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Background Prompt notification of critical laboratory values to providers is essential for effective patient care. To improve the delivery of these critical values, a quality improvement project was initiated to determine the obstacles to prompt notification and to identify possible interventions to improve this process. Methods Critical value call logs were retrieved, and delivery time, patient location, test name, and call time were abstracted and analyzed. All critical values with delivery times greater than 60 min were reviewed by 2 authors for 1 representative month in both the pre- and postintervention period. Results Based on the results of the data review, a modification to the laboratory information system call center color-coded alerts was introduced to address delays attributable to the laboratory. The overall rate of calls greater than 60 min decreased from 3.4% ± 0.8% in the preintervention study period to 1.3 ± 0.3%, postintervention. The average number of values not delivered within 60 min decreased by 64% across all locations, following with an 82% decrease for values originating from inpatient locations, and a 39% decrease for outpatient values. Conclusions Low complexity interventions to critical value callback protocols can significantly increase the efficacy of communication between the laboratory and providers.

Home health care is a hot research field in the 21 century. It can reduce the risky and critical cases that may happen to elder and disabled patients. It also improves life quality of patients in their familiar environment. On the other hand, home health care will reduce the medical expense. With the help of the sophisticated communication techniques, widespread applied computers and microcomputers, and micro electro-mechanical systems, as sensing elements and actuators, home health care network has become a reality. Many researches went for excellent applicable results that are used nowadays in any hospitals. These hospitals are equipped with what is called "hospital monitoring centre", which receives a 24 hours precise measured data from the patients at their home directly. In this paper, a modified Smart Pill (SP) and a finger ring are used to complete health care controlling systems. The complete system is very important in situation when the patients are in an uncontrolled state. The block-diagram of the already existing health care system and the block-diagram of the modified health care system will be shown. Patients and elder people swallow these pills everyday and live normally. In case of emergency when they are disables, doctors in the hospital or centers while monitoring them can sent a coded signal that is received by the pill to release the precise amount of required medicine for the case. This step saves the time up to 30 minutes (according to European Standards) of sending the care ambulatory team to the patient location.

Several terms are used to describe changes in PROM scores in relation to treatments. Whether the change is small, large, or relevant is defined in different ways, yet these change scores are used to recommend or oppose treatments. They are also used to calculate the necessary number of patients for a study. This article offers a theoretical explanation behind the terms responsiveness, minimal important difference (MID), minimal important change (MIC), minimal relevant difference (MIREDIF), and threshold of clinical importance. It also gives instructions on how these and the optimal number of patients for a study are calculated. Responses to two domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS), before and 1 year after reconstruction of the anterior cruciate ligament of 164 patients, are used to illustrate the calculations. This paper presents the most common methods used to calculate and interpret MID. Results vary substantially across domains, patient location on the scale, and health conditions. The optimal number of patients depends on the minimal relevant difference (MIREDIF), the standard error of the measure (SEM), the desired statistical power for the measurement, and the responsiveness of the measurement instrument (the PROM). There is often uncertainty surrounding the calculation and interpretation of responsiveness, MID, and MIREDIF, as these concepts are complex. When MID is used to evaluate research results, authors should specify how the MID was calculated, and its relevance for the study population. These measures should only be used after thorough consideration to justify healthcare decisions.

Objectives To describe patient behaviour related to mobility in a rehabilitation inpatient setting and compare intensive and Transition Care Program (TCP, slow-stream rehabilitation) models. Methods Prospective cross-sectional design including weekday and weekend sampling in two rehabilitation wards (one intensive and one TCP) in a publicly funded facility. A single trained observer undertook behavioural mapping, observing patient location, mobility, activity and company on all inpatients 8 am-4 pm using a structured 2-minute observation protocol. Observations were summarised and compared between wards. Results We observed 74 inpatients on a Tuesday and 77 on a Sunday. Participants spent 7% (median) of daytime standing or walking. They spent 62%-87% in their room, 22%-40% sleeping or resting and 74%-86% alone. The only significant difference between wards was time spent off ward on Tuesday. Activity was lower on Sunday. Conclusions Time spent in physical, cognitive and social activities is low in inpatient rehabilitation and TCP wards.

Nowadays, more number of people are affected by COVID by other infected people. The coronavirus spreads through an infected person when he/she talks, coughs or sneezes in front of others. Before getting COVID test results, infected person may be moving along with normal people in shopping malls, education campus and industries. It is difficult to identify uninfected people who are moving along with the infected people. This paper proposed location identification model which is used to track and locate the infected person or recovered person inside the building. The location sensing model in wireless network and global positioning system (GPS) cannot be used to track users inside the buildings. The proposed system uses Wi-Fi-based model for monitoring patients and identifying the location of infected people in different floors of the building. RSSI technology is used for tracking the mobile device that is carried by patients in the indoor environments. Then, it finds the other uninfected people near them by using their smartphones. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Currently, the world requires techniques that match infected people and hospital beds together given various criteria such as the severity of infection, patient location, hospital capacity, etc. Deep Learning might seems to be a perfect fit for this: various configurations from a broad range of parameters that need to be reduced to a few solutions. But, this models require to be trained, hence the need for historical data on previous cases leading to a waste of time would in cleaning and consolidating a dataset and lengthy training sessions need to be performed with a variety of architectures.

