Sharp HealthCare

About: Sharp HealthCare is a based out in . It is known for research contribution in the topics: Health care & Population. The organization has 207 authors who have published 243 publications receiving 15480 citations.

Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST‐Elevation Myocardial Infarction

Abstract: Objectives Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). Methods A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Results Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups. Conclusions Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes.

Impact of Behavioral Health Screening on Proactive Identification of Patients at Risk for Hospital Readmission

Abstract: Improving the ability to predict which patients are at increased risk for readmission can lead to more effective interventions and greater compliance with CMS Hospital Readmissions Reducti...

The Impact of a Pharmacist Driven 48-hour Antibiotic Time Out during Multi-disciplinary Rounds on Antibiotic Utilization in a Community Non-teaching Hospital

Abstract: Abstract Background An antibiotic time out (ATO) at 48–72 hours is a critical component of antimicrobial stewardship programs to improve judicious antibiotic use. It is a strategy to prompt clinicians to re-evaluate antibiotic appropriateness including the need for de-escalation and discontinuation. Sharp Memorial Hospital is a tertiary community hospital with 437 beds and 48 Intensive Care Unit (ICU) beds. In May 2016, an ATO program was initiated in the ICU along with the implementation of multidisciplinary daily Medical ICU rounds 5 days a week led by an intensivist. Methods We conducted a pre- and post-intervention study to assess the impact of an ATO on utilization of targeted antibiotics (see Table 1). Pharmacists received mandatory education on the components of an ATO, a reference guidebook, and completed a baseline competency prior to ATO implementation. An on demand report was used to identify patients on antibiotic day > 2. A form prompting review of indication, culture results, de-escalation, treatment duration and proton-pump inhibitor appropriateness was completed as part of the daily workflow. Interventions were discussed during rounds or by contacting the physician. Metrics included days of therapy (DOT) per 1,000 patient days, and intervention numbers, types, and acceptance rates (AR) during two 9-month periods: pre- and post-implementation. Results There were 829 interventions during the post-implementation period with a 96% AR compared with 83 during the pre-intervention period with a 94% AR. Antibiotic discontinuations and de-escalations comprised 52% of accepted interventions. There was a significant reduction in the use of vancomycin and quinolones with no change in anti-pseudomonal β-lactam use (see Table 1). Table 1. DOT per 1,000 patient days July 2015– March 2016 July 2016– March 2017 P-value Vancomycin IV 122.29 103.05 0.0001 Levofloxacin, ciprofloxacin 70.07 41.50 0 Cefepime, piperacillin-tazobactam aztreonam, meropenem 257.13 249.83 0.3626 Conclusion A pharmacist driven ATO with physician support during multidisciplinary daily rounds reduced antibiotic use and could be expanded house-wide. This strategy could serve as a model to improve antimicrobial stewardship in community, non-teaching hospitals. Disclosures All authors: No reported disclosures.