The Impact of Resident Duty Hour Reform on Hospital Readmission Rates 10.27.09
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This study examined the impact of resident duty hour reform on hospital readmission rates using an observational study with interrupted time series analysis of Medicare patients admitted to hospitals from 2003 to 2010. The study found no evidence that readmission rates improved or worsened after duty hour reform when comparing hospitals of different teaching intensities. Readmission rates neither improved nor worsened in association with duty hour reform, and these findings were robust across composite measures of readmission and mortality. The results provide evidence that duty hour reform did not generally impact patient outcomes.
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![The impact of resident duty hour reform on hospital readmission rates Table 1. Characteristics of included hospitals Matthew J. Press 1,2,3,4 , Jeffrey H. Silber 3,4,5,6 , Amy K. Rosen 7 , Patrick S. Romano 8 , Kamal M.F. Itani 9 , Lisa Bellini 3 , Jingsan Zhu 3 , Yanli Wang 6 , Orit Even-Shoshan 6 , Michael J. Halenar 2,3 , Kevin G. Volpp 2,3,4,5 1 Robert Wood Johnson Foundation Clinical Scholars Program; 2 CHERP, Philadelphia VAMC; 3 University of Pennsylvania School of Medicine; 4 Leonard Davis Institute of Health Economics, Philadelphia, PA; 5 The Wharton School, Philadelphia, PA; 6 Center for Outcomes Research, The Children's Hospital of Philadelphia; 7 Bedford VA and Boston University; 8 University of California, Davis; 9 Boston VA Funding for this work was provided in part by the grant NHLBI R01 HL082637. Note: For the outcomes readmission and readmission or post-discharge death, the total number of cases was 3,445,040 in the combined medical group and 4,404,154 in the combined surgical group. For the outcome readmission or 30-day mortality, the total number of cases was 3,759,711 in the combined medical group and 4,523,091 in the combined surgical group. Figure 1. Unadjusted trends in readmission rates, by hospital teaching intensity ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background ,[object Object],Objective Table 2. Unadjusted 30-day all-cause readmission rates by year (%) Results Table 3. Adjusted odds of readmission after duty hour reform in more vs. less teaching-intensive hospitals Results ,[object Object],[object Object],Conclusions ,[object Object],[object Object],[object Object],Policy Implications](https://image.slidesharecdn.com/pressmatthew-theimpactofresidentdutyhourreformonhospitalreadmissionrates-10-27-09-100819084329-phpapp02/85/The-Impact-of-Resident-Duty-Hour-Reform-on-Hospital-Readmission-Rates-10-27-09-1-320.jpg)
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Role of hospital pharmacists in transitions of care
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ANZICS S&Q 2014 - RRT: Anna Green presents the role of the ICU liaison nurses...
The Changing Geography of Outpatient Procedural Care 3.31.10
The Changing Geography of Outpatient Procedural Care 3.31.10
Similar to The Impact of Resident Duty Hour Reform on Hospital Readmission Rates 10.27.09
NYP EBP Cohort 8 Under Pressure
This document summarizes three studies that evaluated the effectiveness of repositioning schedules for preventing pressure ulcers in hospitalized patients. A systematic review by Gillespie et al. found insufficient evidence from three randomized controlled trials to determine whether particular repositioning positions or frequencies reduced pressure ulcer development. A study by Bergquist-Beringer et al. found that patients who were routinely repositioned every 24 hours had a 14% lower risk of pressure ulcers. A systematic review by Moore et al. did not identify any randomized controlled trials comparing different repositioning techniques or frequencies.
The Effect of Resident Work Hour Regulations on ICU 5.12.08
The Effect of Resident Work Hour Regulations on ICU 5.12.08Leonard Davis Institute of Health Economics
This study examined the effect of resident work hour regulations on mortality in intensive care unit patients using data from 40 hospitals from 2001-2005. The study found no evidence that the 2003 regulation limiting resident work hours had any positive or negative effect on ICU mortality overall or when analyzed by hospital teaching status. Risk-adjusted mortality improved over time at all hospital types studied.Delayed Randomized Design
This document describes a doubly randomized delayed-start design for clinical trials. The design consists of two periods. In the first period, patients are randomized to receive either a new drug or placebo. In the second period, patients who received placebo in the first period and meet certain enrichment criteria can be rerandomized to receive either the new drug or continue on placebo. The design aims to reduce bias from high placebo responses and more efficiently study maintenance effects. It is naturally adaptive as aspects of the second period can be modified based on interim analysis of the first period. Efficacy data from both periods are combined for the overall analysis. This design offers greater efficiency for clinical development compared to traditional parallel designs.
Influence of Interns, Residents and Attendings on Inpaitient Length of Stay 4...
