Spartan medical research journal最新文献_第9页

Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation 成人先天性咽网：一例罕见临床异常的联合治疗

Spartan medical research journal Pub Date : 2020-06-08 DOI: 10.51894/001c.12473

Katrina Minutello, Steven Pinther, R. Stachler

{"title":"Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation","authors":"Katrina Minutello, Steven Pinther, R. Stachler","doi":"10.51894/001c.12473","DOIUrl":"https://doi.org/10.51894/001c.12473","url":null,"abstract":"INTRODUCTION TO THE TOPIC Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development. CASE PRESENTATION We present a case of a woman in her mid-40’s with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain. CONCLUSIONS Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45416171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The Face of Clostriodes Difficile Infections in the Outpatient Setting 门诊环境中面临的艰难梭菌感染

Spartan medical research journal Pub Date : 2020-06-08 DOI: 10.51894/001c.12883

Michael S Wang, S. Faheem, Joanna Mangio, Kevin Pham, D. Lloyd, Brianna Hatch-Vallier, E. Johnson

{"title":"The Face of Clostriodes Difficile Infections in the Outpatient Setting","authors":"Michael S Wang, S. Faheem, Joanna Mangio, Kevin Pham, D. Lloyd, Brianna Hatch-Vallier, E. Johnson","doi":"10.51894/001c.12883","DOIUrl":"https://doi.org/10.51894/001c.12883","url":null,"abstract":"BACKGROUND It has long been well-established that Clostridiodes difficile infections (CDI) can cause severe morbidity and mortality. However, most of the literature to date has focused on hospital-diagnosed infections with less emphasis on clinic-based CDI cases. Guidelines from the 2010 IDSA/SHEA for CDI advocate for metronidazole as first-line therapy for mild to moderate CDI cases. However, the 2017 guidelines recommend oral vancomycin or fidaxomicin as first-line therapy due to their superior efficacy. Objective: The purpose of this study was to compare Clostriodes difficile infections in convenience samples of clinic vs. hospital patients. METHODS In 2019, a retrospective, case-controlled study was performed by the first six authors between 2015-2017 (i.e., prior to the 2017 IDSA/SHEA CDI guidelines) to compare ambulatory and hospital CDI treatment prescriptions. Analytic data included frequency of White blood cells (WBC) and creatinine collection, frequency of severe CDI cases, compliance with the 2010 guidelines, CDI recurrence, and mortality. RESULTS An eligible subgroup of N = 92 hospital patients at Spectrum Health Lakeland were more likely to have WBC (98.4% vs 32.6%, p<0.001) and creatinine (97.8 vs. 39.4, P < 0.001) drawn than 184 patients receiving clinic-based care. Hospital sampled patients were more likely to have severe CDI (46.7% vs 6.7%, p < 0.001). Mortality was less common in hospital patients (1.1% vs. 7.6%, p = 0.017) and the recurrence rates were similar. (21.2% inpatient vs. 28.3% outpatient, (p = 0.224). CONCLUSIONS Based on these results, assessment of CDI severity remains limited in the ambulatory population due to the lack of severity markers. It is unclear if this is due to lack of available laboratory resources or difference in clinical presentation. Of those sample patients who have available markers of severity, patients receiving clinic-based diagnoses were less likely assessed to have severe CDI. Keywords: Cloistriodes difficile infection, ambulatory, severity markers","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47282376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Myocardial Ischemia, a Rare Presentation of Meckel’s Diverticulum 心肌缺血，罕见的梅克尔憩室表现

Spartan medical research journal Pub Date : 2020-06-08 DOI: 10.51894/001c.12844

Trevor A. Nessel, C. Kerndt, Zaid J. Shareef, C. Doig

{"title":"Myocardial Ischemia, a Rare Presentation of Meckel’s Diverticulum","authors":"Trevor A. Nessel, C. Kerndt, Zaid J. Shareef, C. Doig","doi":"10.51894/001c.12844","DOIUrl":"https://doi.org/10.51894/001c.12844","url":null,"abstract":"CONTEXT Meckel’s diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases. METHODS This case involves an elderly male in his early 80’s who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy. RESULTS Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel’s diverticulum. CONCLUSIONS This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel’s diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel’s diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel’s diverticula.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42103043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings. 在具有学术和非学术临床环境的社区医院卫生系统中进行形式化超声认证的方法。

