6 research outputs found
Analysis of Patient Handoff between Providers at a Tertiary Urban Medical Center
Introduction. Few studies have quantified the total number of attending and consulting physicians involved in inpatients’ care, and no other research quantifies the total number of all providers participating in inpatients’ care. The purpose of this study was to calculate the number of attending hand-offs, the attending encounter time, and the total number of providers participating in inpatients’ care for all admitted patients at a tertiary urban medical center.
Methods. The study design was an observational retrospective cohort. Subjects included pediatric and adult patients who were admitted to and discharged from Ascension Via Christi St. Francis (AVCSF) in Wichita, Kansas between November 01, 2019 and January 31, 2020. Data were abstracted from the Cerner Electronic Medical Record. Variables included: patient demographics, admitting diagnosis, diagnosis related group (DRG), admission service, and duration of inpatient stay. Provider variables abstracted included provider type and provider specialty. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means ± standard deviation.
Results. The sample included information from 200 patient charts. Patients’ ages ranged from 5 to 94 years, with a mean of 61 years. Approximately 52% were female and 74.9% were admitted to a surgical service. The length of all inpatients’ stays ranged from less than 1 day to 31 days, with a mean of 4 days. Seventy-six different DRGs were recorded. The most frequent attending specialties for medical patients were hospital medicine, internal medicine, general surgery, and interventional cardiology. Consulting physicians had more patient encounters than any other healthcare provider. For all inpatients, an average of two attending physicians participated in care over the duration of their stay with a range of one to six attending physicians. There was an average of one hand-off between attending physicians. Patients had an average of five consulting physicians, two resident physicians, two physician assistants, and two nurse practitioners during a stay. There was an average of 10 total providers, with a range of one to 46 total providers participating in care.
Conclusions. Understanding the provider data surrounding an inpatient stay is a foundational step in assessing the quality of the provider-inpatient encounter and potential areas for improvement. In this study, the average number of attending physicians and handoffs was reasonable; however, the total number of providers involved in care was relatively high. Assessment of staffing and scheduling requirements by hospital administration could identify areas of improvement to reduce the potential for medical error caused by multiple providers being involved in patient care.  
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The Flesh-Eating Bacteria: Necrotizing Fasciitis
https://digitalcommons.wpi.edu/gps-posters/1179/thumbnail.jp
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Hydrology shapes microbial communities and microbiome-mediated growth of an Everglades tree island species
Plant-associated microbiomes can improve plant fitness by ameliorating environmental stress, providing a promising avenue for improving outplantings during restoration. However, the effects of water management on these microbial communities and their cascading effects on primary producers are unresolved for many imperiled ecosystems. One such habitat, Everglades tree islands, has declined by 54% in some areas, releasing excess nutrients into surrounding wetlands and exacerbating nutrient pollution. We conducted a factorial experiment, manipulating the soil microbiome and hydrological regime experienced by a tree island native, Ficus aurea, to determine how microbiomes impact growth under two hydrological management plans. All plants were watered to simulate natural precipitation, but plants in the "unconstrained" management treatment were allowed to accumulate water above the soil surface, while the "constrained" treatment had a reduced stage to avoid soil submersion. We found significant effects of the microbiomes on overall plant performance and aboveground versus belowground investment; however, these effects depended on hydrological treatment. For instance, microbiomes increased investment in roots relative to aboveground tissues, but these effects were 142% stronger in the constrained compared to unconstrained water regime. Changes in hydrology also resulted in changes in the prokaryotic community composition, including a >20 log(2)fold increase in the relative abundance of Rhizobiaceae, and hydrology-shifted microbial composition was linked to changes in plant performance. Our results suggest that differences in hydrological management can have important effects on microbial communities, including taxa often involved in nitrogen cycling, which can in turn impact plant performance
Diversity and Structure of Soil Fungal Communities across Experimental Everglades Tree Islands
Fungi play prominent roles in ecosystem services (e.g., nutrient cycling, decomposition) and thus have increasingly garnered attention in restoration ecology. However, it is unclear how most management decisions impact fungal communities, making it difficult to protect fungal diversity and utilize fungi to improve restoration success. To understand the effects of restoration decisions and environmental variation on fungal communities, we sequenced soil fungal microbiomes from 96 sites across eight experimental Everglades tree islands approximately 15 years after restoration occurred. We found that early restoration decisions can have enduring consequences for fungal communities. Factors experimentally manipulated in 2003–2007 (e.g., type of island core) had significant legacy effects on fungal community composition. Our results also emphasized the role of water regime in fungal diversity, composition, and function. As the relative water level decreased, so did fungal diversity, with an approximately 25% decline in the driest sites. Further, as the water level decreased, the abundance of the plant pathogen–saprotroph guild increased, suggesting that low water may increase plant-pathogen interactions. Our results indicate that early restoration decisions can have long-term consequences for fungal community composition and function and suggest that a drier future in the Everglades could reduce fungal diversity on imperiled tree islands
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Diversity and Structure of Soil Fungal Communities across Experimental Everglades Tree Islands
Fungi play prominent roles in ecosystem services (e.g., nutrient cycling, decomposition) and thus have increasingly garnered attention in restoration ecology. However, it is unclear how most management decisions impact fungal communities, making it difficult to protect fungal diversity and utilize fungi to improve restoration success. To understand the effects of restoration decisions and environmental variation on fungal communities, we sequenced soil fungal microbiomes from 96 sites across eight experimental Everglades tree islands approximately 15 years after restoration occurred. We found that early restoration decisions can have enduring consequences for fungal communities. Factors experimentally manipulated in 2003–2007 (e.g., type of island core) had significant legacy effects on fungal community composition. Our results also emphasized the role of water regime in fungal diversity, composition, and function. As the relative water level decreased, so did fungal diversity, with an approximately 25% decline in the driest sites. Further, as the water level decreased, the abundance of the plant pathogen–saprotroph guild increased, suggesting that low water may increase plant-pathogen interactions. Our results indicate that early restoration decisions can have long-term consequences for fungal community composition and function and suggest that a drier future in the Everglades could reduce fungal diversity on imperiled tree islands