Objectives Vitamin D testing by Primary Care doctors is increasing, placing greater workloads on healthcare systems. There is little data though on vitamin D retesting in Ireland. This study aims to investigate the factors associated with vitamin D retesting by Irish General Practitioners (GPs) and examine the resulting costs. Methods This is a retrospective analysis over 5 years (2014–2018) of GP requested 25-hydroxyvitamin D (25(OH)D) results in 36,458 patients at a major city hospital in Dublin, Ireland. Those with one test were compared with individuals who were retested and samples categorised to determine changes in status between tests. Results Nearly one in four patients (n=8,305) were retested. Positive predictors of retesting were female (p50 nmol/L). The annual cost of inappropriate testing was €61,976. Conclusions One in four patients were retested and this varied by age, gender and patient location. Over 10% of retests were inappropriately early (

Mental or psychiatric wards in hospitals face the problems of handling high risk patient and this has alarming concern to the healthcare workers especially and to the public generally. Currently the monitoring of this special ward are mainly on manual monitoring and using a lot of man power resources. Due to the safety of the healthcare personal and public, improvement on the ward safety should be prioritized. In this paper, we propose a radio frequency identification (RFID) based approach to assist and monitor the mental patients. This is to ensure the patients are in safe location or allowable parameter within the hospital premise. The propose method involves two major components of hardware and software.The first part of the hardware system, consist of an integrated microcontroller inclusive of an electronic component which act to identify the current position l of the patient. Secondly the preparation of software system which involved an integration of a web application with the patient location history record real-time for monitoring activity by the healthcare staff. By adopting this approach, it can improve the safety of the wards and allow more time for the healthcare to give special attention to the patients as they are no longer need to be worry of the location of the patients.

Worldwide, studies investigating the relationship between the lineage of Mycobacterium tuberculosis (MTB) across geographic areas has empowered the “End TB” program and understand transmission across national boundaries. Genomic diversity of MTB varies with geographical locations and ethnicity. Genomic diversity can also affect the emergence of drug resistance. In Myanmar, we still have limited genetic information about geographical, ethnicity, and drug resistance linkage to MTB genetic information. This study aimed to describe the geno-spatial distribution of MTB and drug resistance profiles in Myanmar–Thailand border areas. A cross-sectional study was conducted with a total of 109 sequenced isolates. The lineages of MTB and the potential associated socio-demographic, geographic and clinical factors were analyzed using Fisher’s exact tests. p value of statistically significance was set at < 0.05. We found that 67% of the isolates were lineage 1 (L1)/East-African-Indian (EAI) (n = 73), followed by lineage 2 (L2)/Beijing (n = 26), lineage 4 (L4)/European American (n = 6) and lineage 3 (L3)/Delhi/Central Asian (n = 4). “Gender”, “type of TB patient”, “sputum smear grading” and “streptomycin resistance” were significantly different with the lineages of MTB. Sublineages of L1, which had never been reported elsewhere in Myanmar, were detected in this study area. Moreover, both ethnicity and lineage of MTB significantly differed in distribution by patient location. Diversity of the lineage of MTB and detection of new sublineages suggested that this small area had been resided by a heterogeneous population group who actively transmitted the disease. This information on distribution of lineage of MTB can be linked in the future with those on the other side of the border to evaluate cross-border transmission.

PurposeTeleaudiology helps improve access to hearing health care by overcoming the geographic gap between providers and patients. In many teleaudiology encounters, a facilitator is needed at the patient site to help with hands-on aspects of procedures. The aim of this study was to review the scope and nature of research around patient-site facilitators in teleaudiology. We focused on identifying the facilitators' background, training, and responsibilities.MethodTo conduct this scoping review, we searched PubMed, CINAHL, and Embase. To be included, studies needed to address teleaudiology; be experimental/quasi-experimental, correlational/predictive, or descriptive; be published in English; and include the use of a facilitator at the patient location.ResultsA total of 82 studies met the inclusion criteria. The available literature described a number of different individuals in the role of the patient-site facilitator, including audiologists, students, and local aides. Fifty-seven unique tasks were identified, including orienting the client to the space, assisting with technology, and assisting with audiology procedures. The largest number of studies (n= 42) did not describe the facilitators' training. When reported, the facilitators' training was heterogenous in terms of who delivered the training, the length of the training, and the training content.ConclusionsAcross studies, the range of duties performed by patient-site facilitators indicates they may have an important role in teleaudiology. However, details are still needed surrounding their background, responsibilities, and training. Future research is warranted exploring the role of the patient-site facilitator, including their impact on teleaudiology service delivery.Supplemental Materialhttps://doi.org/10.23641/asha.12475796