Spartan medical research journal Pub Date : 2020-06-08

Jeremy Long, Stefan Meyering, Timothy Scheel

{"title":"Approach to Formalized Ultrasound Credentialing in a Community Hospital Health System with both Academic and Non-Academic Clinical Settings.","authors":"Jeremy Long, Stefan Meyering, Timothy Scheel","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: In the US, ultrasound in Emergency Medicine (EM) is widely considered the standard of care in clinical practice amongst most Emergency Department providers. At the authors' institution and affiliates, there were a variety of health care providers utilizing ultrasound for clinical practice, and their skill levels varied, dependent on training and exposure. As an attempt to standardize credentialing practice and determine need for additional training thresholds, the authors endeavored to perform a skills assessment utilizing both written and clinical based practical assessments.Methods: A 7 point questionnaire was administered to a convenience sample of providers requesting formal training information, number of ultrasounds performed, and self-assessed competency. A 10 point written assessment with ultrasound knowledge and clinical application questions was also administered. A subsequent clinical assessment on live humans and models was then performed with multiple stations assessing 15 different instrumentation skills and technique, as well as image interpretation and evaluation.Results: A total of 23 attending EM board-certified physicians, and four advanced practice providers (PA and NP) took the credentialing assessments scoring an average of 7.3 out of 10 (SD 0.83) for the written assessment. Twenty (71%) of the 28 tested passed the clinical evaluation on their initial attempt. Five (17%) passed on a first remediation. Three (10%) required more than one initial revision attempt. All those who did remediate were able to complete the revision with a passing score.Conclusions: Overall, the testing was considered a successful process. This program appears to have offered a level of standardization that was appealing to the credentialing body at our institution. We were able to assess to a level of competence considered standard of care by national credentialing bodies.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":"12748"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note. 头髓内钉后大腿外侧疼痛的治疗：一项技术注意事项。

Spartan medical research journal Pub Date : 2020-06-08

Michael Rosen, Connor Kasik, Michael Swords

{"title":"Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note.","authors":"Michael Rosen, Connor Kasik, Michael Swords","doi":"","DOIUrl":"","url":null,"abstract":"Peritrochanteric hip fractures are most commonly treated with proximal femoral fixation devices, such as a cephalomedullary nail or sliding hip screw. As usage rates increase for these fixation devices, complications from their insertion are becoming more prevalent. Lateral hip pain from proximal locking device insertion and prominence continues to be one of the most frequent complaints regarding hardware irritation following this surgical procedure. Conservative treatment options for this complaint include local corticosteroid injection and physical therapy, although once these treatments have been exhausted, surgical intervention may be recommended. This has generally been managed previously with implant removal, although studies have shown associated femoral neck fractures after removal even with the prescribed protected postoperative weight bearing. Additionally, in certain situations (e.g., when the nail is placed for prophylactic treatment), its removal is contraindicated. The purpose of this manuscript is to describe an alternative treatment option that would limit morbidity, and the need for proximal locking device or implant removal by excising the portion of the iliotibial band causing hip irritation at the level of the proximal locking device, while leaving the retained implant in place. This surgical option would allow most patients to return to their pre-operative weight-bearing status immediately following surgery without the need for additional postoperative precautions.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"5 1","pages":"12931"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation. 成人先天性咽喉网：通过钴化治疗一种罕见的临床异常。

Spartan medical research journal Pub Date : 2020-06-08

Katrina Minutello, Steven Pinther, Robert Stachler

{"title":"Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation.","authors":"Katrina Minutello, Steven Pinther, Robert Stachler","doi":"","DOIUrl":"","url":null,"abstract":"Introduction to the topic: Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development.Case presentation: We present a case of a woman in her mid-40's with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain.Conclusions: Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"12473"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25424505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence of Heterotopic Ossification in Direct Anterior Approach to Total Hip Arthroplasty with use of Aspirin as Thromboembolic Prophylaxis 使用阿司匹林预防血栓栓塞的全髋关节置换术直接前路异位骨化的发生率

