Saudi Arabian Hospital Research Articles

The influence of electronic health record use on healthcare providers burnout

BackgroundElectronic health records (EHRs) are critical health information technology tools that ensure accuracy and improved management of patient records. However, the use of EHRs can lead to significant burden and burnout among healthcare providers, potentially affecting the quality of care they deliver. ObjectivesThe purpose of this study is to determine the extent of burnout among healthcare providers who use EHRs, with the specific objectives of assessing the level of EHR-related burnout in Saudi Arabian hospitals and identifying the key EHR-related factors contributing to this burnout. MethodsA descriptive quantitative cross-sectional study was conducted. A valid and reliable questionnaire was distributed to healthcare providers in Saudi Arabian hospitals to measure their burnout levels associated with EHR usage. ResultsThe findings indicate that the use of EHRs contributes to healthcare provider burnout, which may diminish the quality of care provided to patients. Several variables were significantly related to the healthcare providers' personal burnout, i.e., their living area, age, job, and year of experience, although only the healthcare provider's age influences their work-related burnout significantly. On the other hand, working hours per week and number of patients per week significantly influence the healthcare provider's EHR-related burnout. ConclusionThe study suggests that EHR usage is a significant factor in healthcare provider burnout. Addressing this issue requires enhanced training, workload reduction, and prompt resolution of EHR-related problems to improve provider well-being and maintain high-quality patient care.

The impact of telemedicine on cardiac patient outcomes: A study in Saudi Arabian hospitals

<sec><title>Introduction</title><p>Telemedicine has been increasingly integrated into cardiac care, thus offering remote monitoring and consultation for patients with cardiovascular diseases. It promises to improve patient outcomes, especially in heart failure management, by enabling continuous monitoring of vital signs and facilitating remote patient-provider interactions. This technology has gained particular significance amidst the COVID-19 pandemic, thereby offering a safer alternative to in-person visits. This study assesses the effectiveness of telemedicine in the management of cardiac patients in Saudi Arabia, and reflects on its benefits, challenges, and overall impact on patient outcomes.</p></sec><sec><title>Methods</title><p>A retrospective cohort study was conducted to analyze patient records from Saudi healthcare facilities and compare health indicators before and after telemedicine implementation. The study involved cardiac patients who received telemedicine consultations and a control group who received traditional care. Statistical analyses, including the chi-square test, t-test, and ANOVA, were performed to identify differences between the groups while controlling for confounders.</p></sec><sec><title>Results</title><p>There were no statistically significant differences between the telemedicine and control groups in terms of blood pressure (P = 0.72), heart rate (P = 0.65), readmission rate (P = 0.54), and medication adherence (P = 0.48). The patient satisfaction was slightly higher in the telemedicine group, although the difference was not statistically significant (mean satisfaction score of 3.01 vs. 2.83, P = 0.41).</p></sec><sec><title>Conclusions</title><p>The introduction of telemedicine did not significantly alter the cardiac patient outcomes compared with traditional in-person care in Saudi Arabia. Although telemedicine offers a promising alternative for patient management, its effectiveness may vary based on the individual patient's needs and specific health indicators. Further research is necessary to explore its full potential and to optimize its application in cardiac care.</p></sec>

Simulation-Based Training in Basic Surgical Skills: Experiences From a Repeat Cross-Sectional Study in Saudi Arabia

Introduction The conventional surgical apprenticeship has been challenged by patient safety concerns, cost of lengthy operation, and surgical complications. Simulation-based training (SBT) has emerged as a realistic option for surgical skills acquisition outside the operating room (OR). The study aimed to document our experience in implementing SBT to acquire basic surgical skills, offered as an educational course, known as the Basic Surgery Skill Course (BSSC). Methods This was a repeated cross-sectional study conducted between January 2017 and December 2019 at King Abdulaziz University Hospital (KAUH) in Saudi Arabia, including all participants who participated during BSSCs. A pretested questionnaire was used to collect data on age, sex, training level, institution, overall experience, course overload, course duration, best feature of the course, and whether participants would recommend the course to their colleagues. Whenever possible, self-reported data were compared with registration records, and any conflict was resolved by discussion. Results BSSC was found in a total of 489 participants. More than 58% of the participants were men. Majority of students came from out of KAUH (61%) and were medical interns (63%). Overall experience of the course was very beneficial (57%). The course workload and duration were rated as about right by 82% and 75% of participants, respectively. Majority of participants found that the “hands-on practice” as the best segment of the course (76%). Conclusion The study showed a positive perception of this surgical education modality among participants. This study will help guide the future research on advanced simulation-based surgical training in the region.