Introduction Nearly 1 in 10 individuals in the US have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Urban and rural patients may have different mortality [2]. Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We determined the 30-day all-cause readmission rate for adults (age >= 18) admitted with a principal diagnosis of DKA and compare the risk factors for urban and rural patients. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify admissions with a principal diagnosis of DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age >= 18) with an index hospitalization between January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. All-cause readmission within 30-days of DKA were analyzed. Predictors for readmission were determined using logistic regression model. Results A total of 65,249 patients met criteria for inclusion. Of which, there was 12,561 readmissions (19.25 %) within 30-days of the index admission. Patients originating from urban locations had a readmission rate of 19.36% compared to 18.56 % for patients from rural locations (p=0.07). Multivariate analysis showed patients from either rural or urban location each had a higher likelihood of readmission if their disposition was home health or AMA, younger age (

Thailand demographic is expected to have superaged society with aged population more than 30% by 2035. With higher incidence of chronic diseases including cardiovascular and strokes in elderly, we expect to have higher rate of emergency cases that need emergency care. Emergency Medicine Act of B.E. 2008 has set the guidelines and strategy for emergency medicine nationwide and the National Emergency Medicine Committee las recently defined category, level, and authority of the operation units in 2019. Such plan aims to increase efficiency of emergency dispatch and hence increase survival numbers of the patients. Here, we propose the solution for Emergency Medicine, combining state-of-the-art Ambulance Operation Center, Genius Safely Ambulance with IoT platform, and smart wristband with application for health monitoring and patient location at real time. Use case of Ambulance Operation Center was demonstrated with 13 Wild Boars situation in Chiang Rai Province. First phase of smart wristband implementation in caregivers and care managers was also evaluated in terms of usability.

Objective: The purpose of this study is to describe the location and patient activity factors associated with falls on one inpatient geriatric psychiatry unit. Methods: This was a descriptive retro...

Objectives Apparent life-threatening event (ALTE) refers to a constellation of unexpected events suddenly occurring in infants that extremely alarm the observers. The objectives of this study were to evaluate 1) intervention of Emergency Service (ES) at home, 2) parental behavior before ES intervention, 3) patients' outcome at follow-up of a minimum of 6 months. Methods Retrospective study of infants younger than 12 months whose parents called ES and were evaluated for ALTE from 2005 to 2014. Tactile stimulation (TS) was defined as any maneuver performed by parents or ES staff aimed at rescuing patients without cardiopulmonary resuscitation attempts. Cardiopulmonary resuscitation was defined according to American Heart Association Guidelines 2010. Results One hundred eighty-eight patients were eligible. Emergency Service provided intervention for 178 infants (10 were assisted only by phone). All patients received TS by parents before ES arrival. Mean time for ES to reach patient location was 15 ± 10 minutes. On examination, 136 patients (76.5%) seemed normal and 42 symptomatic. One hundred sixty-three patients were brought to the emergency department where 23 patients were found symptomatic. One hundred six of 163 patients underwent capillary blood gas determination and, in 28 (26%) of 106, alterations were found. No infant had subsequent cardiopulmonary arrest or clinically evident adverse neurological outcome. Six were found to be epileptic. No infant died during the episode or during follow-up. Conclusions Our findings suggest that ALTE is an alarming but self-limiting phenomenon that can be resolved either spontaneously or by simple TS in most cases. Emergency Service should solicit patients' physiological responses through TS first while considering a cardiopulmonary resuscitation maneuver.

Introduction Little is known about the requests for and recommendations from inpatient pediatric palliative care (PPC) consults and whether they differ by patient location (ward vs. intensive care unit) or patient type (new vs. established with PPC). Methods Single-center, retrospective cohort study comparing PPC consult requests and recommendations for children who received a PPC consult between January 1, 2018 and June 30, 2019. Comparisons were made by patient location and patient type using bivariate statistics. Results Three hundred twenty-seven PPC encounters were evaluated. Symptoms were more likely to be addressed in consults for ward patients than for intensive care unit patients. Compared with established patients, consults for new patients occurred significantly later in the hospital course and were more likely to be for psychosocial support or goals of care. Discussion We found variability in PPC consult requests and recommendations that may inform future work and targeted education for primary providers.

There can be numerous sources of waste in the transfusion service. The most obvious source is wastage of the blood products themselves, either by expiration on the shelf of the blood bank, or else after they have been issued to a patient location in the hospital but not used and not returned to the blood bank in time to be returned into the general inventory. Reducing expiration due to the former mechanism is the sole responsibility of the transfusion service – to make sure that its inventory is commensurate with the volume of transfusions performed at the hospital(s) that it serves. Audits of clinical practice, and the practices in the transfusion service itself, are essential to identify whether these sources of waste are occurring. For example, evaluating the crossmatch:transfusion (C:T) ratio for the various clinical services can identify those that order far more crossmatches compared to the number of red blood cell (RBC) units that they transfuse. Addressing and correcting this issue with the services with high C:T ratios can reduce the workload on the transfusion service by when fewer crossmatches are ordered, and the RBC inventory can be more easily managed if fewer RBCs are reserved for specific patients. Auditing the transfusion service can reveal wasteful practices, too. For example, the crossmatch:issue (C:I) ratio can indicate whether the transfusion service is optimizing their process (i.e. method and timing) of performing RBC crossmatches.