Spartan medical research journal Pub Date : 2020-06-08 DOI: 10.51894/001c.12263

P. Knapp, Ross Doehrmann, S. Yokhana, Syed Rizvi, J. Boura, David Knesek

{"title":"Incidence of Heterotopic Ossification in Direct Anterior Approach to Total Hip Arthroplasty with use of Aspirin as Thromboembolic Prophylaxis","authors":"P. Knapp, Ross Doehrmann, S. Yokhana, Syed Rizvi, J. Boura, David Knesek","doi":"10.51894/001c.12263","DOIUrl":"https://doi.org/10.51894/001c.12263","url":null,"abstract":"CONTEXT Heterotopic ossification (H.O.) is a common occurrence after total hip arthroplasty (THA) with significant potential clinical ramifications. Controversy still exists regarding the exact etiology of the disorder, including possible risk factors. Surgical technique, surgical approach, postoperative medication protocols and even thromboembolic prophylaxis have been implicated in the formation of H.O. Our study looked at one institution with a single surgeon performing direct anterior THA (DAA THA) in patients who received aspirin (ASA) as monotherapy for thromboembolic prophylaxis. METHODS Patients at a single institution who underwent DAA THA between 2015 and 2019 were identified by CPT code. 45 patients ultimately met inclusion criteria. Postoperative radiographs were analyzed retrospectively for H.O. according to the Brooker classification. Several patient characteristics and comorbidities were statistically analyzed using Chi-square tests, Fisher Exact tests, Wilcox rank sum tests, and Pearson correlation. RESULTS 12 patients (26.7%) were found to have heterotopic ossification (67% Class 1, 8% Class 2, 25% Class 3, and 0% Class 4); with a median follow up of 35 weeks (range: 12-96). 25% of these patients received ASA 325mg BID while 75% received ASA 81 BID. No statistical differences in development of H.O. were detected among age, gender, BMI, sex, race, diabetes, or NSAID use in the post-operative interval. There were significantly more smokers in the H.O. group (50% vs. 9%, p<0.006). CONCLUSIONS Our analysis aimed to quantify the incidence of H.O. with consistency in surgical approach and post-operative protocol. There have been few studies on this topic, and we believe it is very relevant with the increasing use of aspirin in the post-operative protocol for thromboembolic prophylaxis. Our retrospective analysis identified H.O. at rates similar to previous studies in DAA.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42932670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note 头髓钉后大腿外侧疼痛的处理:技术说明

Spartan medical research journal Pub Date : 2020-06-08 DOI: 10.51894/001c.12931

M. Rosen, Connor S Kasik, M. Swords

{"title":"Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note","authors":"M. Rosen, Connor S Kasik, M. Swords","doi":"10.51894/001c.12931","DOIUrl":"https://doi.org/10.51894/001c.12931","url":null,"abstract":"Peritrochanteric hip fractures are most commonly treated with proximal femoral fixation devices, such as a cephalomedullary nail or sliding hip screw. As usage rates increase for these fixation devices, complications from their insertion are becoming more prevalent. Lateral hip pain from proximal locking device insertion and prominence continues to be one of the most frequent complaints regarding hardware irritation following this surgical procedure. Conservative treatment options for this complaint include local corticosteroid injection and physical therapy, although once these treatments have been exhausted, surgical intervention may be recommended. This has generally been managed previously with implant removal, although studies have shown associated femoral neck fractures after removal even with the prescribed protected postoperative weight bearing. Additionally, in certain situations (e.g., when the nail is placed for prophylactic treatment), its removal is contraindicated. The purpose of this manuscript is to describe an alternative treatment option that would limit morbidity, and the need for proximal locking device or implant removal by excising the portion of the iliotibial band causing hip irritation at the level of the proximal locking device, while leaving the retained implant in place. This surgical option would allow most patients to return to their pre-operative weight-bearing status immediately following surgery without the need for additional postoperative precautions.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44826485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Removal of Ioban May Pull Bacteria to the Surface of the Skin: Lessons Learned. 移除伊班可能将细菌带到皮肤表面：经验教训。