Describing Self-Reported Penicillin Allergy Using a Penicillin Allergy Risk Tool (PEN-FAST) in an Outpatient Setting at a Tertiary Hospital in Saudi Arabia.

Introduction Penicillin is a widely used antibiotic and is frequently reported as a cause of allergic reactions. However, many individuals reporting penicillin allergies are later found to be tolerant. This study, conducted in an outpatient setting at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, aimed to assess the prevalence of self-reported penicillin allergy and to evaluate further the risk of a positive penicillin allergy test using the PEN-FAST tool. Methods A cross-sectional study was conducted via in-person questionnaires with patients in the waiting area at the outpatient clinics of KAUH in Jeddah, Saudi Arabia. Results Among 140 participants, 4% reported a penicillin allergy, with most identifying their allergies based on symptoms. None of these allergies resulted in severe reactions. Notably, 50% reported nausea and itching as symptoms. The PEN-FAST tool categorized 33.3% as moderate risk and 50% as low to very low risk for a positive penicillin skin test. One participant was confirmed to be allergic via a skin prick test. Discussion and conclusion The prevalence of reported penicillin allergy was lower in our study than that previously reported. Evaluation of the PEN-FAST score demonstrated that this prevalence is even lower at 2%. While this single-center study offers valuable insights, further research in diverse healthcare settings is required to validate these findings and refine our understanding of penicillin allergies.

Application of Mirena Intrauterine Device in Cesarean Section: Experience from a Private Hospital in Saudi Arabia - A Prospective Cohort Comparative Study

Application of Mirena Intrauterine Device in Cesarean Section: Experience from a Private Hospital in Saudi Arabia - A Prospective Cohort Comparative Study

Profile of a large cohort of children with persistent fetal vasculature and their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia.

To present the profile of a large cohort of children with persistent fetal vasculature (PFV) and identify their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia. This was a single-center study. Medical records of children diagnosed with persistent fetal vasculature between January 1990 and January 2020 at King Khaled Eye Specialist Hospital (KKESH), Riyadh, were reviewed. Data were collected on PFV type, presenting features, management, and visual acuity. Poisson regression with robust error variance was used to identify the predictors of poor visual outcome. Data of 175 eyes of 170 children with PFV were analyzed. Most had unilateral disease (n = 165, 96.2%), and over half of them (57.1%) were males. The main presenting complaints were leukocoria (n = 126, 72.0%), followed by smaller eye (n = 36, 20.6%), poor vision (n = 15, 8.6%), and strabismus (n = 13, 7.4%). Anterior, posterior, and combined PFV were present in 30.9%, 10.9%, and 58.3% eyes, respectively. In eyes with measurable visual acuity (n = 124), BCVA at the last follow-up was ≥20/100, <20/100-20/400, CF/HM and LP/NLP in 11 (8.9%), 32 (25.8%), 43 (34.7%), and 38 (30.6%) eyes, respectively. In the multivariable poisson regression analysis, eyes with posterior PFV were approximately two times more likely to have a BCVA of CF or worse than those with anterior PFV (Adjusted incidence ratio: 1.82 (95%: 1.23, 2.70; P = 0.003). Compared with eyes with primary or secondary IOL implantation, aphakic eyes or those with no cataract surgery were significantly more likely to have BCVA of CF or worse (adjusted incidence ratio: 1.84 [95%: 1.18, 2.86], p = 0.007 and adjusted incidence ratio: 1.64 [95%: 1.08, 2.50], p = 0.020, respectively). The prognosis of PFV varies depending on the severity of the disease. Patients with posterior PFV had worse visual outcome than anterior or combined type. Whether primary or secondary, IOL implantation increases the probability of having BCVA better than CF.

