This study describes a novel transfer model implemented between an academic, level 1 trauma center (Hospital A) and a nearby affiliate community hospital (Hospital B). Primary outcome is change in ...boarding hours and percentage of boarders in the Hospital A emergency department. Secondary objectives of this study include how improved flow in the emergency department to reduce boarding improves length of stay, prevents patients from escalating to more acute acuity levels of care, reduces patient morbidity and mortality and therefore improves health care costs as well.
A retrospective chart review was conducted over a consecutive 14-months period of all patients that presented to main hospital emergency department who were transferred to the Hospital B for inpatient admission. This included analysis of patient cohort characteristics, hospital LOS, return rate to the Hospital A (boomerang), rates of against medical advice (AMA) dispositions, post-discharge recidivism, in addition to enterprise data on total number of boarders, percent of boarders, and total boarding hours.
There was a total of 718 transfer encounters during the study period. Percent boarding decreased from 70.6% in the pre-period to 63.8% in the post-period (p < 0.001). Total boarding hours decreased at both the main hospital and the sister hospital with this transfer process. The median length of stay at the sister hospital was 74 h, with 9 upgrades to ICU admissions. Five patients were dispositioned back to the hospital A after admission to hospital B.
A distributive model was useful in transferring admissions within a healthcare system, reducing number of boarders, percent of boarders, and boarding hours in Hospital A emergency department. Furthermore, the Hospital B was an appropriate location for transfers, based on the low number of ICU transfers and dispositions back to the main hospital.
In this issue, we are honored to have a rare interview with Judy Faulkner, the founder of Epic, the nation's leading (and dominant) provider of electronic health records (EHRs). There will be a robot ...who can remember all signs of an illness, and correlate those signs with personalized genetic markers, with risk profiles, and with evidence-based protocols for treating that patient.
Today, she is unique as a woman pioneer of one of America's most successful information technology companies, and unique among major electronic medical record (EMR) company CEOs in having built the ...company from code--herself. Epic is the nation's dominant provider of electronic medical records. ...I think I am surprised that there are not more major vendors that are like us in that the system is built from the start with the patient at the center.
Because that's where they had spent their money. Dr. Klasko: Well, we're talking in a city where scrapple is considered a vegetable. ...this year I've been proud to be the president of a university ...that is the namesake of Thomas Jefferson, but recently some suggest we shouldn't be so proud of Thomas Jefferson based on the lens of certain things Jefferson did. Would you repeat what you said? Because in private, he Dr. King was a clown.
The Drive for Disruption Klasko, Stephen K.
Healthcare transformation,
09/2016, Letnik:
1, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The problem is we have to warn parents not to let their kids read it, so I'm not sure it would become another Goodnight Moon. Here, a medical student describes how virtual rounds lead her to ...appreciate the nuances and sometimes difficulties of hospitalization.
We CAN Fix Healthcare Klasko, Stephen K.
Healthcare transformation,
06/2016, Letnik:
1, Številka:
2
Journal Article
Recenzirano
Odprti dostop
...to produce something else, such as better outcomes and better care for less cost, for instance, requires stepping back and looking at the system as a whole. ...the authors seek to go back to what ...President Obama did not do in order to go forward. ...planners can use a disciplined step-by-step backward walk from the future to the present.
: Human umbilical cord blood (HUCB) is now considered a valuable source for stem cell‐based therapies. HUCB cells are enriched for stem cells that have the potential to initiate and maintain tissue ...repair. This potential is especially attractive in neural diseases for which no current cure is available. Furthermore, HUCB cells are easily available and less immunogenic compared to other sources for stem cell therapy such as bone marrow. Accordingly, the number of cord blood transplants has doubled in the last year alone, especially in the pediatric population. The therapeutic potential of HUCB cells may be attributed to inherent ability of stem cell populations to replace damaged tissues. Alternatively, various cell types within the graft may promote neural repair by delivering neural protection and secretion of neurotrophic factors. In this review, we evaluate the preclinical studies in which HUCB was applied for treatment of neurodegenerative diseases and for traumatic and ischemic brain damage. We discuss how transplantation of HUCB cells affects these disorders and we present recent clinical studies with promising outcome.
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