The purpose of this study was to assess if clinical indications, patient location, and imaging sites predict the viewing pattern of referring physicians for CT and MR of the head, chest, and abdomen. Our study included 166,953 CT/MR images of head/chest/abdomen in 2016–2017 in the outpatient (OP, n = 83,981 CT/MR), inpatient (IP, n = 51,052), and emergency (ED, n = 31,920) settings. There were 125,329 CT/MR performed in the hospital setting and 41,624 in one of the nine off-campus locations. We extracted information regarding body region (head/chest/abdomen), patient location, and imaging site from the electronic medical records (EPIC). We recorded clinical indications and the number of times referring physicians viewed CT/MR (defined as the number of separate views of imaging in the EPIC). Data were analyzed with the Microsoft SQL and SPSS statistical software. About 33% of IP CT and MR studies are viewed > 6 times compared to 7% for OP and 19% of ED studies (p 6 times) in IP (55%) and ED (46%) than in OP settings (22%). Patient location and imaging site regardless of clinical indications have a profound effect on viewing patterns of referring physicians. Understanding viewing patterns of the referring physicians can help guide interpretation priorities and finding communication for imaging exams based on patient location, imaging site, and clinical indications. The information can help in the efficient delivery of patient care.

Background: Mobile stroke units (MSU) have been proposed to expedite delivery of recombinant tissue plasminogen activator (tPA) and expedite endovascular clot retrieval (ECR). Unexplored questions in the use of MSU include: maximal distance from base, time limit with regards to the use CT imaging, CT Angiography, CT Perfusion, and Telemedicine. We developed a computational model as an app (https://gntem3.shinyapps.io/ambmc/), taking into account traveling time to explore this issue. The aim of this study was to define the operating parameters for an MSU in a large metropolitan city, based on the geography of Melbourne. Methods: There are 2 hospitals (Royal Melbourne Hospital/RMH, Monash Medical Center/MMC) designated to provide state-wide ECR services. In these spatial simulations, the MSU is based at RMH and delivers tPA at the patient's pick-up address and then takes the patient to the nearest ECR center. We extracted the geocode of suburbs in Melbourne and travel time to each hospital using ggmap, an interface to Google Map API. The app contains widgets for varying the processing time at the patient location (default = 30 min), performing CT angiography (default = 10 min), performing telemedicine consultation (default = 15 min). The data were compared against those for usual ambulance metrics (default traveling time = 15 min, processing time at patient's location = 20 min, door to tPA = 60 min, door to groin = 90 min). Varying the widgets allow the viewer to explore the trade-off between the variable of interest and time to therapy at a suburb level. Results: The MSU was superior for delivering tPA to all Melbourne suburbs (up to 76 min from RMH). If the CTA times or processing time at location increased by 20 min then it was superior for providing ECR to only 74.9% of suburbs if the return base was RMH. Addition of CT Perfusion or telemedicine consultation affect the ability of a single hospital to provide ECR but not tPA if these additions can be limited to 20 min. Conclusion: The app can help to define how best to deploy the MSU across Melbourne. This app can be modified and used to optimize operating characteristics of MSU in other centers around the world.

Introduction: Inpatient strokes have a higher mortality risk and longer length of stay compared to community-onset strokes. The inpatient stroke population is often not included in national registries. This study examines a hospital-wide standardized process for acute triage of Code Stroke Inpatient Activations (CSIAs) at a Comprehensive Stroke Center. Methods: CSIA data collected between September 2016-July 2018 from the Stroke and Rapid Response Team pager were used. False CSIAs were excluded. Outcomes included percentage of CSIAs by patient location (PL), primary problem (PP), and final discharge diagnosis (FDD), as well as percentage treated with IV-alteplase (tPA) and thrombectomy. Evaluation times of symptom discovery-to-stroke MD page (Sx-SMDP), symptom discovery-to-CT (Sx-CT), stroke MD page time-to-CT (SMDP-CT) were compared across PP and PL using one-way analysis of variance for log-transformed time with pairwise comparisons. Among CSIAs with a new stroke diagnosis at discharge, the percentage found in our Comprehensive Stroke Registry (CSR) was identified. Results: Among all CSIAs (n=99), 47.1% (n=41) of patients were admitted for cardiac, post cardiac surgery or TAVR; 19.5% (n=17) for stroke; and 33.3% (n=29) for other PP. Among 79 CSIAs with PL, 30.4% (n=24) were in cardiac units, 24.1% (n=19) in stroke units, 21.5% (n=17) in non-stroke/non-cardiac units, 17.7% (n=14) in peri-procedural units, and 6.3% (n=5) in the observation unit. Among 72 CSIAs with FDD, 72.2% (n=52) had a new stroke diagnosis whereas 27.8% (n=20) did not. Overall treatment rate was 6.0% with median Sx-tPA of 68 minutes (n=2) and median Sx-GP of 147 minutes (n=4). No differences in Sx-SMDP, Sx-CT, or SMDP-CT by PL or PP were found. Among 52 CSIAs with stroke FDD, 21.2% (n=11) were identified as inpatient strokes at discharge in our CSR. Conclusions: Standardized Code Stroke Inpatient Activation process resulted in consistent evaluation times regardless of primary problem or patient location. Code Stroke Inpatient Activations in the cardiac population need further examination and may reflect the presence of comprehensive cardiac surgical services at this hospital. National stroke registries do not reflect the size or full spectrum of the inpatient stroke population.

