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Background: Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs. Aim(s): To evaluate the outcomes of guideline-based application of cardiac telemetry. Method(s): Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward-based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II - baseline) was completed prior to a 3-month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration. Result(s): In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean +/- standard deviation (SD) age 73 years +/- 14.9, 57% male), whilst 65 patients were included in the intervention (mean +/- SD age 71 years +/- 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 +/- 1.8 vs 2.4 +/- 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05). Conclusion(s): Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.Copyright © 2017 Royal Australasian College of Physicians

Background: Inappropriate cardiac telemetry use is associated with reduced patient flow and increased healthcare costs. Aim(s): To evaluate the outcomes of guideline-based application of cardiac telemetry. Method(s): Phase I involved a prospective audit (March to August 2011) of telemetry use at a tertiary hospital. Data were collected on indication for telemetry and clinical outcomes. Phase II prospectively included patients more than 18 years under general medicine requiring ward-based telemetry. As phase II occurred at a time remotely from phase I, an audit similar to phase I (phase II - baseline) was completed prior to a 3-month intervention (May to August 2015). The intervention consisted of a daily telemetry ward round and an admission form based on the American Heart Association guidelines (class I, telemetry indicated; class II, telemetry maybe indicated; class III, telemetry not indicated). Patient demographics, telemetry data, and clinical outcomes were studied. Primary endpoint was the percentage reduction of class III indications, while secondary endpoint included telemetry duration. Result(s): In phase I (n = 200), 38% were admitted with a class III indication resulting in no change in clinical management. A total of 74 patients was included in phase II baseline (mean +/- standard deviation (SD) age 73 years +/- 14.9, 57% male), whilst 65 patients were included in the intervention (mean +/- SD age 71 years +/- 18.4, 35% male). Both groups had similar baseline characteristics. There was a reduction in class III admissions post-intervention from 38% to 11%, P < 0.001. Intervention was associated with a reduction in median telemetry duration (1.8 +/- 1.8 vs 2.4 +/- 2.5 days, P = 0.047); however, length of stay was similar in both groups (P > 0.05). Conclusion(s): Guideline-based telemetry admissions and a regular telemetry ward round are associated with a reduction in inappropriate telemetry use.Copyright © 2017 Royal Australasian College of Physicians

Introduction & Aim: Current American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend laparoscopic common bile duct exploration (LCBDE) or post operative endoscopic retrograde cholangiopancreaography (ERCP) for management of retained common bile duct (CBD) stones post laparoscopic cholecystectomy confirmed with intraoperative cholangiogram (IOC). This retrospective observational study aims to determine the number of negative ERCP findings after a positive IOC and the number of subsequent post ERCP complications in this group. Method(s): All Patients who had an ERCP performed following a positive IOC finding in a Tertiary teaching hospital between January 2012 to May 2015 were identified from surgical and endoscopic records. Medical records and laboratory results were reviewed to determine patient demographics, indication for cholecystectomy, IOC and ERCP findings and post ERCP complications. A negative ERCP was defined as no stones identified post sphincterotomy and CBD sweep. Result(s): There were 139 patients with a positive IOC finding and referred for ERCP; 52 (38%) were male with a median age of 51 years (range 24 to 92). Of the 139 patients who had ERCP performed, 44 patients had an on table ERCP and 95 patients had ERCP performed on the next available ERCP list. There were 30 out of 139 (22%) patients with a negative ERCP finding despite the initial abnormal IOC. Of these 30 patients, 7 (23%) experienced post ERCP complications, including 4 (13%) patients with post ERCP pancreatitis, 2 (7%) patients with post sphincterotomy bleeding, and 1 (3%) patient with cholangitis. There were no deaths. The indications for cholecystectomy included 20 (66%) cholecystitis, 8 (27%) symptomatic cholelithiasis and 2 (7%) pancreatitis. Conclusion(s): This study highlights a significant number of unnecessary ERCP procedures after positive IOC. These negative ERCP procedures are associated with an increased risk of ERCP related complications. Further prospectiv

Introduction: Current American Association for the Study of Liver Diseases guidelines recommend hepatitis B virus (HBV) screening with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (antiHBs) and hepatitis B core antibody (antiHBc) prior to commencing therapy with TNFalpha inhibitors such as infliximab. HBV flares have been increasingly reported to occur in patients who are HBsAg negative and antiHBc positive who receive infliximab. Screening for tuberculosis (TB) is recommended by European Crohn's and Colitis Organisation in the same patient population. The aim was to audit the screening practices for all patients receiving infliximab in a large tertiary academic hospital. Method(s): All patients who had received infliximab from 2010 to 2013 were identified from pharmacy records. Medical records and laboratory results were reviewed to determine patient demographics, TB and HBV screening practices. Result(s): Of the 216 patients who received infliximab between 2010 and 2013, 51% were male with a mean age of 44 years. Patients were from Australia (67%), Greece (3%) and Sri Lanka (2%). Indications for infliximab included Crohn's disease (49%), ulcerative colitis (10%), inflammatory arthropathies (39%) and psoriasis (10%). Fifty-six per cent (121) of patients were tested for TB and of these 3% were Quantiferon- Gold positive and 11% were indeterminate. Ninety-eight (45%) patients had hepatitis B serology performed, of these 85% had testing prior to commencement of infliximab. In patients tested for HBV, 91% (89) had HBsAg performed, none were positive; 32 (33%) had antiHBs tested and 50% were positive; only 28 (31%) had antiHBc tested and 6% were positive. There were no patients with active TB or HBV flares and there were no deaths. Conclusion(s): Current screening rates for TB and HBV in patients commencing TNFalpha inhibitors are less than recommended by international guidelines. In the majority of patients screened for HBV, antiHBc and antiHBs wer

Introduction: Current American Association for the Study of Liver Diseases guidelines recommend hepatitis B virus (HBV) screening with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (antiHBs) and hepatitis B core antibody (antiHBc) prior to commencing therapy with TNFalpha inhibitors such as infliximab. HBV flares have been increasingly reported to occur in patients who are HBsAg negative and antiHBc positive who receive infliximab. Screening for tuberculosis (TB) is recommended by European Crohn's and Colitis Organisation in the same patient population. The aim was to audit the screening practices for all patients receiving infliximab in a large tertiary academic hospital. Method(s): All patients who had received infliximab from 2010 to 2013 were identified from pharmacy records. Medical records and laboratory results were reviewed to determine patient demographics, TB and HBV screening practices. Result(s): Of the 216 patients who received infliximab between 2010 and 2013, 51% were male with a mean age of 44 years. Patients were from Australia (67%), Greece (3%) and Sri Lanka (2%). Indications for infliximab included Crohn's disease (49%), ulcerative colitis (10%), inflammatory arthropathies (39%) and psoriasis (10%). Fifty-six per cent (121) of patients were tested for TB and of these 3% were Quantiferon- Gold positive and 11% were indeterminate. Ninety-eight (45%) patients had hepatitis B serology performed, of these 85% had testing prior to commencement of infliximab. In patients tested for HBV, 91% (89) had HBsAg performed, none were positive; 32 (33%) had antiHBs tested and 50% were positive; only 28 (31%) had antiHBc tested and 6% were positive. There were no patients with active TB or HBV flares and there were no deaths. Conclusion(s): Current screening rates for TB and HBV in patients commencing TNFalpha inhibitors are less than recommended by international guidelines. In the majority of patients screened for HBV, antiHBc and antiHBs wer