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Extracorporeal Membrane Oxygenation Utilization across US Hospitals
Vol. 225, No. 4S1, October 2017
Scientific Forum Abstracts
S115
to 56 (California) across the states. Nebraska had the highest density of ECMO centers per population (4.8 hospitals/1,000,000 people). North Carolina and Washington had the highest density of ECMO centers per land area (1.5 hospitals/1,000 square miles). Across most states, many low volume centers existed within counties with neighboring higher volume centers (15 admissions/year). CONCLUSIONS: The number of ECMO centers and the utilization of ECMO by hospital vary substantially by state. The high proportion of low-volume hospitals raises concerns over maintenance of ECMO expertise and may represent an opportunity for system-level improvements within states. Subsequent analyses will investigate the effect of ECMO volume on in-hospital mortality.
CONCLUSIONS: Early-phase MRI-Bx adoption rose rapidly vs TP- and TRUS-Bx and was concentrated within urban areas and among patients with prior negative biopsies. Extracorporeal Membrane Oxygenation Utilization across US Hospitals Dani O Gonzalez, MD, Yuri V Sebastiao, PhD, Jennifer N Cooper, PhD, Peter C Minneci, MD, Katherine J Deans, MD, FACS Nationwide Children’s Hospital, Columbus, OH INTRODUCTION: The Extracorporeal Life Support Organization recommends that extracorporeal membrane oxygenation (ECMO) centers perform at least 6 ECMO procedures per year to maintain clinical expertise. The objective of this study was to examine the extent of hospital and state variation in ECMO utilization patterns. METHODS: We conducted a retrospective cohort study of the Healthcare Cost and Utilization Project State Inpatient Databases from 17 states during 2008 to 2014. We included admissions for patients of all ages who had an ECMO procedure record. Summary measures were used to examine the distribution of ECMO admissions by hospital and state. ECMO volumes were categorized into groups: 5, 6e14, 15e30, and >30 admissions/year. RESULTS: There were 9,835 ECMO admissions across 306 hospitals. Overall, 79% of centers were in the lowest volume category, with 55% of centers averaging <1 admission/year. The number of hospitals that offered ECMO ranged from 4 (Iowa)
Enhanced Readability of Discharge Summaries Decreases Provider Phone Calls in the Post-Hospital Setting Asad J Choudhry, MBBS, Moustafa Younis, MBBS, Mohamed D Ray-Zack, MBBS, Amy Glasgow, Elizabeth B Habermann, PhD, MPH, Stephanie Heller, MD, FACS, Henry J Schiller, MD, FACS, Martin D Zielinski, MD, FACS, Nadeem N Haddad, MD Mayo Clinic, Rochester, MN INTRODUCTION: Disparities in health literacy are increasingly cited as a barrier to patients’ involvement in their own care. In our previous study, patient discharge instructions were found to be written at a substantially greater readability level than the 6th grade level, as recommended by the American Medical Association (AMA) and the National Institutes of Health (NIH). We hypothesized that improving the readability of discharge instructions will decrease phone calls and readmission rates in the post-hospital setting. METHODS: A prospective observational study of adult trauma patients from September 2015 to August 2016 was conducted. Discharge instructions were edited to improve readability in August 2015; patients admitted prior to this intervention from August 2014 to August 2015 were compared to the prospective cohort. The Flesch-Kincaid Grade Level (FKGL), a universally accepted scale for evaluating the readability of medical information, was used. Differences in phone calls and readmission rates prior to, and after discharge template edits, were analyzed. RESULTS: A total of 1,006 patients were included (pre-intervention n ¼ 493, post-intervention n ¼ 513), patients’ education level were similar in both groups (Table). The median discharge instruction readability levels in the post-intervention group was significantly lower (8.6, 95% CI 8.8e8.9 vs 10.0, 95% CI 10.0e10.2, p < 0.0001). The number of phone calls per 100 patients was 2.4 times lower in the post-intervention group (22 vs 9, p < 0.0001). There was no difference in readmission rates (8.5% vs 8.6%, p ¼ 0.97).