Influence of Interns, Residents and Attendings on Inpaitient Length of Stay 4...Leonard Davis Institute of Health Economics
A study examined the influence of interns, residents, and attending physicians on patient length of stay in a general medicine service. The study found that interns accounted for 49.3% of the variation in length of stay between patients, residents accounted for 9.5%, and attendings only accounted for 2.4%. Even after adjusting for patient characteristics, the team composition still explained 17.5% of length of stay variation. Reducing variation between the lowest and highest performing interns could lower average length of stay by 10%.Healthcare transition.pptx
Transitions of care between healthcare settings like hospitals, primary care, and home present opportunities for errors and safety issues. Medication discrepancies occur for 30-80% of patients during transitions. Improving care coordination through standardized documentation, medication reconciliation, and follow up can help reduce errors and adverse events during these vulnerable periods. Primary care has an important role to play in transition management through activities like timely receipt of discharge information and follow up appointments.
roleofhospitalpharmacistsintransitionsofcare-130301172100-phpapp01 (1).pdf
Transitions of care refer to the movement of patients between different healthcare settings or providers. Medication errors are common during transitions of care and can negatively impact patient outcomes. Three studies found high rates of medication errors or discrepancies during hospital admissions and discharges. Rates of unintended medication discrepancies ranged from 53.6-60% and a significant portion were considered clinically important. Hospital pharmacists can play an important role in reducing medication errors during transitions. Activities like medication reconciliation at admission and discharge can identify up to 486 discrepancies per 100 patients discharged. Pharmacist involvement is associated with reduced rates of medication errors and improved patient outcomes.
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/CAUTI Article
Physician-initiated daily verbal reminders to remove unnecessary urinary catheters decreased catheter duration more than nurse-initiated reminders. In a study comparing the two approaches, the mean catheter duration after physician reminders was 0.5 days compared to 1.7 days for nurse reminders. The physician reminders also significantly decreased catheter duration compared to a control group that received no reminders. Daily reminders from an infectious disease physician who was familiar with the hospital teams may have led to quicker catheter removal than from infection control nurses.
Measuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliation
in a Large Subspecialty Outpatient Practice
Elizabeth Kern, MD, MS; Meg B. Dingae, MHSA; Esther L. Langmack, MD; Candace Juarez, MT; Gary Cott, MD;
Sarah K. Meadows, MS
Background: To assess performance in medication reconciliation (med rec)—the process of comparing and reconciling
patients’ medication lists at clinical transition points—and demonstrate improvement in an outpatient setting, sustainable
and valid measures are needed.
Methods: An interdisciplinary team at National Jewish Health (Denver) attempted to improve med rec in an ambulatory
practice serving patients with respiratory and related diseases. Interventions, which were aimed at physicians, nurses (RNs),
and medical assistants, involved changes in practice and changes in documentation in the electronic health record (EHR).
New measures designed to assess med rec performance, and to validate the measures, were derived from EHR data.
Results: Across 18 months, electronic attestation that med rec was completed at clinic visits increased from 9.8% to 91.3%
(p < 0.0001). Consistent with this improvement, patients with medication lists missing dose/frequency for at least one prescription-
type medication decreased from 18.1% to 15.8% (p < 0.0001). Patients with duplicate albuterol inhalers on their list decreased
from 4.0% to 2.6% (p < 0.0001). Percentages of patients increased for printing of the medication list at the visit (18.7% to
94.0%; p < 0.0001) and receipt of the printed medication list at the visit (52.3% to 67.0%; p = 0.0074). Documentation
that patient education handouts were offered increased initially then declined to an overall poor performance of 32.4% of
clinic visits. Investigation of this result revealed poor buy-in and a highly redundant process.
Conclusion: Deriving measures reflecting performance and quality of med rec from EHR data is feasible and sustainable
over the time periods necessary to demonstrate change. Concurrent, complementary measures may be used to support the
validity of summary measures.
Medication reconciliation (med rec) is the process of sys-tematically and comprehensively reviewing the
medications a patient is taking, to ensure that medications
added, changed, or discontinued are evaluated for poten-
tial safety concerns. One of the three current Joint
Commission National Patient Safety Goals (NPSGs) on med-
ication safety (Goal 3), concerns medication reconciliation,
which ambulatory care organizations have been expected to
perform since 2005. The current version of the goal
(NPSG.03.06.01), effective July 1, 2011, stipulates that am-
bulatory care organizations maintain and communicate
accurate patient medication information.1 One require-
ment is that the organization obtain the patient’s medication
information at the beginning of an episode of care, with the
information to be updated when the patient’s medications
change. Ideally, med rec should occur at each transition of
care or han.
Poster-v9 (Steven Asbill, TOC)
This document describes a pilot study that evaluated the impact of including a pharmacist in the transitions of care process for patients discharged from an inpatient family medicine service. Key findings include:
- A pharmacist called patients within 2-7 days of discharge and documented any interventions in the electronic medical record. This reduced medication errors and delays in initiating new medications.
- A physician questionnaire found that including the pharmacist improved quality of care, reduced medication errors and prior authorization delays, and saved physician time with medication reconciliation.
- The readmission and emergency department visit rates during the 6 month pilot period were lower than the previous 6 months, suggesting the pharmacist interventions may have prevented readmissions.