Summary Objective Seasonal variations in temperature exert strong selective pressure on microorganism population dynamics and should be taken into account in epidemiological studies. The objective of the present study was to characterize the seasonal variation of staphylococcal infections in respect to patient location, specimen source, month of year, and temperature variation. Methods A retrospective longitudinal time-series analysis of methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA) was conducted in northeastern Ohio over a 5-year period. Multivariable time-series analyses were performed to detect the variations in the monthly incidence based on location of patients (inpatient, outpatient, and nursing homes), source of specimen (wound, respiratory tract, and urine), time of year (January–December), and temperature variation (average monthly over 5 years). Results The results indicated a gradual increase in both MRSA and MSSA infections, with outpatient cases representing the majority of cases. If present, the seasonal nature of MRSA infections varied based on specimen source and patient location, with wound infections from outpatients more prevalent in warmer months, and respiratory infections among inpatients more prevalent during colder months. Conclusions The current report provides a longitudinal analysis of staphylococcal epidemiology, and in the process, identifies the seasonal nature of infections to be multifactorial, depending on such variables as specimen source and patient location. The seasonal nature of staphylococcal infections appears to be the product of a complex interaction among host, pathogen, and environment.

Objective Multiple reports have shown echocardiograms for certain indications are neither cost-effective nor of high diagnostic yield. Given the ease with which tests can be obtained at a tertiary academic children's hospital, our aims were to: (1) determine the diagnostic yield of inpatient studies by in-hospital location; (2) evaluate inpatient echocardiograms to determine indications and level of appropriateness; and (3) evaluate the frequency of cardiology involvement prior to those echocardiograms. Design All initial inpatient echocardiograms interpreted at our institution from February 2009 to December 2014 were reviewed retrospectively. Patient location was grouped as pediatric intensive care (PICU), emergency department (ED), and general floor. Results There were 727 first-time inpatient echocardiograms that met inclusion criteria. Pathology was identified in 25% of the study echocardiograms, with 11% of all studies demonstrating pathology that could alter patient management (moderate or severe pathology). The studies performed in the PICU and ED had more severe pathology compared with those from the general floor (P

Purpose To report discrepancy rates for examinations interpreted by on-call residents overall and by resident training level, and to describe a novel discrepancy classification system based on patient location and severity that facilitates recording of discrepancy data, helps ensure proper communication of report changes, and allows our radiology department to assume responsibility for contacting discharged patients with non-time-dependent results. Methods A HIPAA-compliant, institutional review board–exempt review of two years (January 2013 to December 2014) of discrepancy data was retrospectively performed for total number of examination interpreted, discrepancy rates, resident training level, and discrepancy categories. Most common diagnoses and means of results communication for discharged patients were also recorded. Results Radiology residents interpreted 153,420 examinations after hours and had 2169 discrepancies, for an overall discrepancy rate of 1.4%. Discrepancy rates for postgraduate year (PGY)-3, PGY-4, and PGY-5 residents were 1.31%, 1.65%, and 1.88%, respectively. The rate of critical discrepancies was extremely low (10/153,420 or 0.007%). A total of 502 patients (23.2% of all discrepancies) were discharged at the time their discrepancy was identified, 60% of whom had non-time-dependent discrepancies that were communicated by radiologists; 32.4% of these had addended results telephoned to a PCP, 43.4% had addended results telephoned to the patient, and the remaining 24.2% required a registered letter. Eight percent of patients with non-time-dependent findings were lost to follow-up. Conclusions Our resident discrepancy rates were comparable to those published previously, with extremely low rates of critical discrepancies. Radiologists assumed responsibility for contacting the majority of discharged patients with discrepant results, a minority of whom were lost to follow-up.

Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis has shown that nearly one in six patients will have an all-cause 30-day readmission. Given the disparities in access to healthcare between rural and urban settings, we sought to see if patient location influenced the incidence rate for 30-day readmission after treatment for Gram Positive Pneumonia. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify index admissions with a principal diagnosis of Gram Positive Pneumonia (ICD-9 codes 482.3, 482.31, 482.32, and 482.39 for streptococcus and 482.40, 482.41, 482.42, and 482.49 for staphylococcus). The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. Applicable admissions were all adults (age >= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmissions within 30-days of an index admission were analyzed. Predictors for readmission were determined using a multivariable logistic regression model. Results A total of 8,130 patients met criteria for inclusion of which 1,631 (20.06%) were readmitted (all-cause) within 30-days. There was no statistically significant difference in readmission between patients from a rural (18.7%) or urban (20.4%) location. The statistically significant predictors for readmission for patients from a rural location were those admitted on a weekend (OR: 1.41, CI: 1.04-1.90), discharged to short term hospital (OR: 2.70, CI: 1.18-6.19) or AMA (OR: 6.53, CI: 1.46-29.10), and those with a LOS between 7 and 14 days (OR: 1.48, CI: 1.10-2.00). For patients from an urban location, statistically significant predictors were those admitted on a weekend (OR: 1.17, CI 1.02-1.34), discharged AMA (OR: 2.89, CI: 1.74-4.78), LOS between 7 and 14 days (OR: 1.19, CI: 1.03-1.37) and those with CKD (OR: 1.20, CI: 1.03-1.39). Conclusion The risk factors for readmission after Gram Positive Pneumonia for patients from a rural and urban location are similar. More research is needed to develop interventions for those who are at risk for readmission after Pneumonia to reduce future morbidity and mortality. Disclosures All Authors: No reported disclosures