Scientific Forum Abstracts
S115
to 56 (California) across the states. Nebraska had the highest density of ECMO centers per population (4.8 hospitals/1,000,000 people). North Carolina and Washington had the highest density of ECMO centers per land area (1.5 hospitals/1,000 square miles). Across most states, many low volume centers existed within counties with neighboring higher volume centers (15 admissions/year). CONCLUSIONS: The number of ECMO centers and the utilization of ECMO by hospital vary substantially by state. The high proportion of low-volume hospitals raises concerns over maintenance of ECMO expertise and may represent an opportunity for system-level improvements within states. Subsequent analyses will investigate the effect of ECMO volume on in-hospital mortality.
CONCLUSIONS: Early-phase MRI-Bx adoption rose rapidly vs TP- and TRUS-Bx and was concentrated within urban areas and among patients with prior negative biopsies. Extracorporeal Membrane Oxygenation Utilization across US Hospitals Dani O Gonzalez, MD, Yuri V Sebastiao, PhD, Jennifer N Cooper, PhD, Peter C Minneci, MD, Katherine J Deans, MD, FACS Nationwide Children’s Hospital, Columbus, OH INTRODUCTION: The Extracorporeal Life Support Organization recommends that extracorporeal membrane oxygenation (ECMO) centers perform at least 6 ECMO procedures per year to maintain clinical expertise. The objective of this study was to examine the extent of hospital and state variation in ECMO utilization patterns. METHODS: We conducted a retrospective cohort study of the Healthcare Cost and Utilization Project State Inpatient Databases from 17 states during 2008 to 2014. We included admissions for patients of all ages who had an ECMO procedure record. Summary measures were used to examine the distribution of ECMO admissions by hospital and state. ECMO volumes were categorized into groups: 5, 6e14, 15e30, and >30 admissions/year. RESULTS: There were 9,835 ECMO admissions across 306 hospitals. Overall, 79% of centers were in the lowest volume category, with 55% of centers averaging <1 admission/year. The number of hospitals that offered ECMO ranged from 4 (Iowa)
Enhanced Readability of Discharge Summaries Decreases Provider Phone Calls in the Post-Hospital Setting Asad J Choudhry, MBBS, Moustafa Younis, MBBS, Mohamed D Ray-Zack, MBBS, Amy Glasgow, Elizabeth B Habermann, PhD, MPH, Stephanie Heller, MD, FACS, Henry J Schiller, MD, FACS, Martin D Zielinski, MD, FACS, Nadeem N Haddad, MD Mayo Clinic, Rochester, MN INTRODUCTION: Disparities in health literacy are increasingly cited as a barrier to patients’ involvement in their own care. In our previous study, patient discharge instructions were found to be written at a substantially greater readability level than the 6th grade level, as recommended by the American Medical Association (AMA) and the National Institutes of Health (NIH). We hypothesized that improving the readability of discharge instructions will decrease phone calls and readmission rates in the post-hospital setting. METHODS: A prospective observational study of adult trauma patients from September 2015 to August 2016 was conducted. Discharge instructions were edited to improve readability in August 2015; patients admitted prior to this intervention from August 2014 to August 2015 were compared to the prospective cohort. The Flesch-Kincaid Grade Level (FKGL), a universally accepted scale for evaluating the readability of medical information, was used. Differences in phone calls and readmission rates prior to, and after discharge template edits, were analyzed. RESULTS: A total of 1,006 patients were included (pre-intervention n ¼ 493, post-intervention n ¼ 513), patients’ education level were similar in both groups (Table). The median discharge instruction readability levels in the post-intervention group was significantly lower (8.6, 95% CI 8.8e8.9 vs 10.0, 95% CI 10.0e10.2, p < 0.0001). The number of phone calls per 100 patients was 2.4 times lower in the post-intervention group (22 vs 9, p < 0.0001). There was no difference in readmission rates (8.5% vs 8.6%, p ¼ 0.97).