Surgical Experience Improved With Patient Text Alerts and Web App

Dr. Carmine Simone MD, FRCSC Chief, Department of Surgery, Toronto East General Hospital Co-Program Medical Director, Surgery Health Service, Toronto East General Hospital Lecturer, University of Toronto, Division of Thoracic Surgery Courtesy Staff, Sunnybrook Health Sciences Centre & Royal Victoria Hospital, Barrie

Dr. Simone

MedicalResearch.com Interview with:
Dr. Carmine Simone MD, FRCSC 
Chief, Department of Surgery, Toronto East General Hospital
Co-Program Medical Director, Surgery HealthService, Toronto East General Hospital
Lecturer, University of Toronto, Division of Thoracic Surgery
Courtesy Staff, Sunnybrook Health Sciences Centre & Royal Victoria Hospital, Barrie

Medical Research: What is the background for this study? What are the main findings?

Dr. Simone: Patients preparing for surgery are often overwhelmed with information. Most of the time patients are given written instructions regarding preoperative preparation as well as written information at discharge. Our own institutional experience is that only 2/3 of patients read the information we provide and less than half of these patients can understand or retain the information they read.

We have found that providing patients SMS alerts or reminders leading up to their surgery increases the likelihood that they will follow instructions and keep their appointments. Furthermore having patients log their progress after discharged from hospital allows patients to track their progress and report complications earlier and avoid coming to the ER. Educational modules enable patients to better gauge their symptoms and make more informed decisions about calling the surgeon’s office or proceeding to the emergency department. We found a significant reduction in the number of ER visits and cancelled procedures after implementing the mobile device reminders and post-discharge daily log.
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Easing ICU Admission Threshold May Improve Care and Reduce Costs

Joseph M Carrington DO, MHA Department of Medicine - PGY3 Johns Hopkins University/Sinai Hospital

Dr. Carrington

MedicalResearch.com Interview with:
Joseph M Carrington DO, MHA
Department of Medicine – PGY3
Johns Hopkins University/Sinai Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Carrington: This study looked at a total of 886 patients at a community hospital. We were faced with the dilemma that our ICU beds were frequently over utilized with severely ill patients for whom our interventions had minimal impact. This prevented patients who were less ill from coming to the ICU who may have benefited from our services. We made a hospital wide culture change to lower ICU admission thresholds. Any patient felt to be “borderline” received an automatic ICU evaluation without any push-back. The result of these earlier interventions was a decrease in complications from patients decompensating in the ED and floors. In turn, the overall ICU length of stay, mortality, and ICU transfers all decreased. By decreasing these overall complications and mortality, our number of ICU over-utilizes decreased. This saved our hospital an annualized amount of over $2 million and freed up ICU beds and resources.

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Electronic Alerts Improved Sepsis Care and Outcomes

Dr. Pablo Moreno Franco Assistant Professor of Medicine MAYO Clinic

Dr. Franco

MedicalResearch.com Interview with:
DrPablo Moreno Franco MD
Assistant Professor of Medicine
MAYO Clinic

Medical Research: What is the background for this study? What are the main findings?

Dr. Pablo Franco: Early alerts and prompt management of patient with severe sepsis and septic shock (SS/S) starting in the emergency department (ED) have been shown to improve mortality and other pertinent outcomes. With this in mind, we formed a multidisciplinary sepsis and shock response team (SSRT) in September 2013. Automated electronic sniffer alerted ED providers for possible sepsis and when S/SS was identified, they were encouraged to activate SSRT.

SSRT-Compliance-Study-Cohort Two blinded reviewers retrospectively abstracted data on clinical trajectory and outcomes of all patients with sepsis and SS/S admitted at a single academic medical center between September 2013 and September 2014. Given importance of timely recognition and interventions in S/SS, we specifically focused on 2 periods: 0-4 hours and 4-12 hours after hospital admission. Additionally, we compared the compliance to “standard of care” between the SSRT pre-implementation period and the study period.

There were 167 patients admitted with sepsis, among which there were 3 SSRT activations and sepsis mortality was 3.6%. There were 176 patients with SS, SSRT was called in 42 (23%) and SS mortality was 8.5%. CCS was involved in 66 patients and mortality was 6.9% if SSRT was activated, versus 21.6% if SSRT was not activated. There were 76 patients with septic shock, SSRT was called in 44 (57%) and septic shock mortality was 25%. Critical Care Service (CCS) was involved in 68 patients and mortality rates with and without SSRT were 30.9% and 15.4%, respectively. The all-or-none compliance with applicable goals of resuscitation improved from the baseline 0% to over 50% at the study period end. Overall observed/expected sepsis mortality index improved from 1.38 pre-SSRT to 0.68 post-SSRT implementation.

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Veterans with PTSD Require More Sedatives in Critical Care Units

Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo

Dr. Jad Kebbe

MedicalResearch.com Interview with:
Jad Kebbe, MD
Jacobs School of Medicine and Biomedical Sciences
Department of Medicine
University of Buffalo

Medical Research: What is the background for this study? What are the main findings?

Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter.

Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case.

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