Comparative effectiveness and cost evaluation of Risankizumab and Adalimumab in the management of psoriasis: a real-world study in Saudi Arabia

BackgroundPsoriasis, an immune-mediated chronic inflammatory disease primarily affecting skin and joints, has varying prevalence rates globally. It manifests in five types, with chronic plaque psoriasis being the most common. Treatment, which has no definitive cure, aims for complete resolution of skin symptoms and depends on disease extent, severity, and impact on patients’ lives. Biologics are an emerging treatment for psoriasis, targeting specific inflammatory pathways for potentially safer, more effective outcomes. However, these come with significant costs, necessitating more research to ensure value for money. This study aimed to compare the effectiveness of Risankizumab versus Adalimumab, the most commonly utilized biologic for managing psoriasis in Saudi Arabia.MethodsThis study retrospectively compared the effectiveness and direct medical cost of Risankizumab and Adalimumab in treating chronic plaque psoriasis in adults from two Saudi Arabian healthcare centers. The Psoriasis Area and Severity Index (PASI) and body surface area (BSA) were used to assess treatment effectiveness, with patient data sourced from electronic medical records. Multiple regression analysis was performed to examine various factors affecting treatment outcomes. An economic evaluation was conducted to examine the cost-effectiveness of the two drugs, considering four scenarios with varying dosage patterns and costs. Analysis was performed from the perspective of public healthcare payers and considered all utilized health services.ResultsThe data for 70 patients were analyzed, with comparable baseline characteristics between groups. While Risankizumab led to a greater reduction in PASI scores and BSA affected, these results were not statistically significant. The annual treatment cost for Risankizumab was higher than Adalimumab. Various scenarios were studied, considering real acquisition costs, double dosing for Adalimumab, and the use of biosimilars. A scenario assuming double dosing for Adalimumab and a 40% discount for Risankizumab demonstrated both cost and efficacy advantages in 71.25% of cases.ConclusionsThis study compared the effectiveness and cost of Risankizumab and Adalimumab for treating chronic plaque psoriasis in Saudi Arabian hospitals. Although Risankizumab showed a greater reduction in symptoms, the difference was not statistically significant. However, under certain scenarios, Risankizumab demonstrated cost and efficacy advantages. These findings may influence treatment decisions for psoriasis, but further research is needed.

Exercise-induced rhabdomyolysis manifestations and complications: a case report

Introduction: Rhabdomyolysis is a medical condition that results from damage to striated muscles that causes the release of their components into the bloodstream. Laboratory indications include high levels of creatinine kinase and myoglobin in the serum. Importance: This case report emphasizes the importance of having professional trainers in gyms and training centers who respect trainees’ limitations and physical capabilities and ensure that physical exercise programs are being conducted safely and effectively. Case presentation: A 39-year-old female healthcare provider presented to the emergency department at a tertiary/quaternary hospital in Saudi Arabia, with progressive right arm pain, swelling, weakness, and dark urine 2 days after an unaccustomed heavy physical exercise session with her personal trainer following a long pause from physical training. Clinical discussion: Levels of serum creatinine kinase, aspartate aminotransferase, and alanine transaminase were moderately elevated. There was no evidence of renal impairment, electrolyte disturbance, or coagulopathy. The patient was treated with analgesics, received hydration, and was discharged home under close observation and with a follow-up clinic visit scheduled to check for complications. Data were collected from the hospital’s electronic medical records, including clinical notes and laboratory investigations. Conclusion: Awareness campaigns need to be conducted to educate the public about healthy ways to exercise, such as gradually increasing the intensity of physical activity, warming up before exercising, cooling down after each workout, and staying hydrated. It is important that healthcare providers, trainees and trainers are able to recognize the signs of muscular injury following vigorous exercise in order to reduce the incidences of complications that could be deadly if they are not caught and managed early.

IBC-Oxford University2023_BJSPoster_9Causes of re-hospitalization according to the bariatric procedures, single center experience

Abstract The numbers of bariatric procedures are increasing dramatically worldwide. Despite the international guidelines and recommended preventive perioperative steps, postoperative complications still occur with significant numbers. Postoperative complications differ and represent a heterogeneous group of diseases with different pathophysiology, severity and management plans reaching up to major revisional surgery. Many patients require rehospitalization for managing these complications. The observed increasing numbers of rehospitalization prompted us to study and analyse the causes of readmission. This retrospective descriptive study aimed to report our experience, as a tertiary university institute in managing various complications after different bariatric procedures that necessitated hospital readmission. All patients who have been admitted in a university tertiary hospital in Saudi Arabia with any post-bariatric surgery complication for the last five years were included. A total of 228 admitted patients were included due to any post-bariatric complications. Most of them was diagnosed with more than one clinical entity. These patients underwent different bariatric procedures either performed in our institution or referred to us from other hospitals. Demographic data revealed that both genders were equally involved, the age ranged from 15-68 years. Most of bariatric procedures were reported. The length of hospital stay ranged from 1 – 84 days. Postoperative leakage was found in 23 patients after sleeve gastrectomy. Therefore, better recognition and diagnosis of postoperative complications is mandatory. Analysis of the common causes could prompt a clinical pathway and preventing programs.