This paper will establish a set of the wireless medical system for medical environment simulation. Patients will focused more on safety and improved quality of care than ever before. If an emergency occurs at any time, the medical staff will send to the radio frequency identification (RFID) patient location. In the event of an emergency, the RFID positioning system allows the medical staff always to observe the patient's health status, and reach in time to solve medical problems.

Objective: To investigate whether a patient’s proximity to the nurse’s station or ward entrance at time of admission was associated with increased risk of adverse outcomes. Method: We conducted a retrospective cohort study of consecutive adult inpatients to 13 medical–surgical wards at an academic hospital from 2009 to 2013. Proximity of admission room to the nurse’s station and to the ward entrance was measured using Euclidean distances. Outcomes of interest include development of critical illness (defined as cardiac arrests or transfer to an intensive care unit), inhospital mortality, and increase in length of stay (LOS). Results: Of the 83,635 admissions, 4,129 developed critical illness and 1,316 died. The median LOS was 3 days. After adjusting for admission severity of illness, ward, shift, and year, we found no relationship between proximity at admission to nurse’s station our outcomes. However, patients admitted to end of the ward had higher risk of developing critical illness (odds ratio [ OR] = 1.15, 95% confidence interval [CI] = [1.08, 1.23]), mortality ( OR = 1.16, 95% CI [1.03, 1.33]), and a higher LOS (13-hr increase, 95% CI [10, 15] hours) compared to patients admitted closer to the ward entrance. Similar results were observed in sensitivity analyses adjusting for isolation room patients and considering patients without room transfers in the first 48 hr. Conclusions: Our study suggests that being away from the nurse’s station did not increase the risk of these adverse events in ward patients, but being farther from the ward entrance was associated with increase in risk of adverse outcomes. Patient safety can be improved by recognizing this additional risk factor.

Telemedicine is a technology that permits patients to be seen at a distance. This review describes different types of telemedicine, why they might be useful for a practice, what equipment is needed, and how to select and schedule patients. The use of synchronous telemedicine is increasing rapidly and has surpassed 50% of ambulatory encounters in some instances. Management of patients is particularly germane for an allergy practice since it is an outpatient specialty with patients who live in widely distributed locations with limited access to allergists. With utilization of digital exam equipment, in vitro tests for diagnosis, and spirometry at the patient location, there are few clear advantages of seeing patients in-person over virtual visits. Telemedicine is here today. As its use increases, it is critical that allergy specialists embrace this new technology.

Background Avalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts. Methods This 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported. Results Our analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period. Conclusions Our data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step. Electronic supplementary material The online version of this article (10.1186/s13049-018-0520-3) contains supplementary material, which is available to authorized users.

Background:The current study involves a national survey of healthcare providers who offer services for individuals with a variety of neurological conditions. It aims to describe the provision of health and community-based services as well as the admission criteria, waitlist practices, and referral sources of these services.Methods:An online survey was directed at administrators/managers from publicly funded hospital programs, long-term care homes, and community-based healthcare provider agencies that were believed to be providing information and/or services to patients with a variety of neurological conditions.Results:Approximately 60% (n=254) of respondents reported providing services in either urban/suburban areas or rural/remote areas only, whereas the remaining 40% (n=172) provided services regardless of patient location. A small proportion of respondents reported providing services for individuals with dystonia (28%), Tourette syndrome (17%), and Rett syndrome (13%). There was also a paucity of diverse healthcare professionals across all institutions, but particularly mental healthcare professionals in hospitals. Lastly, the majority of respondents reported numerous exclusion criteria with regard to service provision, including prevalent comorbid conditions.Conclusions:If the few services provided for these neurological patient populations exclude common comorbidities, it is likely that there will be no other place for these individuals to seek care.