Workcopyfinalproprosal
The document proposes developing an occupational therapy outreach service for elderly patients being discharged from medical assessment wards. Research shows elderly patients are often unprepared for discharge and lack communication between health services. The outreach program aims to facilitate smooth transitions, reduce readmissions, and relieve hospital bed pressures through home-based rehabilitation and empowering patients. Outcomes would be measured through tools like the Barthel Index to evaluate the program's effectiveness.
Artículo seminario 4
A randomized controlled trial tested the effects of a palliative care intervention on clinical outcomes in 322 patients with advanced cancer. The intervention consisted of 4 weekly educational sessions and monthly follow-up sessions led by advanced practice nurses, focusing on problem solving, communication, symptom management, and advance care planning. Compared to usual care, the intervention led to higher quality of life and mood scores but did not significantly reduce symptom intensity or hospital resource use. The intervention helped improve patients' well-being and engagement in their care near the end of life.
Impact of a designed nursing intervention protocol on myocardial infarction p...
This study examined the impact of a designed nursing intervention protocol on myocardial infarction patients' outcomes at a university hospital in Egypt. Forty adult myocardial infarction patients were included. The study found that after exposure to the nursing intervention protocol, patients had significantly higher total mean knowledge scores and total mean practice scores. It also found that patients had medium to high levels of compliance to lifelong instructions. The results support the hypotheses that the nursing intervention protocol improved patients' knowledge, practices, and compliance. The study concluded that a nursing intervention protocol can have a positive impact on myocardial infarction patient outcomes.
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
1) The study assessed the impact of enhanced external counterpulsation (EECP) combined with heart failure education on reducing 90-day readmission rates in 99 patients with heart failure due to ischemic cardiomyopathy who began EECP within 90 days of hospital discharge.
2) Only 6 patients (6.1%) had unplanned readmissions within 90 days, which was significantly lower than the predicted rate of 34%. Functional status, walk distance, and symptoms also improved after EECP based on various clinical measures.
3) In conclusion, patients who received EECP and education within 90 days of discharge had significantly lower readmission rates than predicted, and also showed improvements in functional status, walk distance, and symptoms.
the GRImP protocol
This document outlines a study protocol to evaluate the feasibility of implementing grip strength measurement into routine clinical practice for hospitalized older patients. The study will take place in five acute medical wards for older people in one hospital. It will have three phases: 1) Define current practices for identifying at-risk patients and their nutrition/mobility care through interviews and record reviews. 2) Develop and implement staff training on grip strength measurement using Normalization Process Theory. 3) Evaluate the acceptability, adoption, coverage, and basic costs of routine grip strength measurement through interviews, record reviews, and focus groups with staff and patients. The results will inform how grip strength can be translated from a research tool into clinical practice to improve identification of at-
Heart failure resources
This study aims to determine if a nurse-delivered discharge planning bundle that includes a follow-up phone call within 1 week of discharge will decrease rapid readmissions of patients with heart failure. The researchers will implement a discharge care bundle including patient education and a follow-up phone call on a hospital unit. They will compare rates of readmission before and after the intervention to see if the bundle reduces readmissions. The goal is to improve patient outcomes and lower healthcare costs for heart failure patients.
Certified Nurse Leader (CNL) Capstone Project
The document recommends continuing to use the Post-Discharge Questionnaire (PDQ) on Unit P7 to assess patient satisfaction and gather data in real-time. Results from the PDQ administered in June 2011 to 101 discharged patients on Unit P7 showed high patient satisfaction scores above the 80th percentile for most discharge measures. Scores were below the 80th percentile for information provided in the discharge packet. The PDQ provided a larger sample size than other surveys and captured feedback that can be used to improve the discharge process.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery
PausraCeMaAna Deb Dec Insd DeInternati.docx
This document summarizes a study that investigated patient preference and satisfaction with hospital-at-home care versus usual hospital care for COPD exacerbations. The study involved 139 patients who were randomized to either early assisted discharge (hospital-at-home care) or usual hospital care. Results showed that at 4 days, patients receiving early assisted discharge were less satisfied with care at night and ability to resume daily activities, but overall satisfaction did not differ. At 90 days, there were no differences in satisfaction between groups. Preference for home treatment was higher in the early assisted discharge group at 4 days and 90 days. Patients' mental state was associated with their treatment preference. The results support wider implementation of early assisted discharge and offering this option to
Similar to The Impact of Resident Duty Hour Reform on Hospital Readmission Rates 10.27.09 (20)
The Effect of Resident Work Hour Regulations on ICU 5.12.08
The Effect of Resident Work Hour Regulations on ICU 5.12.08
Influence of Interns, Residents and Attendings on Inpaitient Length of Stay 4...
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roleofhospitalpharmacistsintransitionsofcare-130301172100-phpapp01 (1).pdf
roleofhospitalpharmacistsintransitionsofcare-130301172100-phpapp01 (1).pdf
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...
Measuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliationin a Large Sub.docx
Impact of a designed nursing intervention protocol on myocardial infarction p...
Impact of a designed nursing intervention protocol on myocardial infarction p...
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
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This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
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Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort. How to choose the best dermatologists in Indore.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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