Abstract #1595972: Metabolic and Renal Outcomes of Empagliflozin in Patients With Type 2 Diabetes Mellitus Attending Armed Forces Hospital in Saudi Arabia

Abstract #1595972: Metabolic and Renal Outcomes of Empagliflozin in Patients With Type 2 Diabetes Mellitus Attending Armed Forces Hospital in Saudi Arabia

IBC-Oxford University2023_BJSPoster_10Surgical management of intra-gastric balloon complications

Abstract In Saudi Arabia, the intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications has been reported for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. We aim to report our experience as a tertiary university hospital in the Eastern Province of Saudi Arabia in dealing with different complications of IGBs that necessitated any type of surgical interventions. A retrospective descriptive study was conducted in a tertiary hospital in Saudi Arabia for 5 years to include all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively, and any complications related to other bariatric procedures. Six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had esophageal rupture that required left thoracotomy, pleural flap and insertion of an esophageal stent. All cases were discharged and followed up with no related complications.

Efficacy of docetaxel, cisplatin, and 5-fluorouracil as an induction chemotherapy in oral squamous cell carcinoma in a tertiary hospital in Saudi Arabia

ObjectiveTo assess the efficacy and safety of the induction chemotherapy's combination of docetaxel, cisplatin, and 5-fluorouracil (TPF) in Oral Squamous Cell Carcinoma (OSCC) patients and its positive outcomes on tumor size and surgical resection. MethodA retrospective chart review of patient's medical records was conducted from 2018 to 2023. All patients diagnosed with OSCC and who received induction chemotherapy combination of TPF were included in the study. Patients with other conditions that affect chemotherapy tolerability, other primary malignancy, or incomplete medical records were excluded. Descriptive analysis was undertaken to summarize the data pertaining to tumors before and after administration of the TPF chemotherapy. ResultFive patients met the inclusion criteria. All five patients experienced a reduction in tumor size after receiving the TPF induction chemotherapy. Three patients showed a downstaging to [stage 0] after surgical resection. Specifically, one patient demonstrated a reduction in overall stage from [IVb] to [IVa] after receiving TPF induction chemotherapy, and two patients demonstrated a noteworthy improvement in N staging, reducing from [N2c] to [N2b]. In contrast, the fourth patient slightly improved after the induction chemotherapy and surgical resection procedures. However, the stage of the fifth patient remained unchanged before and after the treatment approach. ConclusionThe study shows that implementing TPF induction chemotherapy to surgical resection improves clinical outcomes in a subset of patients with advanced OSCC without any harmful consequences.

The mediation role of safety training between risk perception and safety behaviors among non-medical hospital staff

The relationship between risk perception and safety outcomes has been extensively studied in the past, but there is scarce research on the mediating effect of safety training on risk perception and both safety dimensions of safety behaviors in hospital settings. This study investigates the role of safety training as a mediator in the relationship between risk perception and safety behavior, as measured by compliance and participation in safety measures. The cross-sectional data from one big private hospital in Saudi Arabia was examined using the most recent iteration of Smart Partial Least Squares (PLS4). A 71% response rate was achieved on surveys that were personally handed out to 155 non-medical staff in hospitals. In this study, the significance level for Percentile Bootstrapping with a 95% confidence interval and p ≤ 0.05 was utilized to analyze mediation. Safety training served as a full mediating variable in the link between risk perception and safety compliance. Surprisingly, safety training did not act as a mediator in the relationship between risk perception and safety participation. This study fills a gap in the body of knowledge about non-medical staff's attitudes toward risk, safety training, and safety behaviors. Additionally, it helps us comprehend how safety training can help people perceive risks and behave safely. Considering that hospital management and safety officials receive high-quality training on safety concerns, more workers follow safety precautions, and the number of workplace accidents is reduced. The results of this study can be used as a foundation for future studies to enhance occupational safety practices.

