Focal Spot, Winter 2005/2006

https://digitalcommons.wustl.edu/focal_spot_archives/1101/thumbnail.jp

The Impact of a Revised Discharge Process from Acute Care to Home Care on Hospital Utilization in Children with Single Ventricle Heart Disease

Problem Description: It is estimated that approximately ~0.5%, or ~400,000, of all U.S. children, are identified as having complex chronic conditions (CCC) and account for as much as one-third, or ~$100 billion, of health care spending for all children. The goal of this quality improvement (QI) project was to identify the impact of a revised discharge process for children with Single Ventricle Heart Disease (SVHD) on hospital utilization rates and the parent’s perception of discharge readiness during the interstage period. The QI project was conducted in a 44-bed cardiac care unit within a 336-bed freestanding pediatric, academic medical center in a large urban area. The participants of the project are the parents or guardians of the children with SVHD, not the children themselves. Interventions: The outputs of the QI project included the development of a discharge bundle, which consisted of four specific aspects; 1. Assignment of a specific outpatient nurse coordinator; 2. Revised discharge education; 3. Utilization of remote home monitoring; and 4. Completion of a telemedicine encounter within 48 hours of discharge. Data reports were developed to measure hospital utilization rates and parent’s perception of discharge readiness was measured utilizing two validated surveys, the Quality of Discharge Teaching Scale and the Patient Readiness for Hospital Discharge Study. Results: This QI project was well received by all members of the clinical team as well as the parents. A total of five patients were enrolled with 100$140,050 down from $164,088 in the pre-bundle discharge group, a decrease of 15%. There was no statistical difference in parent’s perception of discharge readiness, however, subjective data gathered from families was extremely positive. Interpretation: Implementing new IT solutions at any organization is often time-consuming and challenging; this was no different for this QI project. Although the implementation of the home monitoring portion of this project took longer than expected, the outcome was a comprehensive, well-configured system that has provided a framework by which LCH could follow when future initiatives are identified Conclusion: This project demonstrated the benefits and considerations that exist when implementing a revised discharge process for SVHD patients during the interstage period. Benefits came in the form of the telemedicine encounter and the ability of the nurse coordinator to address and visualize concerns related to feeding, breathing, and socialization. The acceptance of this QI project by all members of the clinical team and families suggest the need for a longitudinal review of the impact of this initiative

Emerging Pathogens in Cystic Fibrosis Patients at Virginia Commonwealth University Medical Center (VCUMC)

Cystic fibrosis (CF) is an autosomal recessive disorder affecting 70,000 individuals worldwide. This disease is characterized by the buildup of mucus in the airways leading to chronic lung infections resulting in pulmonary failure and death in 95% of CF patients. Routine surveillance of CF pathogens using traditional microbiology culture guides management and treatment of CF patients. Molecular profiling studies have revealed emerging pathogens that may play a role in CF lung disease by either directly causing infection or upregulating the virulence factors of classic CF pathogens, such as P. aeruginosa; however, routine CF culture protocols have not been modified to detect these organisms. The goal of this study was to expand the data relevant to the use of microbiology cultures for the management and treatment of CF patients at Virginia Commonwealth University Medical Center (VCUMC) by directly selecting for emerging CF pathogens in culture. This was accomplished by developing,optimizing, and implementing an agar to select for colistin-resistant non-fermenting Gram- negative rods (NF GNRS). In addition, McKay agar and anaerobic media were utilized to recover members of the Streptococcus anginosus group (SAG) and anaerobes in CF respiratory samples. The prevalences of SAG, anaerobes, and colistin-resistant NF GNRs recovered on study media from 75 adult and pediatric CF patients at VCUMC were 17.33%, 41.33%, and 4% respectively. Approximately 62% of patients culture-positive for SAG were also infected with P. aeruginosa and 53.8% of SAG recovered in culture were from CF patients experiencing PE. These findings further support the claim that interspecies interactions among emerging and classic CF pathogens may result in periods of clinical instability or PE. Twenty-eight of the 75 patients were culture-positive for Veillonella species, with the majority of samples collected during a period of surveillance. Four colistin-resistant NF GNRs were isolated on the study media alone. The selective nature of the study media prevented the mixed respiratory flora and classic CF pathogens from overgrowing and obscuring the growth of these colistin-resistant NF GNRs. The presence and role of emerging pathogens in the CF patient population at VCUMC warrants further investigation; therefore, the routine culture protocol needs to be revised to recover and select for those organisms thought to play a role in PE and lung function decline

