre-implementation period and 1.36 ± 0.55 years in the post-implementation period (p = 0.20). Technician voluntary turnover was similar between the time periods. ConclusionIn conclusion, the standardization of a systems-level pharmacy technician promotion ladder from a single hospital to a systems-level was associated with positive job satisfaction and similar promotions and turnover rates as the historic, single hospital-based promotion ladder.

Internal medicine physician embedded in an orthopedic service in a level 1 hospital: clinical impact.

The aim of our study was to evaluate the impact of an internist physician specialized in diabetes, appointed as an in-house physician in the orthopedic wards, on improving clinical outcomes and in particular 30-day mortality. We analyzed a cohort of patients hospitalized more than 24h in the orthopedic service. The analyses included a comparative analysis between the pre- and post-intervention time periods and an interrupted time series (ITS) analysis, which were conducted in stratification to three populations: whole population, patients with at least one chronic disease and/or older than 75years of age and patients diagnosed with diabetes. The primary outcome was 30-day mortality following the hospitalization. A total of 11,546 patients were included in the study, of which 19% (2212) were hospitalized in the post intervention period. Although in the comparative analysis there was no significant change in 30-day mortality, in the ITS there was a decrease in the mortality trend during the post intervention period in the entire and chronic disease/elderly populations, compared to no change during the pre-intervention period: a post-intervention slope of -0.14(p value < 0.001) and -0.11(p value = 0.03), respectively. Additionally, we found decrease in length of stay, increase in transfers to the internal medicine department with a negative trend, increase in HbA1c testing during the hospitalization and changes in diabetes drugs administration. The presence of an internist in the orthopedic wards is associated with health care improvement; decrease in the 30-day mortality trend, decrease in length of stay, increase in HbA1c testing during the hospitalization and an increase in diabetes drugs administration.

588. Implementation of a standardized OPAT SmartForm was associated with improved post-discharge outcomes

BackgroundThe outpatient parenteral antimicrobial therapy (OPAT) plan has frequently been omitted or incompletely communicated during transitions of care at our institution. Better communication of the OPAT plan at discharge has the potential to improve patient outcomes.MethodsA standardized OPAT documentation tool (SmartForm) was developed in our electronic health record system for use by our inpatient Infectious Disease (ID) consult service. This intervention was part of an ongoing quality improvement project to improve communication of the OPAT plan at discharge. Outcomes were assessed prospectively during the post-intervention time period (11/18/2019 - 4/13/2020) and compared to the pre-intervention time period (10/14/2019 - 11/11/2019). Patients were included if discharged on IV antibiotics with follow up by a University of Utah Health ID provider. Patients discharged to long-term acute care facilities were excluded.ResultsThree hundred five patients were included: 231 in the post-intervention period and 74 in the pre-intervention period. Demographic characteristics were similar between time periods with the exception of older age (mean 60 vs 56 years), a greater percentage of patients receiving OPAT via an infusion center (19% vs 9%), and fewer patients receiving OPAT via home health (54% vs 64%) in the pre-intervention cohort. Documentation of an OPAT progress note occurred more frequently (94% vs 85%, p = 0.02) and patients were more likely to be enrolled in our OPAT program (77% vs 51%, p < 0.0001) after implementation of the OPAT SmartForm. Outpatient laboratory monitoring occurred with similar frequency during the pre- and post-intervention time periods (85% vs 82% of expected laboratory encounters completed, p = 0.31). Sixty-day unplanned hospital readmissions were reduced after implementation of the SmartForm (22% vs 35%, p = 0.02). Multivariable logistic regression identified Charlson comorbidity index (OR 1.10, 95% CI: 1.02–1.18) and the pre-intervention time period (OR 1.78, 95% CI: 0.99–3.18) as variables independently associated with readmission.ConclusionImplementation of an OPAT SmartForm was associated with improved documentation of the OPAT plan, increased enrollment in the OPAT program, and reduction in hospital readmissions.DisclosuresRussell J. Benefield, PharmD, Merck and Co (Grant/Research Support)Paratek Pharmaceuticals (Grant/Research Support)Rempex Pharmaceuticals (Grant/Research Support)