The Concordance between Laboratory and POCT INR and the Value of Bedside Measurement of INR in Patients on Warfarin Undergoing Dental Procedures: A Prospective Cohort Study

Introduction: Patients on anticoagulation particularly warfarin suffers when they have a dental problem that requires intervention. Most of dentists worry and refuse to perform procedures on patients on warfarin because of the risk of bleeding and request the availability of international normalized ratio (INR) results before procedure which can delay the procedure and add another burden on the patient particularly who live away from the treating center. Objective: To evaluate the efficacy and the value of using point of care testing (POCT) (INR) in patients on warfarin undergoing dental procedures. We also had analyzed the frequency and severity of dental bleeding in patients on warfarin therapy and the concordance between Laboratory based INR and POCT INR. This is the first interim analysis on ongoing prospective study. Methods: A cohort study of 30 patients on chronic use of anticoagulation therapy with warfarin for different clinical indications who planned to undergo dental procedures at a teaching hospital in Saudi Arabia. The patients' demographic and clinical characteristics, type and severity of bleeding, and INR measured by both HemoChrone (POCT) and prothrombin time (PT) were performed at same time. Descriptive statistics, paired samples statistics, correlations, and analysis of variance (ANOVA) were performed. Results: The sample consisted of 60% females, with a mean age of 49.9 (SD 13.3) years. The most common indications for warfarin therapy were mechanical aortic valve replacement (56.7%), atrial fibrillation (13.3%), and atrial flutter (16.7%). Before the procedure, the mean Laboratory INR was 2.6 (SD 0.6) and the mean HemoChrone POCT INR was 2.8 (SD 0.8). There was a significant positive correlation between the two methods (r = 0.81, p &amp;lt; 0.001). There was no significant difference in the INR and type of bleeding, dentist performed the procedure, or dose of warfarin. There was no correlation between the Bleeding severity or type and the INR level in patients undergoing different dental procedures. Even among those with HemoChrone POCT INR &amp;gt; 3, which is considered high and increases the risk of bleeding, there was no significant correlation with bleeding. Conclusion: These results imply that warfarin therapy can be safely continued for most dental procedures without increasing the risk of bleeding regardless of the INR results. The HemoChrone POCT INR is a dependable and practical method to monitor the effect of warfarin in dental settings which can reassure the dentists before procedure. Figure 1: The concordance between Laboratory and POCT INR

1270. Impact of a Multidisciplinary Antimicrobial Stewardship Program (ASP) on Antibiotic Utilization and Clinical Outcomes at Tertiary Hospital in Saudi Arabia: A Quasi-experimental Study

Abstract Background The concept of antimicrobial stewardship has been introduced for over a decade in response to the rapid global emergence and spread of antimicrobial resistance. To measure the impact of ASP interventions, several ASP metrics were developed. Very limited studies from Saudi Arabia have evaluated the impact of ASP interventions on antibiotic use and clinical outcomes of non-ICU patients. Therefore, we aimed to assess the impact of this ASP intervention on various ASP metrics by comparing the data of the post-intervention phase to that of the pre-intervention phase. Methods A quasi-experimental study was performed on patients admitted to non-ICU wards for whom a restricted antibiotic was ordered. Prospective audit and feedback (PAF) were already in place; however, on September 1st, 2020, a bundle of changes was introduced to improve the intervention making it a multifaceted intervention. These included the involvement of an infectious diseases clinical pharmacist, review of orders by attending (consultant) infectious diseases physicians, utilization of electronic resources instead of paperwork, and improvement of documentation. The primary outcomes were antibiotic utilization measures as defined daily dose per 100-patient days (DDD/100PD) and days of therapy per 100-patient days (DOT/100PD). Secondary outcomes were clinical outcomes of patients. Results A total of 402 episodes were evaluated for 167 and 188 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD in the pre phase vs the post phase were 1.75 vs. 2.54 and 16.13 vs. 44.93, respectively (P &amp;lt; 0.001 for both comparisons). Antibiotic de-escalation and clinical cure rates were significantly higher in the post phase than in the pre phase (62% vs. 40.6% and 83.5% vs. 65.8%; P &amp;lt; 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post phase than in the pre phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). Length of stay in both hospital and ICU were shorter in the post phase (14 vs. 22 days and 3 vs. 9 days, respectively; P &amp;lt; 0.001 for both comparisons). Conclusion Our study demonstrates that the ASP intervention was associated with significant improvement in antibiotic utilization and patients’ clinical outcomes. Disclosures Khalid Eljaaly, PharmD, MS, BCPS, BCIDP, FCCP, Reckitt Benckiser Healthcare International Ltd, UK: Member of the Global Respiratory Infection Partnership, supported by unrestricted educational grant from Reckitt Benckiser Healthcare Ltd