Data-Driven Audiogram Classification for Mobile Audiometry

Recent mobile and automated audiometry technologies have allowed for the democratization of hearing healthcare and enables non-experts to deliver hearing tests. The problem remains that a large number of such users are not trained to interpret audiograms. In this work, we outline the development of a data-driven audiogram classification system designed specifically for the purpose of concisely describing audiograms. More specifically, we present how a training dataset was assembled and the development of the classification system leveraging supervised learning techniques. We show that three practicing audiologists had high intra- and inter-rater agreement over audiogram classification tasks pertaining to audiogram configuration, symmetry and severity. The system proposed here achieves a performance comparable to the state of the art, but is signific

Utilizing TIGER Competencies to Improve Informatics Practice

Nursing Informatics (NI) is quickly becoming an essential part of nursing. From the classroom, to the bedside, and to the boardroom, nurses across the nursing continuum are expected to use NI in their practice with the hopes of delivering better quality care to their patients. However, the training and education of NI provided to all levels of nurses is unable to keep up with the pace of technology. This project seeks to improve the NI competency of the nursing workforce at a pediatric hospital through an educational course using NI competencies identified by the Technology Informatics Guiding Educational Reform (TIGER) Initiative (2009). The value of this project is that it addresses the gap in NI education and competencies at a 265-bed pediatric hospital and creates a NI curriculum that is relevant, timely, and teaches nurses the essential skills to use NI to provide quality care and become a driver of patient quality outcomes

2017 Annual Research Symposium Abstract Book

2017 annual volume of abstracts for science research projects conducted by students at Trinity College

19th Annual Symposium of the School of Science, Engineering and Health

We in the School of Science, Engineering and Health welcome you to this 19th Annual Symposium, and we are pleased to invite you to join us physically on campus in the Frey, Kline, and Jordan buildings or to join sessions virtually. Each year our students, faculty and staff present the fruits of their basic and applied research in science and health fields. The outcomes of scientific research expand intellectual understanding and have tremendous impact on quality of life, environmental health, and human flourishing. We warmly welcome you as guests for the day. Angela Hare Dean School of Science, Engineering and Health, Messiah Universit

A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with Catheter Associated Urinary Tract Infection (CAUTI) Prevention Standards

