Parkview Health Research Repository
Not a member yet
774 research outputs found
Sort by
Bair Gown Evaluation of Implementation: Patient comfort, Surgical Site Infection, and Cost Analysis
Get PDFPoster presented at the Parkview Nursing Research Symposium, 2023.
It is a Perioperative (Periop) Standard of Care to maintain normothermia or a temperature above 36.0°C (96.9°F) for all patients receiving general anesthesia. The Parkview Randallia periop area has implemented a Bair Gown Active Warming System; this paper evaluates patient comfort, staff perception, surgical site infection (SSI) rate, and cost of said system. Previously, all patients would receive passive warming via warm blankets in preop and postop and active warming in the Operating Room (OR) via a Bair Hugger Blanket. The average preop temperatures were the same before and after implementation at 97.9°. The average intraop temperatures showed the most improvement: 96.8° pre-implementation to 97.2° post implementation. Post Anesthesia Care Unit (PACU) average temperatures were lower post-implementation: 97.7° pre-implementation and 97.4° post implementation. We had three reportable SSIs in 2022 year to date (YTD) before implementing the Bair System. After the implementation YTD, there is only one reportable SSI for the unit. Staff did perceive that patients had less postop shivering and overall felt warmer while utilizing the Bair System. Staff also perceived that the patients enjoyed the warming and cooling features of the gowns. The Bair System has saved an average of $2,456 monthly in linen costs at Randallia. The temperature data was pulled from seventy-six charts. The pre-implementation collection period was from July 2022 and post implementation data from July 2023. YTD following implementation, Randallia has lowered reportable infection rates compared to pre-implementation: thereby improving our reputation in the eyes of our community. We significantly decreased unit linen costs. We have higher intraoperative temperatures with less variance throughout all phases of care. The staff have an increased perception of patient warmth and noticed less postop shiverin
A Delphi Process to Identify Relevant Outcomes That May Be Associated With a Predictive Analytic Tool to Detect Hemodynamic Deterioration in the Intensive Care Unit.
No full textBackground The critical care literature has seen an increase in the development and validation of tools using artificial intelligence for early detection of patient events or disease onset in the intensive care unit (ICU). The hemodynamic stability index (HSI) was found to have an AUC of 0.82 in predicting the need for hemodynamic intervention in the ICU. Future studies using this tool may benefit from targeting those outcomes that are more relevant to clinicians and most achievable.
Methods A three-round Delphi study was conducted with a panel of 10 critical care physicians and three nurses in the United States to identify outcomes that may be most relevant and achievable with the HSI when evaluated for use in the ICU. To achieve criteria for relevance, at least 65% of panelists had to rate an outcome as a 4 or 5 on a 5-point scale.
Results Nineteen of 24 outcomes that may be associated with the HSI achieved consensus for relevance. The Kemeny-Young approach was used to develop a matrix depicting the distribution of outcomes considering both relevance and achievability. Reduces time spent in hemodynamic instability and reduces times to recognition of hemodynamic instability were the highest-ranking outcomes considering both relevance and achievability.
Conclusion This Delphi study was a feasible method to identify relevant outcomes that may be associated with an appropriate predictive analytic tool in the ICU. These findings can provide insight to researchers looking to study such tools to impact outcomes relevant to critical care practitioners. Future studies should test these tools in the ICU that target the most clinically relevant and achievable outcomes, such as time spent hemodynamically unstable or time until actionable nursing assessment or treatment
Online Risks for Youth and Families
Get PDFParkview Mirro Center for Research and Innovation
Executive Statement
Recent congressional attention has focused on the online risks of youth [1]. Parents, caregivers, and families are often unprepared to handle many of these risks, and parents/caregivers also experience some of these risks themselves. Although not an exhaustive list, risks can include cyberbullying, social comparisons, exposure to sexualized content, gambling addiction, Internet addiction, self-harm, and negative impacts on family and personal relationships [1]. Internal platform policies and design features are not enough to fully address key aspects of risky online behavior and potentially harmful digital habits. Additionally, current public policies and regulations have also proven to be insufficient in alleviating these risks. In this brief, we review our prior research that has focused on understanding potential harms associated with online activities, both for children themselves as well as their families. Our primary concerns are (1) key data are not accessible by the public and thus not enough is known about digital use and the varying adverse impacts on individuals due to their unique contexts, lived experiences, and mental health, and (2) policies that address risky online behavior among children that do not consider the home environment, including the struggles parents experience managing their own online and digital behavior, are not sufficient
Pulmonary & Critical Care Insider: Issue 4
Get PDFPulmonary & Critical Care Insider Issue 4
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.
Summaries/Topics in this issue:
Inside Medicine- Ozempic
Inhaled Amikacin for VAP (AMIKINHAL Trial)
2023 GOLD Guidelines for COPD
SAGA of Antibiotics in the ICU
The MANDALA trial
The DENALI trial
RESCUE IHCA – Not perfect but maybe the best we hav
Tertiary drug information sources for treatment and prevention of COVID-19.
Get PDFOBJECTIVE: To evaluate tertiary drug information databases in terms of scope, consistency of content, and completeness of COVID-19 drug information.
METHODS: Five electronic drug information databases: Clinical Pharmacology, Lexi-Drugs, AHFS DI (American Hospital Formulary Service Drug Information), eFacts and Comparisons, and Micromedex In-Depth Answers, were evaluated in this cross-sectional evaluation study, with data gathered from October 2021 through February 2022. Two study investigators independently extracted data (parallel extraction) from each resource. Descriptive statistics were primarily used to evaluate scope (i.e., whether the resource addresses use of the medication for treatment or prevention of COVID-19) and completeness of content (i.e., whether full information is provided related to the use of the medication for treatment or prevention of COVID-19) based on a 10-point scale. To analyze consistency among resources for scope, the Fleiss multi-rater kappa was used. To analyze consistency among resources for type of recommendation (i.e., in favor, insufficient evidence, against), a two-way mixed effects intraclass coefficient was calculated.