2231. Point Prevalence Survey on Antimicrobial Appropriateness in a Tertiary Care Hospital in Saudi Arabia

Abstract Background Antimicrobial resistance is a significant global health problem. Optimizing the use of antimicrobial agents is a key strategic objective for any antimicrobial stewardship program (ASP). In the literature, 9-64% of antimicrobials prescriptions were inappropriate the hospital setting. We aim to evaluate antimicrobial utilization practices and subsequently implement informed interventions to optimize antimicrobial use by conducting a point prevalence survey (PPS). Methods This is a single-center PPS at King Fahad Specialist Hospital-Dammam, Saudi Arabia. The hospital is specialized in Transplant, Oncology/hematology, and Neuroscience, with approximately 350 beds. All inpatient wards were conducted over one week period ward by ward. All inpatients on active antimicrobials were included. Data were collected from patients’ electronic medical records based on the WHO methodology for PPS on antibiotic use in hospitals. The outcome (appropriateness of antimicrobial treatment) included five elements: indication, duration, administration route, spectrum, and dosing. Assessments were made according to the local and international guidelines and the ASP team (Infectious diseases consultant and pharmacist). Results A total of 316 patients’ medical records were screened. Of whom 121 were included. Nineteen (16%) patients were pediatrics, and 102 (84%) were adults. Patients’ characteristics are presented in Table 1. A total of 207 systemic antimicrobials were recorded, 117/207 (57%) therapeutic and 90/207 (43%) prophylactic. The antimicrobials were inappropriate in 73 /207 (35%) antimicrobial orders that included 84 elements. Eleven out of the 73 orders have more than one inappropriate element. The main reasons were inappropriate indication 31/84 (37%), followed by the antimicrobial spectrum 21/84 (25%). Figure 1Table 1:Characteristics of patients receiving systemic antimicrobial treatment, n (%)Figure 1:Elements of antimicrobials inappropriateness Conclusion This point prevalence survey showed 35% of the antimicrobial prescription in the inpatient setting was inappropriate. The most common reasons were the indication followed by the spectrum and duration of antimicrobials. These findings provide valuable insight into stewardship's best approach and interventions to improve antimicrobials appropriateness. Disclosures All Authors: No reported disclosures

2572. Adherence to Evidence-based Guidelines for the Management of Pneumonia in a Tertiary Teaching Hospital in Saudi Arabia

Abstract Background Abstract: Background Adherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh. Methods Methods A single-centered, retrospective observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) who have been diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included. Results A total of 148 patients were included in this study, with an average age of 65 ± 20 years. Demographics and baseline characteristics of the included patients are shown in Table 1. The data showed that only 74 (50%) were treated according to the guidelines' recommendations, while the other 74 (50%) were not. The former group had a statistically higher cure rate and lower mortality compared to the latter (95% vs. 84%; p = 0.034) and (5% vs. 14%; p = 0.022), respectively (Figure 1). Nevertheless, patients who were treated according to the guidelines had a higher CURB-64 score for pneumonia severity and Average Calculated Charlson comorbidity index than patients who were treated irrespectively of the guidelines (1.86 vs 1.39) and (4.62 vs 3.28), respectively, yet, no statistically significant difference was observed (Table 1 and 2). Demographics and Clinical outcomes of included patients n=148 Conclusion Conclusion Non-adherence to the evidence-based guidelines has been observed in 50% of patients treated for pneumonia. In addition, higher clinically cure rate, shorter length of stay and lower mortality rate have been observed in patients who were treated based on the evidence-based guidelines. Disclosures All Authors: No reported disclosures

Impact of a multidisciplinary antimicrobial stewardship program on antibiotic utilization and clinical outcomes at a tertiary hospital in Saudi Arabia: a quasi-experimental study

