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HJ Aboumatar D Thompson A Wu P Dawson J Colbert J Marsteller P Kent LH Lubomski L Paine P Pronovost 《Postgraduate medical journal》2012,88(1043):545-551
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Christopher J. Graber Makoto M. Jones Peter A. Glassman Charlene Weir Jorie Butler Kevin Nechodom Chad L. Kay Amy E. Furman Thuong T. Tran Christopher Foltz Lori A. Pollack Matthew H. Samore Matthew Bidwell Goetz 《Hospital pharmacy》2015,50(11):1011-1024
Background:
Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation.Objective:
We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval.Methods:
The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign.Results:
In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior (P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior (P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior (P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior (P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates.Conclusions:
By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward. 相似文献45.
Timothy W. Farrell MD AGSF Tiffany A. Volden MD Jorie M. Butler PhD G. Paul Eleazer MD Randall W. Rupper MD MPH Katharina V. Echt PhD Marianne Shaughnessy PhD AGPCNP-BC GS-C Mark A. Supiano MD AGSF 《Journal of the American Geriatrics Society》2023,71(1):18-25
The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure. These innovative care models also contributed to the evidence base supporting the present-day Age-Friendly Health Systems movement, with which VHA is inherently aligned. As both a provider of and payor for care, VHA is strongly incentivized to promote coordination across the continuum of care, with resultant cost savings. VHA is also a major contributor to developing the workforce that is essential for the provision of age-friendly care. As VHA continues to develop and refine innovative geriatric models of care, policymakers and non-VHA health care systems should look to VHA programs as exemplars for the development and implementation of age-friendly care. 相似文献