US Teaching Hospitals Research Articles

(O-K4) Two-year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban US Teaching Hospital and Emergency Department During COVID-19 Pandemic

(O-K4) Two-year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban US Teaching Hospital and Emergency Department During COVID-19 Pandemic

Characterizing industry payments to US teaching hospitals and affiliated physicians: a cross-sectional analysis of the Open Payments datasets from 2016 to 2022.

Industry payments to US teaching hospitals are common; however, little is known about whether these financial relationships influence affiliated physicians to engage in similar financial relationships with industry. Using national hospital, physician, and industry payment data we investigated trends in industry payments made to US teaching hospitals and affiliated physicians to characterize the magnitude and nature of payments. In addition, we assessed if physicians may be influenced to accept higher value industry payments depending on the value of promotional payments accepted by the teaching hospital they affiliate with. We found that physicians with a US teaching hospital affiliation are associated with accepting higher value industry payments as the total value of industry payments of the teaching hospital increases. Our findings varied by specialty, with surgeons accepting the highest value payments. These results highlight the need for greater public disclosure and awareness of payments to better manage and mitigate industry-biased clinical decision making.

S1366 Impact of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States

Introduction: Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. Percutaneous paracentesis is frequently a bed-side procedure that is commonly performed by healthcare providers in training. However, impact of teaching hospital status on outcomes of percutaneous paracentesis to the best of our knowledge have never been studied before. Methods: Hospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database 2016 to 2019 across United States teaching and non-teaching hospitals. Univariate and Multivariate logistic regression analysis was performed to determine the risk difference in mortality, postprocedural outcomes and healthcare resources utilization in the studied groups. Multivariate logistic analysis was performed using STATA software and results were adjusted for patient and hospital characteristics and comorbidities. Results: Among 1,031,485 admitted adults’ patients who underwent percutaneous paracentesis, 791,700 (76.8%) subjects were managed at US teaching hospitals, while 239,785 (23.2%) were admitted to non-teaching hospitals (Figure). Patients baseline comorbidities are listed in Table. Inpatient mortality rates (Figure) were significantly higher in individual undergoing paracentesis at US teaching hospitals (aOR 1.29, 95% CI 1.23 - 1.35, p< 0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95% CI 1.65 – 2.20, p< 0.001), hollow viscus perforation (aOR 1.97, 95% CI 1.54 - 2.51, p< 0.001) and vessel injury/laceration (aOR 15.3, 95% CI 2.12 - 110.2, p=0.007) were noticed in study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95% CI 1.68 - 1.94, p< 0.001) and increased charge of care (106,014$ vs 80,493$, aMD 24,926$, 95% CI 21,617$ – 28,235$, p < 0.001). Conclusion: Hospitalized patients undergoing paracentesis in US teaching hospitals have increased risk of mortality, postprocedural complications, prolonged length of stay and increased charge of care when compared to non-teaching hospitals. As the first study to answer this question, further studies are needed to confirm our findings and the relationship impact of new trainees involved in the care of ascites patients on the outcomes of those undergoing paracentesis. Table 1. - Baseline characteristics and comorbidities of patients managed with percutaneous paracentesis in US teaching and non-teaching hospitals Paracentesis %, NO. Teaching %, NO. Non-teaching %, NO. P-value (100,0) 1,031,485 (76.8) 791,700 (23.2) 239,785 Patient’s characteristics Age, mean years 59.3 59.0 60.6 < 0.001 Female 43.8 (451790) 43.9 (347556) 43.3 (103827) 0.028 Racial distribution White 66.0 (680780) 64.23 (508509) 72.15 (173005) < 0.001 Black 12.6 (129967) 13.8 (109255) 8.70 (20861) < 0.001 Hispanic 14.4 (148534) 14.7 (116380) 13.3 (31891) < 0.001 Others 2.75 (28366) 2.88 (22801) 2.32 (5563) < 0.001 Insurance type Medicaid 46.1 (475515) 45.2 (357848) 49.2 (117974) < 0.001 Medicare 23.6 (243430) 23.9 (189216) 22.8 (54671) < 0.001 Private 24.9 (256840) 25.7 (203467) 22.3 (53472) < 0.001 Uninsured 5.33 (54978) 5.20 (41168) 5.75 (13788) < 0.001 Charlson comorbidity index score 1 9.47 (97682) 9.09 (71966) 10.7 (25657) < 0.001 2 7.89 (81384) 7.71 (61040) 8.47 (20310) < 0.001 ≥3 75.2 (775677) 75.6 (598525) 74.0 (177441) < 0.001 Median annual income, us$ 1–43,999 31.0 (319760) 30.8 (243844) 31.7 (76012) < 0.001 44,000–55,999 26.0 (268186) 25.1 (198717) 28.9 (69298) < 0.001 56,000–73,999 23.9 (246525) 24.1 (190800) 23.0 (55151) < 0.001 ≥74,000 19.1 (197014) 20.0 (158340) 16.3 (39085) < 0.001 Hospital characteristics Hospital region Northeast 18.5 (190825) 20.7 (163882) 11.2 (26856) < 0.001 Midwest 21.7 (223832) 22.8 (180508) 18.2 (43641) < 0.001 South 38.0 (391964) 36.0 (285012) 44.6 (106944) < 0.001 West 21.8 (224864) 20.5 (162299) 26.0 (62344) < 0.001 Hospital bed size Small 15.8 (162975) 17.5 (138548) 10.3 (24698) < 0.001 Medium 27.4 (282627) 27.0 (213759) 28.5 (68339) < 0.001 Large 56.8 (585883) 55.5 (439394) 61.2 (146748) < 0.001 Comorbidities Hypertension 27.7 (285721) 27.6 (218509) 28.1 (67380) 0.066 Diabetes mellitus 31.8 (328012) 31.5 (249386) 32.9 (78889) < 0.001 Smoking history 39.9 (411563) 39.6 (313513) 40.9 (98072) 0.001 Hyperlipidemia 22.9 (236210) 22.7 (179716) 23.3 (55870) 0.039 Obesity 12.1 (124810) 12.1 (95796) 12.2 (29254) 0.745 Chronic kidney disease 28.1 (289847) 27.8 (220093) 29.1 (69777) < 0.001 Coronary artery disease 15.4 (158849) 15.1 (119547) 16.5 (39565) < 0.001 Peripheral vascular disease 1.87 (19289) 1.80 (14251) 2.30 (5515) < 0.001 Chronic obstructive lung disease 13.5 (139250) 12.7 (100546) 16.3 (39085) < 0.001 Human immunodeficiency virus 0.60 (6189) 0.70 (5542) 0.40 (959) < 0.001 Congestive heart failure 19.0 (195982) 18.8 (148840) 20.0 (47957) < 0.001 Nephrotic syndrome 0.20 (2063) 0.22 (1742) 0.15 (360) 0.002 Chronic liver disease 66.0 (680780) 65.2 (516188) 68.7 (164732) < 0.001 Malignancy 12.5 (128936) 12.8 (101338) 11.6 (27815) < 0.001 Pancreatitis 4.11 (42394) 4.10 (32460) 3.90 (9352) 0.028 Figure 1.: Flow diagram of study sample.