Spartan medical research journal Pub Date : 2020-06-08

Jacob Lytle, Jordan McCoy, Katie Smeltzer, Ryan Nelson

{"title":"Removal of Ioban May Pull Bacteria to the Surface of the Skin: Lessons Learned.","authors":"Jacob Lytle, Jordan McCoy, Katie Smeltzer, Ryan Nelson","doi":"","DOIUrl":"","url":null,"abstract":"Context: Cutibacterium acnes (C. Acnes, formerly known as Propionibacterium acnes) are slow growing, gram positive, anaerobic bacilli. C. acnes are found in many locations, both as part of normal skin flora, as well as a contaminant of environmental surfaces. These bacteria have been associated with prosthetic joint infections of the shoulder, and it has been challenging to prevent such infections for a variety of reasons. The purpose of this quality improvement project was to investigate whether the surgical adhesive dressing Ioban could pull subcutaneous C. acnes bacteria from the surgical field.Methods: During this quality improvement project, a convenience sample of 16 adult volunteers were gathered from other residency departments and from medical students at our hospital. The volunteers were used to take samples from two sites on each shoulder. The shoulder sites were prepped and covered with iodine-impregnated dressings.Results: There were 26 of 64 (40.6%) samples in the no Ioban group that grew C. acnes. The Ioban group had 37 of 64 (57.8%) samples found to be positive for C. acnes growth. During this project, we identified several key points that could be useful to future researchers working in community hospitals. We describe these lessons concerning ongoing communication with lab and research departments, offering volunteers compensation to participate, interacting with departments unaccustomed to research, and development of a clear methodology.Conclusions: This was the first time our department had conduct a project utilizing the laboratory as well as volunteers. This came with unforeseen challenges which caused significant time delays. We believe that by highlighting these lessons for future researchers, they might avoid such problems during project activities.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"12463"},"PeriodicalIF":0.0,"publicationDate":"2020-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25424504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Provider Driven Follow-Up in a Chest Pain Accelerated Diagnostic Protocol: Round Two of the PDSA Cycle in a Multidisciplinary Quality Improvement Patient Safety Project. 胸痛加速诊断方案中由提供者驱动的随访：多学科质量改进患者安全项目中的 PDSA 循环第二轮。

Spartan medical research journal Pub Date : 2020-01-30

Isaac Troiano, Mary Mitchell, Mark Schury, Nikolai Butki

{"title":"Provider Driven Follow-Up in a Chest Pain Accelerated Diagnostic Protocol: Round Two of the PDSA Cycle in a Multidisciplinary Quality Improvement Patient Safety Project.","authors":"Isaac Troiano, Mary Mitchell, Mark Schury, Nikolai Butki","doi":"","DOIUrl":"","url":null,"abstract":"Context: In 2016, the McLaren Oakland Department of Emergency Medicine developed and implemented a Chest Pain Accelerated Diagnostic Protocol (CP-ADP) to identify patients presenting to the emergency department (ED) with chest pain who were at low risk for acute coronary syndrome (ACS) and appropriate for outpatient follow-up. The evaluation of the QI/PS project demonstrated that only 47% of the patients discharged from the ED under the CP-ADP received outpatient follow-up. In response, a second round of the PDSA cycle modified the CP-ADP to add a multidisciplinary provider driven follow-up.Methods: After ED discharge, patients in the CP-ADP with provider driven follow-up were contacted by a primary care physician to schedule a follow-up appointment. The premise was that this provider driven follow-up would alleviate navigation of the health care system as a barrier to follow-up.Results: The evaluation of the modified CP-ADP with provider driven follow-up demonstrated that 9 of the 30 patients discharged from the ED were able to be contacted. 21 of the patients were unable to be reached by the phone number they provided. Only 3 patients discharged with provider driven follow-up showed up to follow up appointments.Conclusions: There were some internal process failures identified that contributed to the low numbers of patients that were successfully contacted. External factors such as patient access to phones and means of communication were also discussed as factors that were originally not considered.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"4 2","pages":"11727"},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25424500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0