ABSTRACT Background This study aims to assess the impact of a multidisciplinary antimicrobial stewardship program (ASP) intervention on various metrics. Methods A quasi-experimental study was performed on non-ICU patients for whom a restricted antibiotic was ordered. In September 2020, a prospective audit and feedback was implemented involving infectious disease clinical pharmacists, utilization of electronic resources, and improved documentation. Outcomes included defined daily dose and days of therapy per 100-patient days (DDD/100PD and DOT/100PD) and patient clinical outcomes. Results 402 episodes were evaluated for 167 and 190 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD were lower in the post-phase than in the pre-phase (1.75 vs. 2.54 and 16.13 vs. 44.93). Antibiotic de-escalation and clinical cure rates were significantly higher in the post-phase than in the pre-phase (62% vs. 40.6% and 83.5% vs. 65.8%; P < 0.001 for both comparisons). Hospital and ICU stays were significantly shorter in the post-phase (14 vs. 22 and 3 vs. 9, respectively; P < 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post-phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). Conclusion The implemented multidisciplinary ASP intervention was associated with a significant improvement in antibiotic utilization and patient clinical outcomes.

Profile of orthopaedic day-case procedures at a district general hospital (retrospective study)

BackgroundThe outcomes of orthopaedic day-case procedures have been reported widely, but there is a lack of reports from secondary health facilities such as district hospitals.AimWe aimed to perform a retrospective analysis of patient records to capture the profile of day-case procedures performed.Materials and methodsWe conducted a retrospective analysis of day-case procedures at the dedicated Day Surgery Unit of a moderate-sized district hospital in Saudi Arabia between January 2021 and December 2022. The medical records of all the patients who had day-case procedures by the hospital's orthopaedic unit were analyzed.ResultsWithin the study period, 71 out of 914 elective orthopaedic procedures were carried out as day-cases, giving a day-case surgery rate of 7.8%. The mean age was 25.3 ± 12.2 (range, 4–55 years), and the male-to-female ratio was 6:1. The spectrum of the procedures was dominated by implant removal in 59 cases (83.1%). Whilst the anaesthetic technique varied, all the patients were ASA class I or II. There were minor complications in 10 patients (14.0%), with 7 of them (9.8%) needing inpatient admission. There was no cancellation of cases in our study.ConclusionWe found day-case procedures to be safe and effective but with low utilisation of the Day Surgery Unit, which can be improved through the development of a detailed protocol for day surgery in the hospital.

Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia

BackgroundCardiovascular disease is the leading cause of death and disability worldwide. It is a general term used to describe a group of disorders that affect the heart or blood vessels. This study aimed to evaluate the prevalence and predictors of polypharmacy in patients with heart failure. MethodsWe conducted a cross-sectional study in a tertiary hospital in Saudi Arabia. Data was extracted from an electronic database between January 2019, and December 2022. The study included all adult patients with heart failure who visited outpatient clinics; individuals with cancer were excluded. The outcome variable in our study was “polypharmacy” which was defined as the use of eight or more medications. Descriptive analysis was performed using frequencies and percentages for categorical variables. In addition, Multivariate logistic regression was used to assess the covariates associated with polypharmacy. ResultsA total of 331 patients with heart failure were included in this study. The prevalence of polypharmacy among our HF population was 39.88 %. Most participants were male (60.73 %), and 60 years or older (68 %). The most frequently used medications were beta-blockers (67.98 %) and diuretics (58.31 %), whereas the least frequently used medications were hydralazine and histamine H2 blockers (5.74, and 3.02 %, respectively). Polypharmacy was likely to be a non-significantly higher in individuals aged between 60 and 69 years (adjusted odds ratio (AOR) = 1.52; 95 % confidence interval (CI) 0.78–2.98) and suffering from hypertension (AOR = 1.48; 95 % CI 0.83–2.64). However, patients with heart failure and diabetes mellitus had a significant six-fold higher of polypharmacy than those without diabetes mellitus (AOR = 6.55; 95 % CI 3.71–11.56). ConclusionPatients with heart failure often use multiple medications. Patients with heart failure together with diabetes have a higher risk of polypharmacy. Therefore, healthcare professionals should manage polypharmacy to improve the outcomes in patients with heart failure.