Changes in Industry Marketing and Research Payments to US Physicians and Teaching Hospitals During the COVID-19 Pandemic

This cross-sectional study explores ways that the COVID-19 pandemic was associated with changes in research and marketing payments from pharmaceutical and medical device companies before and during the pandemic.

July Effect on Mortality and Complications in Patients With ARDS in US Teaching Hospitals.

Each July, teaching hospitals in the United States experience an influx of new resident and fellow physicians. It has been theorized that this occurrence may be associated with increased patient mortality, complication rates, and health care resource use, a phenomenon known as the "July effect." To assess the existence of a July effect in clinical outcomes of patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation in the intensive care unit in US teaching hospitals. The National Inpatient Sample database was queried for all adult patients with ARDS who received mechanical ventilation from 2012 to 2014. Using a multivariate difference-in-differences (DID) model, differences in mortality, ventilator-associated pneumonia, iatrogenic pneumothorax, central catheter-associated bloodstream infection, and Clostridium difficile infection were compared between teaching and nonteaching hospitals during April-May and July-August. There were 70 535 and 43 175 hospitalizations meeting study criteria in teaching and nonteaching hospitals, respectively. Multivariate analyses revealed no differential effect on the rates of all-cause inpatient mortality (DID, 0.66; 95% CI, -0.42 to 1.75), C difficile infection (DID, 0.29; 95% CI, -0.19 to 0.78), central catheter-associated bloodstream infection (DID, 0.14; 95% CI, -0.04 to 0.33), iatrogenic pneumothorax (DID, 0.00; 95% CI, -0.25 to 0.24), ventilator-associated pneumonia (DID, 0.22; 95% CI, -0.05 to 0.49), and any complication (DID, 0.60; 95% CI, -0.01 to 1.20) for July-August versus April-May in teaching hospitals compared with nonteaching hospitals. This study did not show a differential July effect on mortality outcomes and complication rates in ARDS patients receiving mechanical ventilation in teaching hospitals compared with nonteaching hospitals.