Executive Summary A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with (CAUTI) Prevention Standards Problem Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infection (HAI) in the United States, representing about 40% of all HAIs (Palmer, Lee, Dutta-Linn, Wroe & Hartmann, 2013). Approximately 25% of indwelling urinary catheters are unnecessary and may potentially lead to CAUTIs if not maintained, cleaned, and cared for appropriately (Nazarko, 2012). Literature suggests that preventing CAUTIs is possible by implementing evidence based prevention standards. The PICO research question for CAUTI prevention and prevention standard data collection is: In a sampling of clinical auditors (P) does implementation of an electronic audit tool to collect data on compliance with CAUTI prevention care standards in addition to education on the electronic audit tool (I) differ from paper form auditing for CAUTI prevention care standards (C) and does it impact auditor satisfaction and/or data collected using the new tool (O). Goal The goal of this project was to assess if there were differences in paper versus electronic audit collection methods by evaluating pre- and post-implementation auditor satisfaction. In addition, an assessment of the two collection methods was completed to evaluate consistency related to number of audits collected and notable changes in compliance, thereby providing insight into if electronic data capture (EDC) is a reliable and efficient method. Objectives Project objectives included determining auditor satisfaction with paper versus electronic data collection methods and evaluation of implications of reliability with data collection methods by maintaining consistency with data. Plan Following Institutional Review Board approval from Regis University, the project was implemented and data were collected retro- and prospectively. There was an organizational transition to EDC, a questionnaire was distributed eliciting feedback from auditors on their satisfaction level, and compliance with the prevention standards was assessed for consistency pre- and post-implementation of the EDC tool. Questionnaire data were coded and entered into a spreadsheet and statistical software was used to determine if there were significant changes in auditor satisfaction. Finally, an assessment of differences in processes used to collect CAUTI prevention standard data was completed. Outcomes and Results Nine clinical auditors and one data analyst were exposed to both paper and EDC tools and completed the questionnaire. While there was not a statistically significant increase in satisfaction, there was a clinically significant increase in auditor satisfaction. There was a statistically significant difference noted between pre- and post- implementation compliance data, but this does not prove a causal relationship due to other confounding factors. There was also a statistically significant decrease in average time it took for auditors to collect audit data

Effects of age and stimulation strategies on cochlear implantation and a clinically feasible method for sound localization latency

Treating prelingual deafness with cochlear implants paves the way for spoken language development. Previous studies have shown that providing the intervention at six to 11 months is better than at 12-17 months. However, interventions at even earlier ages have not been researched to the same extent, for example by comparing five to eight months with nine to 11 months. That is why we retrospectively assessed the surgical risks, and analyzed the longitudinal spoken language tests, of 103 children who received their first cochlear implant between five and 30 months of age. This research particularly focused on surgery before 12 months of age (Paper I). Apart from language development, we expected that early implants would provide access to the interaural time differences that are crucial for localizing low frequency sounds. We were interested to examine this in combination with novel sound processing strategies with stimulation patterns that convey the fine structure of sounds. Therefore, in addition to the retrospective analysis, we studied the relationships between stimulation strategies, lateralization of interaural time differences and horizontal sound localization in 30 children (Paper II). Then we decided to develop a method to objectively assess sound localization latency to complement localization accuracy. A method that assesses latency needed to be validated in adults with normal hearing, and in hampered conditions, so that the relationship between accuracy and latency could be clarified. In our study, the gaze patterns from the localization recordings were modelled by optimizing a sigmoid function (Paper III). Furthermore, we addressed the lack of studies on the normal development of sound localization latency of gaze responses in infancy and early childhood (Paper IV). Our study of spoken language development showed the benefit of cochlear implantation before nine months of age, compared to nine to 11 months of age, without increased surgical risks. This finding was strongest when it came to the age at which the child’s language could be understood (Paper I). When our group of 30 subjects underwent tests for interaural time differences, 10 were able to discriminate within the range of naturally occurring differences. Interestingly, the choice of stimulation strategy was a prerequisite for lateralizing natural interaural time differences. However, no relationships between this ability to lateralize and the ability to localize low frequency sounds were found (Paper II). The localization setup meant that detailed investigations of gaze behavior could be carried out. Eight normal hearing adults demonstrated a mean sound localization latency of 280 ± 40 milliseconds (ms), with distinct prolongation with unilateral earplugging. It is interesting to observe the similarity in latency, dynamic behavior, and overlap of anatomical structures between the acoustic middle ear reflex and sound localization latency (Paper III). In addition, normal hearing infants showed diminished sound localization latency, from 1000 ms at six months of age down to 500 ms at three years of age (Paper IV). Latency in children with early cochlear implants still needs to be studied. The findings in this thesis have important clinical implications for counseling parents and they provide valuable data to guide clinical choices about the age when cochlear implants are provided and processor programming takes place. The fast, objective and non-invasive method of sound localization latency assessment may further enhance the clinical processes of diagnosing and monitoring interventions in children with hearing impairment