A5021076446- Emergency and Acute Care Studies
- Sepsis Diagnosis and Treatment
- Frailty in Older Adults
- Hemodynamic Monitoring and Therapy
- Clinical Reasoning and Diagnostic Skills
- Health disparities and outcomes
- Geriatric Care and Nursing Homes
- Delphi Technique in Research
- COVID-19 Clinical Research Studies
- Grief, Bereavement, and Mental Health
- Homelessness and Social Issues
- Food Security and Health in Diverse Populations
- Patient Satisfaction in Healthcare
- Healthcare Systems and Technology
- Family and Patient Care in Intensive Care Units
- Patient Dignity and Privacy
- Nutrition and Health in Aging
- Healthcare Decision-Making and Restraints
- Intensive Care Unit Cognitive Disorders
- Healthcare Policy and Management
- Heart Failure Treatment and Management
- Renal function and acid-base balance
- Long-Term Effects of COVID-19
- Palliative Care and End-of-Life Issues
- Health Systems, Economic Evaluations, Quality of Life
San Francisco General Hospital
2023-2024
University of California, San Francisco
2022-2024
While social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact factor, many studies exclude factors altogether. Our objective was develop validate a summary measure risk determine its ability risk-stratify beyond traditional models. We examined participants in Health Retirement Study, longitudinal, survey US older adults. developed...
Abstract Background Patients hospitalized with COVID-19 can clinically deteriorate after a period of initial stability, making optimal timing discharge clinical and operational challenge. Objective To determine risks for post-discharge readmission death among patients COVID-19. Design Multicenter retrospective observational cohort study, 2020–2021, 30-day follow-up. Participants Adults admitted care respiratory disease between March 2, 2020, February 11, 2021, to one 180 US hospitals...
OBJECTIVES: To evaluate the relationship between early IV fluid volume and hospital outcomes, including death in-hospital or discharge to hospice, in septic patients with without heart failure (HF). DESIGN: A retrospective cohort study using logistic regression restricted cubic splines assess for nonlinear relationships stratified by HF status adjusted propensity receive a given first 6 hours. An ICU subgroup analysis was performed. Secondary outcomes of vasopressor use, mechanical...
Abstract Objective Recent clinical guidelines for sepsis management emphasize immediate antibiotic initiation suspected septic shock. Though hypotension is a high‐risk marker of severity, prior studies have not considered the precise timing in relation to and how characteristics outcomes may differ. Our objective was evaluate characterize differences presentation patients with Methods Adults presenting emergency department (ED) June 2012–December 2018 diagnosed (Sepsis‐III electronic health...
Abstract Background Identifying COVID‐19 patients at the highest risk of poor outcomes is critical in emergency department (ED) presentation. Sepsis stratification scores can be calculated quickly for but have not been evaluated a large cohort. Objective To determine whether well‐known predict among hospitalized patients. Designs, Settings, and Participants A retrospective cohort study adults presenting with to 156 Hospital Corporation America (HCA) Healthcare EDs, March 2, 2020, February...
Abstract Background Racial and ethnic minority groups are less likely to have advance directives living wills, despite the importance of advanced care planning (ACP) in end‐of‐life care. We aimed understand impact an intervention improve ACP documentation across race, ethnicity, language on hospitalized patients at our institution. Methods launched rates for aged >75 or with illness defined by International Classification Diseases 10th Revision codes. analyzed completion rates,...
ABSTRACT Objective To develop and validate the Social Frailty Index, a summary measure of social risk in older adults, determine its ability to stratify beyond traditional medical models Design Prognostic model development validation using demographics comprehensive inventory characteristics Setting The Health Retirement Study, longitudinal, nationally representative survey U.S. adults >50 years. We developed 2010 wave validated it 2012 wave; there was no overlap between respondents....
Abstract Background Closing the gap between evidence‐supported antibiotic use and real‐world prescribing among clinicians is vital for curbing excessive use, which fosters antimicrobial resistance exposes patients to side effects. Providing information via scorecard improves clinician adherence quality metrics. Objective We aimed delineate actionable, relevant metrics extractable from electronic health record in an automated way. Design used a modified Delphi consensus‐building approach....
We created a concise nurse-driven delirium reduction workflow with the aim of reducing rates and length stay for hospitalized adults. Our included five evidence-based daytime "sunrise" interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patient's reach patient awake) nighttime "turndown" off, down, television noise pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without interruption from outside...
Health systems have developed automated telephone call programs to screen and triage patients' post-hospital discharge issues concerns. The aims of our study were determine whether how older adults engage with describe the prevalence patient-reported post-discharge issues.We identified all calls made by an urban academic medical center as part a program between May 1, 2018 April 30, 2019. used outreach patients or their caregivers that included 11 distinct steps 3 days post-discharge. All...
Background: Patients experiencing homelessness have higher rates of substance use and related mortality, often driven by opioid overdose. Conversely, disorder (OUD) is a leading risk factor for homelessness. Our goal was to test the efficacy an electronic health record (EHR) screen in identifying this vulnerable population during hospitalization assess feasibility bundled intervention improving safety. Methods: We assessed patients’ housing status, use, previous MOUD treatment, barriers...
Academic medical centers (AMCs) often operate at or near full capacity, which leads to delays in care while smaller community hospitals may have excess capacity. To address this issue and match patient needs acuity, patients be transferred from an AMC emergency department for direct admission a hospital. We aimed explore the experiences perspectives of who were transferred. randomly selected between February 2019 2020. conducted structured thirty-minute interviews containing fixed response...