Impact of anesthesia resident staff assignment decisions on nurse anesthetist and anesthesia resident staff scheduling and productivity: Tutorial using data from a pediatric hospital

BackgroundMost large US teaching hospitals have anesthesia fellows, anesthesia residents, and nurse anesthetists or anesthesiologist assistants. The objective of the tutorial is the review of how fellow and resident staff scheduling and staff assignment decisions can influence not only their productivity but that of the nurse anesthetists (or anesthesiologist assistants). MethodsWe developed scenarios for this tutorial using data from 35 consecutive Tuesdays at a pediatric hospital, May through December 2020. This organizational case study used given probability distributions of workload, along with the resulting allocations of anesthesia time based on minimizing the inefficiency of use of anesthesia providers. Four scenarios were created. ResultsOne scenario highlights that if (a) residents are assigned to cases based on the procedure category corresponding to their rotation, (b) the workday at that anesthetizing location is relatively brief, and (c) the residents are not assigned also to start one or two brief cases of different types, then productivity can be reduced substantially because of variability among operating rooms in the daily hours of cases.Another scenario highlights that productivity would be greater if the resident rotation included a pair of two specialties that took into account expected durations of the workday for the paired specialties. ConclusionsOur tutorial highlights how the effect of resident staff assignments on anesthesia group productivity can be substantial because functionally, their minimum shift length would not be known from the staff schedules months in advance but instead only be realized upon the day of surgery. When a department is investigating reasons for apparently lower nurse anesthetists’ (or anesthesiologist assistants’) and anesthesia residents’ productivity, assignments based on first case starts, for whatever educational or other reasons, but not considering the duration of the workday should be part of the differential diagnosis.

1091. An Ethnographic Approach to Interrogating Antimicrobial Stewardship at US Teaching Hospitals

BackgroundHospital antimicrobial stewardship programs (ASPs) deploy variably evidence-based interventions aimed at improving antimicrobial use and reducing antimicrobial resistance. Little is known about how ASPs are perceived by hospital clinicians or how such data might inform ASP improvement. We conducted an ethnographic study of hospital ASPs and infectious diseases (ID), surgical intensive care unit (SICU) and medical intensive care unit (MICU) practitioners to identify how ASPs are understood and integrated into everyday practice by hospital staff.MethodsA medical anthropologist performed direct observation of patient care and semi-structured interviews with ID (N = 29), SICU (N = 10), and MICU (N = 19) practitioners at two affiliated teaching hospitals in Chicago, IL, between July 2017 and September 2018, accruing >576 hours of direct observations and 48 hours of semi-structured interview data. Data collection and analysis centered on explicating the understandings and interpretations of ASPs present in diverse practice groups. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software.ResultsUnderstandings and interpretations of ASPs varied greatly between the practice groups. ID practitioners commonly focused on “changing prescribing behavior” and “restricting inappropriate usage,” while MICU and SICU practitioners more often emphasized “following guidelines” and maintaining clinical “balance.” Additionally, direct observation data demonstrate that MICU and SICU practitioners are bounded by social and institutional determinants of antimicrobial prescribing (Table 1) that affect the pursuit of “appropriate antimicrobial use.”ConclusionEthnographic interrogation found that practice groups understand and integrate ASPs differently according to everyday encounters with the social and institutional determinants of antimicrobial prescribing. ASP effectiveness might be enhanced by adopting a more mindful approach to accounting for and addressing the distinct understandings and interpretations of ASPs among diverse practice groups operating within the same institution. Disclosures All authors: No reported disclosures.

Defining a Leader—Characteristics That Distinguish a Chair of Surgery

BackgroundChair of the Department of Surgery, sometimes known as the Chief, holds a title that has significant historical connotations. Our goal was to assess a group of objectively measurable characteristics that unify these individuals as a group. MethodsUtilizing publicly available data for all US teaching hospitals, demographic information was accumulated for the named chiefs/chairs of surgery. Information collected included location of their program, their medical/surgical training history, their surgical specialty, previous chair/chief titles held, and academic productivity. ResultsOf the 259 programs listed, data were available on 244 individuals who were trained in 19 different specialties. The top three specialties of these practitioners are General Surgery (40, 16.3%), Surgical Oncology (38, 15.5%), and Vascular Surgery (33, 13.5%). There were only 14 female chairs (5.7%) and only one chair with a doctor of osteopathic medicine degree. The majority (62.3%) had been a previous chief of a surgical subdivision with only 26% having been a previous chair/chief of the surgical department.The average chair had 72 peer-reviewed manuscripts with 28 published book chapters. Chair's at academic institutions with university affiliation had a significantly higher number of peer-reviewed manuscripts (P < 0.0001) as well as were more likely to be trained at academic institutions (P = 0.013). ConclusionsThere are no set characteristics that define the Chair of a Department of Surgery. By understanding a group of baseline characteristics that unify these surgical leaders, young faculty and trainees with leadership aspirations may begin to understand what is necessary to fill these roles in the future.

