The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand include hip and knee surgery-related readmissions in the future. To ensure quality of care avoid penalties, related fractures require further investigation. goal this study was evaluate factors associated with hospital after fracture at a level I trauma center. This retrospective cohort included 1486 patients who were 65...

The department of trauma at a Level 1 center sought to improve outcomes by enhancing the continuity care for patients admitted services. Departmental leadership explored opportunities this aspect patient through expansion existing nurse practitioner (NP) restructured NP service model was implemented in September 2013. A retrospective study conducted with who presented between 2012 and August 2015. Patients least 24-hr hospital length stay (LOS) were separated into 3 comparator groups...

Enoxaparin regimens commonly used for prophylaxis fail to achieve optimal anti-factor Xa levels in up 70 per cent of trauma patients. Accordingly, services at the study institution endeavored develop a standardized approach optimize pharmacologic prevention with enoxaparin. An enoxaparin venous thromboembolism (VTE) protocol implemented October 2015 provided weight-adjusted initial dosing parameters subsequent dose titration targeted levels. Symptomatic VTE rate was evaluated 12 months pre-...

Preexisting conditions and decreased physiological reserve in the elderly frequently complicate provision of health care this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission low-acuity patients, including elderly, services. This enabled NPs initiate admissions coordinate day-to-day for patients under supervision a attending. The complexity need evaluate efficacy management provided by led development current study. Accordingly, study...

The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews nonsurgical admissions when rates allocation to this service exceed 10% inpatient traumas. Nonsurgical admission at the study institution, which is a Level I center, historically exceeded ACS criterion. In an effort decrease admissions, institution recruited nurse practitioners (TNPs) who began managing low acuity patients with oversight from attending physicians. This examines impact TNPs on...

Introduction: Stressors unique to trauma patients may potentiate burnout in the care team. Among health workers, nurses historically demonstrate high rates of and are often first caregivers which interact. There is limited research, however, investigating nurses. This study aims evaluate levels perceptions work-life ancillary staff at a Level 1 center. Methods: An anonymous, cross-sectional, online survey was administered utilizing Maslach Burnout Toolkit investigate work-life. Supplemental...

Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained care, mortality rates are unacceptably high this patient population.We sought to retrospectively describe knowledge acquisition confidence improvement practitioners who attend Fundamental Critical Care Support (FCCS) course Rwanda.We conducted a retrospective study which we assessed survey data multiple-choice question that...

Abstract Purpose The American Association for the Study of Liver Diseases guidelines recommend ciprofloxacin as a first-line option spontaneous bacterial peritonitis (SBP) prophylaxis, citing literature that is over 30 years old. There insufficient data and guidance prophylaxis in cases fluoroquinolone treatment failure or intolerance. This study aimed to evaluate outcomes patients whose antimicrobial was switched from therapies an alternative agent versus those who were not following...

Bethea, Audis; Seidler, David; Coleman, Cynthia; Johnson, Kimberly; Davis, Elaine; Thompson, Stephanie Author Information

**Background:** Literature identifying risk factors for self-extubation in trauma patients is limited. This study endeavors to identify characteristics, factors, and evaluate outcomes of who self-extubate. **Methods:** Self-extubated admitted a Level 1 center were matched individuals did not self-extubate 1:1 ratio based on injury severity score admission date. **Results:** Self-extubation occurred 81 the 162 included patients. had lower mortality rate (2.5% vs. 13.6%, p=0.02). Male gender...

Background Intravenous contrast media-enhanced computed tomography is vitally important in the early identification of traumatic injuries. Contrast media, however, has propensity to promote nephrotoxicity. Age, injury severity score, renal dysfunction, and hypotension upon presentation are factors associated with contrast-associated acute kidney current trauma literature. This study endeavors expand these findings evaluate relationship between injuries injury. Methods a retrospective cohort...

1Charleston Area Medical Center, Charleston, WV 2Charleston Center Health Education and Research Institute,

Akuamoah-Boateng, Kwame; Banguti, Paulin; Starling, David; Mvukiyehe, Jean Paul; Moses, Benjamin; Tuyishime, Eugene; Samanta, Damayanti; UMUHIRE, Olivier; Bethea, Audis Author Information

Introduction: Trauma patients typically have numerous injuries that require the use of opioid narcotics to control pain. The repeated these agents has been associated with decreased bowel motility which leads a lack movements and constipation. There several used try combat induced This study retrospectively evaluates two specific enteral regimens: senna docusate or naloxone docusate. Methods: is retrospective review admitted surgical-trauma intensive care unit (STICU) at CAMC General...

Introduction: Endotracheal intubation and mechanical ventilation (MV) are often necessary, life saving interventions for trauma patients. Self-extubation has been associated with increased mortality longer duration of MV, ICU hospital stay. Previous research identified several factors which increase a patient’s risk self-extubation; however, limited information is available in trauma. The purpose the study was to identify characteristics compare outcomes patients who self-extubate versus...

Bethea, Audis; Lucente, Frank; Chumbe, Julton Tomanguillo; Samanta, Damayanti Author Information

Akuamoah-Boateng, Kwame1; Bethea, Audis2; Griffiths, Carrie3; Borchers, C. Todd4; Whitcomb, John5; Samanta, Damayanti6; Lowson, Stuart7; Sessler, Curtis8 Author Information

1Charleston Area Medical Center, Charleston, WV 2Charleston Center Health Education and Research Institute,

Objective: To determine the incidence and factors associated with long-term opioid use in trauma patients who were previously opioid-naïve.Design: A retrospective cohort study.Setting: Level I Trauma Center.Patients, participants: Patients admitted to study institution between January October 2016 following traumatic injury. linked data from state's Controlled Substance Monitoring Program (CSMP) database regarding controlled substance use.Main outcome measure(s): Long-term (LTU) of...

Introduction: Sedatives are utilized in intensive care unit (ICU) patients to reduce anxiety and prevent agitation-related harm. Dexmedetomidine is an intravenous alpha-2 agonist often ICU due its sedative, anxiolytic, analgesic properties. Certain situations may favor enteral therapies adverse effects, fluid load, level of for administration, cost agents. Two oral agonists, clonidine guanfacine, have been wean dexmedetomidine. While many studies investigated clonidine, the data on...