A5065478070- Central Venous Catheters and Hemodialysis
- Patient Satisfaction in Healthcare
- Antibiotic Use and Resistance
- Emergency and Acute Care Studies
- Sepsis Diagnosis and Treatment
- Pneumonia and Respiratory Infections
- Patient Safety and Medication Errors
- Urinary Tract Infections Management
- Hemodynamic Monitoring and Therapy
- Electronic Health Records Systems
- Pediatric Urology and Nephrology Studies
- Acute Kidney Injury Research
- Disaster Response and Management
- Dialysis and Renal Disease Management
- Pharmaceutical Practices and Patient Outcomes
- Pneumocystis jirovecii pneumonia detection and treatment
- Bacterial Identification and Susceptibility Testing
- Nursing Diagnosis and Documentation
- Venous Thromboembolism Diagnosis and Management
- Primary Care and Health Outcomes
- Healthcare Policy and Management
- Tuberculosis Research and Epidemiology
- Innovations in Medical Education
- Healthcare Systems and Technology
- COVID-19 and Mental Health
Michigan Medicine
2020-2025
Michigan United
2022-2025
University of Michigan
2019-2024
National Patient Safety Foundation
2020-2021
VA Center for Clinical Management Research
2021
VA Ann Arbor Healthcare System
2019
American Nurses Association
2004
Immersion (United States)
2004
Kettering Medical Center
2004
Omnicell (United States)
2004
Importance Little is known about incidence of, risk factors for, and harms associated with inappropriate diagnosis of community-acquired pneumonia (CAP). Objective To characterize CAP in hospitalized patients. Design, Setting, Participants This prospective cohort study, including medical record review patient telephone calls, took place across 48 Michigan hospitals. Trained abstractors retrospectively assessed patients treated for between July 1, 2017, March 31, 2020. Patients were eligible...
Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases resistance and adverse events.To determine whether diagnostic stewardship (avoiding urine cultures) or (reducing treatment after an culture) is associated better outcomes in reducing use for ASB.This 3-year, prospective quality improvement study included hospitalized general care medicine a positive culture among 46 hospitals participating collaborative initiative, the...
Abstract Background Inappropriate diagnosis of infections results in antibiotic overuse and may delay underlying conditions. Here we describe the development characteristics 2 safety measures inappropriate urinary tract infection (UTI) community-acquired pneumonia (CAP), most common inpatient on general medicine services. Methods Measures were developed from guidelines literature adapted based data patients hospitalized with UTI CAP 49 Michigan hospitals feedback end-users, a technical...
Importance Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. Objectives To determine prevalence factors associated bacteremia from a presumed urinary source inpatients or without AMS estimate avoided if 2% risk were used as threshold to prompt empiric antibiotic ASB. Design, Setting, Participants This cohort study assessed...
Abstract Background Inappropriate treatment of asymptomatic bacteriuria (ASB) among hospitalized patients leads to longer length stay (LOS) without improving outcomes. ASB is common in individuals with neurogenic bladder (NB); however, little known about the epidemiology, treatment, and outcomes inpatients NB ASB. Methods Between 1/1/2017-12/31/2023, abstractors collected deidentified data—including signs/symptoms urinary tract infections (UTI) 30-day outcomes—from a positive urine culture...
Abstract Background Patients with structural lung disease (SLD) are more susceptible to community-acquired pneumonia (CAP) and at higher risk for resistant organisms. CAP studies often exclude patients SLD making it difficult determine when treat empirically broad-spectrum antibiotics (BSA). Here, we describe the epidemiology of in inpatients moderate severe SLD. Methods Between 1/2017 12/2023, analyzed data from 68 Michigan hospitals. was defined as documented or chronic obstructive...
Sepsis is a common cause of hospital mortality, as well new morbidity among survivors. Clinical practice guidelines recommend assessing goals care (GoC) during sepsis hospitalization to ensure goal-concordant provided. To determine how often GoC are assessed in routine practice. Cohort study adult patients hospitalized with community-onset at 66 hospitals (2020-2023) participating the Michigan Hospital Medicine Safety Consortium's initiative (HMS-sepsis). The primary outcomes were discussion...
Background The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown. Methods A quasiexperimental study design to implement in 52 hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three measured: short-term use (≤5 days), of multilumen PICCs...
Rationale: Little is known about the safety of infusing vasopressors through a midline catheter. Objectives: To evaluate outcomes after vasopressor administration midline. Methods: We conducted cohort study adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received while either or peripherally inserted central catheter (PICC) was place. Patients receiving were compared with those PICC and, separately, midlines place but different used descriptive statistics...
Little is known about the safety of midline catheters vs peripherally inserted central (PICCs) for outpatient parenteral antimicrobial therapy (OPAT).
Background The risk of peripherally inserted central catheter (PICC)‐related complications in patients hospitalized with solid tumors remains unclear. Existing studies are limited by single‐center, outpatient designs and include heterogenous patients. Methods A retrospective cohort study was designed included adult organ cancers who were admitted to a general medicine ward or intensive care unit received PICC. Data collected from November 2013 December 2019 at 50 Michigan hospitals. Major...
Sepsis, life-threatening organ dysfunction secondary to infection, contributes at least 1.7 million adult hospitalizations and 350,000 deaths annually in the United States. Sepsis care is complex, requiring coordination of multiple hospital departments disciplines. programs can coordinate these efforts optimize patient outcomes. The 2022 National Healthcare Safety Network (NHSN) annual survey evaluated prevalence characteristics sepsis acute hospitals. Among 5,221 hospitals, 3,787 (73%)...
To examine the effectiveness of antimicrobial and antithrombogenic materials incorporated into peripherally inserted central catheters (PICCs) to prevent bloodstream infection, thrombosis, catheter occlusion.Prospective cohort study involving 52 hospitals participating in Michigan Hospital Medicine Safety Consortium. Sample included adult hospitalized medical patients who received a PICC between January 2013 October 2019. Coated impregnated were identified by name, brand, device marketing or...
Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI CAP also commonly overdiagnosed, resulting unnecessary antibiotic use diagnostic delays. While much is known individually about overdiagnosis of CAP, it not whether hospitals with higher one have other. Correlation these two conditions may indicate underlying hospital-level contributors, which turn represent targets for intervention. To evaluate association we first...
Abstract Background Peripherally inserted central catheters (PICCs) and midline are often placed by nurse‐led vascular access teams (VATs). While some data regarding the effectiveness of these exists, less is known about their structure function. Objectives To examine roles, functions, composition VATs related to use management PICC catheters. Methods A descriptive, multi‐method study that included an online survey 62 hospitals participating in a quality improvement consortium qualitative...
Abstract Background Community-acquired pneumonia (CAP) is a common cause for hospitalization and antibiotic overuse. We aimed to improve duration CAP across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). Methods This prospective collaborative quality initiative included patients hospitalized with uncomplicated who qualified 5-day duration. Between 23 February 2017 5 2020, HMS targeted appropriate treatment through benchmarking, sharing best practices,...
Abstract Objective: To assess association of pharmacist gender with acceptance antibiotic stewardship recommendations. Design: A retrospective evaluation the Reducing Overuse Antibiotics at Discharge (ROAD) Home intervention. Setting: The study was conducted from May to October 2019 in a single academic medical center. Participants: included patients receiving antibiotics on hospitalist service who were nearing discharge. Methods: During intervention, clinical pharmacists (none had...