RESULTS: A total of 46 drug monographs, including 3 vaccination monographs, were evaluated. Use of the agents for treatment of COVID-19 was most frequently addressed in Lexi-Drugs (73.9%), followed by eFacts and Comparisons (71.7%), and Micromedex (54.3%). The highest overall median completeness score was held by AHFS DI followed by Micromedex, and Clinical Pharmacology. There was moderate consistency in terms of scope (kappa 0.490, 95% CI 0.399-0.581, p
CONCLUSION: Scope and completeness results varied by resource, with moderate consistency of content among resources
A seven-year review of hospital- onset Clostridioides difficile infection reduction and the case for a multidisciplinary taskforce approach
Get PDFPresented at the 2023 APIC Annual Conference
Background: Hospital-onset Clostridioides difficile infection is a life-threatening disease that can prolong and complicate a patient\u27s hospitalization. To reduce HO-CDIs and ensure positive health outcomes with reduced cost, utilization of a multi-disciplinary taskforce (MDT) is key to identify gaps, develop action plans, and implement and review interventions in the most efficient and effective manner.
Methods: Over the course of seven years, two rounds of interventions were executed consecutively across a nine-hospital healthcare system to reduce HO-CDI events. The first round (Round 1) driven solely by the Infection Prevention (IP) department spanned four years and consisted of three phases of interventions. The second round (Round 2) led by an MDT was comprised of ten disciplines and likewise had three phases of interventions. Timespan and interventions varied between all phases. Data reported to National Healthcare Safety Network (NHSN) was used for statistical analysis. Intervention effectiveness of each phase was measured using a 2x3 Chi-square test, and a 2x2 Chi-square test was used to compare the IP-only versus the MDT approach styles.
Results: Throughout the seven-year process improvement endeavor, the MDT approach style demonstrated by Round 2 revealed higher efficiency and effectiveness with HO-CDI reduction accounting for 33.7% (268/795, p=\u3c.001) total events reported to NHSN compared to events from Round 1. Furthermore, Phase 3 of Round 2 showed most successful, accounting for only 6.3% (11/175, p=\u3c.02) of all interventions from both rounds.
Conclusion: From the start of the MDT to its end, the healthcare system observed an overall HO-CDI reduction of 81.6%. The review of this healthcare system\u27s process improvement course to reduce HO-CDIs reveals utilization of a MDT approach allows for key stakeholders to participate in decision-making, consequently reinforcing ownership of interventions at each phase across the board for a more efficient and effective implementation to sustainable positive result
Pulmonary & Critical Care Insider: Issue 3
Get PDFPulmonary & Critical Care Insider Issue 3
Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.
The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.
Summaries/Topics in this issue:
Lactated Ringer\u27s or Normal Saline in Acute Pancreatitis?
Don’t complain about too many CT scans being ordered by your ED doctor!
Stroke care for intensivists – Not as complicated after all! Blood pressure targets in acute ischemic stroke after thrombectomy
The FRAIL-AF study
“slow correction” vs. “rapid correction”
Balloon pulmonary angioplasty or riociguat in patients with inoperable CTEPH?
Cannot go wrong with a Mediterranean diet even in IPF!
Prognostication for out of hospital cardiac arrest could be useful when talking to family
Evaluation of Ambulatory Care Proton Pump Inhibitor Use
Get PDFPresented at the ASHP Midyear Clinical Meeting. December 2023.
The objectives of this project were to assess appropriateness of PPI utilization and identify possible opportunities for alternative PPI or step-down therapy
Evaluation of Intravenous Iron in the Inpatient Setting at a Large Health System.
Get PDFPresented at the ASHP Midyear Clinical Meeting. December 2023.
This project evaluated the appropriateness of interleukin (IL)-17 and IL-23 inhibitor usage within Parkview Health, in both inpatient and outpatient settings. This project set out to determine whether the inpatient use of intravenous (IV) iron replacement was justified and followed evidence-based guidelines
Conceptualizing care partners\u27 burden, stress, and support for reintegrating Veterans: a mixed methods study.
Get PDFBACKGROUND: People who support Veterans as they transition from their military service into civilian life may be at an increased risk of psychological distress. Existing studies focus primarily on paid family caregivers, but few studies include spouses and informal non-family care partners. We sought to identify key challenges faced by care partners of Veterans with invisible injuries.
METHODS: Semi-structured interviews were conducted with 36 individuals involved in supporting a recently separated US military Veteran enrolled in a 2-year longitudinal study. CPs completed validated measures on perceived stress, caregiving burden, quality of their relationship, life satisfaction, and flourishing. Independent
RESULTS: Care partners reported shifts in self-perception that occurred from supporting a Veteran, emphasizing how they helped Veterans navigate health systems and the processes of disclosing health and personal information in civilian contexts. Exemplar cases with high and low burdens demonstrated divergent experiences in self-perception, managing multi-faceted strain, and coping with stress over time. Case studies of specific care partners illustrate how multi-faceted strain shifted over time and is affected by additional burdens from childcare, financial responsibilities, or lack of education on mental health issues.
CONCLUSIONS: Findings suggest the unique needs of individuals who support military Veterans with invisible injuries, highlighting variations and diachronic elements of caregiving. This sample is younger than the typical caregiver sample with implications for how best to support unpaid care partners caring for Veterans in the early to mid-period of their use of VA and civilian health services