Objective Our aim in this study was to evaluate the effect of the radiologist, technologist, and other examination-related factors on the frequency of recommendations for additional imaging (RAI) during sonographic (US) interpretation. Methods We retrospectively reviewed 719 US reports from a single academic medical center for the presence of RAI. All studies had been interpreted by one of three abdominal radiologists. Examinations were performed at an outpatient radiology facility with no onsite radiologist (n = 299) or at an inpatient emergency department or hospital-based outpatient setting that had an onsite radiologist (n = 420). Possible associations between the frequency of RAI and the presence of an onsite radiologist, location of the examination, body part or region imaged, patient age, technologist performing the exam, and radiologist reading the exam were evaluated. Results There were significant differences between each pair of radiologists in terms of overall frequency of RAI (p

The growing synergy between engineering applications and medical science has resulted in the development of effective health care services and applications responsible for higher quality of living for the world's elderly. The growing numbers of elderly demands more efficient system to monitor patients, especially those with degenerative and chronic diseases constrained to indoor healthcare environments. However, effective monitoring requires constant detection of patients' physical position and orientation, as a large proportion of in-hospital accidental deaths result from delays in responding to the physical needs of frail and elderly patients. In this paper, we propose an unobtrusive hybridized indoor approach using passive RFID sensors, biological pressure sensors, low-resolution infrared detectors and triboelectric motion detectors. The proposed system uses a two-level intelligent framework of location and orientation estimation, providing an efficient and prompt response in any emergency while giving the patients freedom to move around within their healthcare environment.

Administrative data have been used to identify patients with various diseases, yet no prior study has determined the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-based codes to identify CLI patients. CLI cases ( n=126), adjudicated by a vascular specialist, were carefully defined and enrolled in a hospital registry. Controls were frequency matched to cases on age, sex and admission date in a 2:1 ratio. ICD-9-CM codes for all patients were extracted. Algorithms were developed using frequency distributions of these codes, risk factors and procedures prevalent in CLI. The sensitivity for each algorithm was calculated and applied within the hospital system to identify CLI patients not included in the registry. Sensitivity ranged from 0.29 to 0.92. An algorithm based on diagnosis and procedure codes exhibited the best overall performance (sensitivity of 0.92). Each algorithm had differing CLI identification characteristics based on patient location. Administrative data can be used to identify CLI patients within a health system. The algorithms, developed from these data, can serve as a tool to facilitate clinical care, research, quality improvement, and population surveillance.

Background: Opioids are labeled as high-risk medications because of their propensity to cause significant harm or toxicity to patients if used inappropriately. Many incidents of opioid toxicity are the result of preventable causes. Objective: To identify and report the frequency and potential causes of opioid toxicity in the acute care setting. Methods: This single-center chart review evaluated patients receiving naloxone for presumed opioid toxicity from January 2008 through July 2010. Patients were identified for this study using rapid response team charted visits. Charts were then reviewed for opioid medications administered, possible causes of opioid toxicity, signs and symptoms of opioid toxicity, patient location by hospital floor, and prescribing physician service. Results: One hundred twenty-nine incidents of opioid toxicity met inclusion criteria and were placed in 1 or more of the applicable categories for possible causes: administration of multiple opioids (43.4%), medication errors (31.6%), and the administration of morphine to patients with impaired renal function (7.2%); 17.8% of the causes were unknown. Conclusions: Most cases of opioid toxicity were determined to be the result of preventable causes. Prevention strategies for opioid toxicity should consist of educating health care professionals as well as incorporating health information technologies shown to reduce errors. Specific areas of focus should include opioid equianalgesic dosing strategies, removal of duplicate opioid orders, and writing of clear administration guidelines for orders of as-needed opioids or multiple dosage forms of opioids.

In this paper, one of the novel issues of the world regarding the location of ambulance stations within a given area to cover the maximum amount of demand is studied. In this study, the classic version of location problem is improved using the double coverage models so that two radii are considered for covering. Furthermore, the developed study contains the meaningful factors indicating the demand for each patient location covered by each station (vehicle location). In the proposed model, the uncertainty existed in the travel time between the patient locations and vehicle locations have been considered as triangular fuzzy numbers. To solve the proposed model, the goal programming approach is applied in the GAMS software and desired outputs have been achieved. The obtained results represent a significant improvement compared to the past models with uncertainty.

The hospital antibiogram is a periodic summary of antimicrobial susceptibilities of local bacterial isolates submitted to the hospital′s clinical microbiology laboratory. Antibiograms are often used by clinicians to assess local susceptibility rates, as an aid in selecting empiric antibiotic therapy, and in monitoring resistance trends over time within an institution. Antibiograms can also used to compare susceptibility rates across institutions and track resistance trends. Some hospitals have adequate support from the computer department to be able to extract data from their reporting module. The WHONET software can be freely downloaded and used for analysis. Consensus guidelines have been developed by the Clinical and Laboratory Standards Institute (CLSI) to standardise methods used in constructing antibiograms. These guidelines can be incorporated into the WHONET software for analysis. Only the first isolate from the patient is to be included in the analysis. The analysis should be done on the basis of patient location and specimen type. The percentage susceptibility of the most frequently isolated bacteria should be presented in the antibiogram, preferably in a tabular form. The antibiogram must be printed or put up in the intranet for easy access to all clinicians. Antibiotic policy is one of the mandatory requirements for accreditation, and making an antibiogram is the first step before framing the antibiotic policy. The future of antibiograms would be the incorporation of patient related data to make information more reliable and for predicting outbreaks.

