AUTOMATED, eLECTRONIC ALERTS FOR ACUTE KIDNEY injury
Automated electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial
In the article, published February 25, 2015 authors, F Perry Wilson, Michael Shashaty, Jeffrey Testani, Iram Aqueel, Yuliya Borovskiy, Susan S Ellenbery, Harold I Feldman, Hilda Fernandez, Yevgeniy Gitelman, Jennie Lin, Dan Negoianu, Chirag R Parikh, Peter P Reese, Richard Urbani, and Barry Fuchs found that alerts for acute kidney injury did not improve clinical outcomes. Click here > To read full article
The Patient Centered Transition (PaCT) Project
Improving the Transition from Hospital to Primary Care for Socioeconomically Vulnerable Patients
Investigators: Shreya Kangovi, M.D.; Daniel Ryan, B.S.; Sharon McCollum; Mary White; Marisa Rogers, M.D.; David Grande, M.D., MPA; Richard Shannon, M.D.; Judith A. Long, M.D.
Following hospital discharge, up to 23% of patients will have an adverse medical event. The socioeconomically vulnerable are at even higher risk for poor outcomes after hospitalization. Uninsured and Medicaid patients are less likely than the privately-insured to be able to adhere to discharge medications or complete timely follow up with a primary care provider (PCP) and are 3 times more likely to return to the emergency department or be readmitted to the hospital.
Penn Medicine has partnered with Spectrum Health Services, a West Philadelphia community health center, to develop the Patient-Centered Transition (PaCT) Project. PaCT utilizes trained community health workers who provide social support, navigation and advocacy to uninsured or Medicaid patients as they transition from hospital to primary care.
PaCT, a single-blinded randomized-controlled trial, will enroll 513 patients between May 15, 2011 and May 15, 2012. Participants are uninsured or insured by Medicaid, discharged from the General Medicine services of Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC), and residents of five local ZIP codes characterized by extreme poverty where 85% of all HUP and PPMC readmitted patients reside.
The primary outcome measure of The PaCT Study is the proportion of patients who complete primary care follow-up within two weeks of hospital discharge. We will also examine the effect of PaCT on secondary outcome variables including patients’ satisfaction with the experience of transition, medication adherence, self-rated health, and ED revisit or inpatient readmission within 30 days after discharge.
TRansitions of Care
Local Site Investigator: Joshua P. Metlay, MD, PhD
Despite intense scrutiny on the need to reduce readmissions, and a proliferation of models intended to improve care transitions, surprisingly little is known about the factors which lead to readmissions, how to target interventions appropriately, or the degree to which variations in care practices (within or across sites) contribute to the likelihood of readmission. The goals of this project are 1) To collect and compare chart based measures of the adequacy of discharge coordination at The Hospital of the University of Pennsylvania and compare performance locally to that in a national network of academic medical centers, 2) To collect and compare information collected from physicians and patients about the causes of readmissions. The proposed work will be carried out at The Hospital of the University of Pennsylvania, a key member of the Hospital Medicine Reengineering Network (HOMERUN), a 15 hospital collaborative focusing on improving care of general medical patients.
Improving CPR Quality and Resusitation Training by Combining Audiovisual Feedback and Debriefing
Investigator: Benjamin Abella, MD, MPhil
In-hospital cardiac arrest (IHCA) is a widespread problem for hospital healthcare providers and carries a high mortality rate. IHCA events often occur with little warning and require a time-sensitive coordinated team approach to care. While most providers are trained in the basic skills of resuscitation, such as CPR and Advanced Cardiac Life Support (ACLS), very little effort across the hospital environment is placed on team training or improving the quality of care during IHCA events. A growing body of evidence suggests that IHCA outcomes are highly dependant on resuscitation performance variables such as CPR quality, pauses in CPR delivery, and time to defibrillation. Our preliminary work has suggested that periodic resuscitation team debriefing may serve as a useful method to improve subsequent care quality and initial patient survival outcomes.
To extend this work, we will prospectively study the use of immediate team debriefing on subsequent care quality during cardiac arrest events in the critical care setting. Defibrillators in the medical intensive care unit and cardiac care unit have been outfitted with sensors to detect and record chest compression rate and depth, CPR pause times, and other objective metrics of resuscitation performance. These data will be the core material for focused debriefings immediately following IHCA events, and longitudinal data on CPR quality and outcomes will be collected as well.