Scarless Transoral Vestibular Approach for Thyroidectomy and Parathyroidectomy at a US Teaching Hospital

Scarless Transoral Vestibular Approach for Thyroidectomy and Parathyroidectomy at a US Teaching Hospital

Measuring efficiency in US teaching hospitals associated with quality variables

This research compares the efficiency of US teaching and non-teaching hospitals as estimated by using data envelopment analysis. Labour costs, capital costs and other operating expenses are employed as input variables. The research models are divided into two main cases based on different sets of outputs. In both cases, teaching hospitals show higher efficiency scores than non-teaching hospitals. For-profit hospitals show higher efficiency scores than not-for-profit or governmental hospitals. With regard to the size, larger hospitals are associated with higher efficiency scores. Regional variations are detected, but they seem to fade in comparing some regions. This paper addresses the economically important question of what explains heterogeneity in production functions across hospitals by measuring the efficiency of hospitals, including quality variables. The inclusion of quality metrics in efficiency estimates represents an improvement over similar existing studies, since patient outcomes are key to considering welfare implications in the healthcare sector.

Association Between Teaching Status and Mortality in US Hospitals

Few studies have analyzed contemporary data on outcomes at US teaching hospitals vs nonteaching hospitals. To examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions. Use of national Medicare data to compare mortality rates in US teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older. Hospital teaching status: major teaching hospitals (members of the Council of Teaching Hospitals), minor teaching hospitals (other hospitals with medical school affiliation), and nonteaching hospitals (remaining hospitals). Primary outcome was 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size and 7-day mortality and 90-day mortality for all hospitalizations as well as for individual medical and surgical conditions. The sample consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals. After adjusting for patient and hospital characteristics, the same pattern persisted (8.3% mortality at major teaching vs 9.2% at minor teaching and 9.5% at nonteaching), but the difference in mortality between major and nonteaching hospitals was smaller (1.2% [95% CI, 1.0%-1.4%]; P < .001). After stratifying by hospital size, 187 large (≥400 beds) major teaching hospitals had lower adjusted overall 30-day mortality relative to 76 large nonteaching hospitals (8.1% vs 9.4%; 1.2% difference [95% CI, 0.9%-1.5%]; P < .001). This same pattern of lower overall 30-day mortality at teaching hospitals was observed for medium-sized (100-399 beds) hospitals (8.6% vs 9.3% and 9.4%; 0.8% difference between 61 major and 1207 nonteaching hospitals [95% CI, 0.4%-1.3%]; P = .003). Among small (≤99 beds) hospitals, 187 minor teaching hospitals had lower overall 30-day mortality relative to 2056 nonteaching hospitals (9.5% vs 9.9%; 0.4% difference [95% CI, 0.1%-0.7%]; P = .01). Among hospitalizations for US Medicare beneficiaries, major teaching hospital status was associated with lower mortality rates for common conditions compared with nonteaching hospitals. Further study is needed to understand the reasons for these differences.

Improving Adhesion of Internal Jugular Dressings in the Intensive Care Unit

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

The Expansion of a Nurse-led Peripherally Inserted Central Catheter (PICC) Team to a Vascular Resource Team to Insert Peripheral Intravenous Catheters

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Development and Testing of a Short Peripheral Intravenous Catheter Insertion Skills Checklist

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Deployment of a Time of Catheters: Experience Report

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Peripheral Vascular Catheter Research: A Scoping Review

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Using High Flow Flushing Technique (HFFT) as Initial Intervention for Malpositioned Peripherally Inserted Central Catheters (PICC's) in the Adult Population

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Vascular Access Strategies in Intensive Care Units: Antimicrobial + Power Injectable Devices

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Protecting the Vessels- Options for the Cystic Fibrosis Patient

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Training and Implementation of PICC Team of the Hospital sãrio Libanãas - 2011

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from −0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99-0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.