Aims An incompletely filled radiology request form (RRF) is a common problem faced by both radiologists and radiographers. The study was designed to objectively assess the adequacy of completion of radiology request forms from two hospitals in Yorkshire: Harrogate District Hospital and Huddersfield Royal Infirmary. Material and methods Two hundred forms were randomly selected from each hospital. A score was assigned to each form based on completion of 10 different fields. Each field was given a score of 0, 0.5 or 1 with a total of maximum 10 per form. Only the completeness of each field was assessed. A blank field was given a zero score. We did not analyse the accuracy, justification or legibility of the request. Results A total of 400 forms were analysed. The mean score was 8.7 per form (range 4.5–10 and median 9). Out of potential 4000 fields (10 fields each in 400 forms), a total of 455 fields were left blank and a further 71 were incompletely filled. The commonest blank fields were as follows: doctor's bleep number: 42%, patient location: 21%, questions to be answered: 17%, doctor's name: 15%, date of referral: 11% and consultant name: 8%. Conclusions This study has revealed overall satisfactory performance by the referrers in the completion of RRFs (mean score of 8.7/10 per form). There were still a number of inadequacies in completing the RRFs. This may have medico-legal implications and serious consequences on the quality of overall service provided by the radiology departments. Importance of completion of each field is discussed and suggestions have been made to improve these deficiencies. Comparison has been made with similar studies from around the world which shows that the problem is widespread.

Background: The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes.Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency.Methods: LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage.Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices.Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.

In this work we examine the potential of using digital images to classify regions appearing in pressure ulcer images and thus being able to have a diagnosis about the patient's current state. We capitalize on telemedicine infrastructure, which can overcome difficulties posed by remote patient location, and we aim to provide diagnostic tools that will satisfy the above requirements.

Handover is a crucial part of patient care and is a well recognized cause of patient harm if not performed well. The introduction of full shift working for doctors has placed even more emphasis on this area of patient care. We identified handover of orthopaedic admissions in our unit was substandard. A prospective audit over a one week period including the weekend was undertaken. The Royal College of Surgeons of England guidance on handovers was used as minimum criteria and we also included criteria essential for handover of orthopaedic patients. This initial audit revealed a poor standard of handover. 21 patients were included and in particular patient location (57%), responsible consultant (14%), and pending investigations (29%) were poorly performed. In addition two patient safety incidents were noted, including one admission that was not handed over. To improve the handover we created a trauma specific handover proforma. We then conducted a re-audit again over a one week period including the weekend with the proforma in use. There was a notable improvement, 17 patients were included and only 3 criteria fell below 80%. We presented our findings at the local audit meeting where the results were discussed with all members of the trauma team. We suggested that an electronic proforma, accessible from multiple computers within the hospital may improve handover further. This was created in conjunction with the IT department. Once again we reaudited handover over a one week period including the weekend with the electronic proforma in use. 23 patients were included and a further improvement was noted; only one criterion fell below 95%. In conclusion handover of acute fracture admissions within the unit has undoubtedly improved. The electronic proforma tool was a simple, cost effective, and accurate method of improving handover.

Background Pirfenidone is approved in England by NICE for the treatment of Idiopathic Pulmonary Fibrosis (IPF) but its prescription is limited to certain specialised centres. We hypothesised that this may lead to health inequality in the access to the drug per head of population in an area of the Midlands Methods 2 prescribing centres (PC), and 4 non-prescribing centres(NPC) referring into them were studied. They were the George Eliot Hospital (GEH) in Nuneaton and South Warwick FT (SWFT) in Warwick (both NPCs) referring to University Hospitals of Coventry & Warwickshire (UHCW) in Coventry, and Kettering General Hospital (KGH) and Northampton General Hospital (NGH), (both NPCs) referring to Glenfield Hospital, University Hospitals of Leicester (UHL). The number of patients prescribed pirfenidone up to January 2016 was collected, and corrected per 100,000 head of population according to the patient postcode from 2011 census data. All patients were from the CV,LE or NN postcode areas. As data were not normally distributed, analysis was performed with non-parametric statistics using ‘R’, a statistics package. We collected the time and distance of travel to patients’ local hospital, and to their PC. Results There were a total of 64 postcode areas (PCAs) in the region. Travel times to local hospitals (either a PC or NPC according to area) were normally distibuted with a median of 19 minutes (range 5–40). Travel time to relevant PC was bimodally distributed, with a median of 26 ½ minutes (range 5–64). This was significantly different (p,1*10^−7). There were no pirfenidone patients in 20 PCAs. Where patients’ local hospital was a NPS there were significantly more pirfenidone-free PCAs (15/32) than where the local hospital was a PC (5/32), p = 0.015. Median number of pirfenidone patients per 100,000 population was significantly less (2.18) where the local hospital was a NPC than where the local hospital was a PC (4.76), p = 0.019. There were also significant differences across all 6 hospitals in the median prevalence of pirfenidone prescriptions (p = 0.003). Conclusions Our data suggest there are significant health inequality in access to pirfenidone according to patients’ location and whether their local hospital is a PC or not.