News Article | May 22, 2017
MILFORD, Ohio--(BUSINESS WIRE)--A new study concluded that hospital mortality dropped during times of visits from a national accreditation organization. DNV GL Healthcare focuses on reducing patient deaths in hospitals around-the-clock. Most accreditation bodies work closely with a hospital every few years. Extra vigilance among staff tends to kick in only when auditors appear. But DNV GL's team works continuously with hospital staff to ensure that the institution is always operating at peak efficiency and safety. DNV GL staff not only appear for the accreditation audit, but return for regular “checkups” to focus on areas where there remains room for improvement. As a result, there is no tailing off in clinical quality between visits. “It certainly keeps us continuously accreditation ready,” said Barbara Covelli, Corporate Director of Regulatory Compliance for Charleston Area Medical Center in Charleston, West Virginia. “We don’t have the time to fall into bad habits.” DNV GL helps hospitals accomplish such feats through the following innovations: A Non-Adversarial Relationship: Hospital compliance executives typically dread the audit/accreditation process. That's because many accreditation bodies arrive on-site with their own agenda – and their own way for implementing it. DNV GL's process is entirely collaborative. Staff are specifically chosen for their collaborative attitude and trained to work with hospitals as partners rather than adversaries. ISO 9001 – A Unique Approach in Accreditation: Many accreditation bodies have their own set of standards that fluctuate based on internal institutional politics and other unpredictable factors. DNV GL's embrace of ISO 9001 standards are certifiable, verifiable and reliable. More than 1 million businesses – healthcare providers or otherwise – use ISO 9001 standards worldwide. “The way we do this process is not in a traditional way. As a result, we are changing the culture of hospital accreditation,” said Patrick Horine, DNV GL's chief executive officer. Charleston Area Medical Center’s stroke program is accredited by DNV GL. The hospital is able to deliver clot-busting medications to 95 percent of patients within three hours of their showing symptoms. Such swift delivery often significantly reverses the damage from ischemic strokes. Nationwide, hospitals get clot busting drugs to their stroke patients within three hours about 87 percent of the time. In West Virginia, the average is 83 percent. DNV GL's executives and its partnering hospitals who they have accredited are available to discuss how the process works in greater depth. For more information on DNV GL, visit www.dnvglhealthcare.com. DNV GL is a world-leading certification body. We help businesses assure the performance of their organizations, products, people, facilities and supply chains through certification, verification, assessment, and training services. Within healthcare we help our customers achieve excellence by improving quality and patient safety through hospital accreditation, managing infection risk, management system certification and training. The DNV GL Group operates in more than 100 countries. Our 13,500 professionals are dedicated to helping our customers make the world safer, smarter and greener.
Cohen R.A.,Northwestern University |
Petsonk E.L.,West Virginia University |
Rose C.,National Jewish Health |
Rose C.,University of Colorado at Denver |
And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2016
Rationale: Recent reports of progressive massive fibrosis and rapidly progressive pneumoconiosis in U.S. coal miners have raised concerns about excessive exposures to coal mine dust, despite reports of declining dust levels. Objectives: To evaluate the histologic abnormalities and retained dust particles in available coal miner lung pathology specimens, and to compare these findings with those derived from corresponding chest radiographs. Methods: Miners with severe disease and available lung tissue were identified through investigator outreach. Demographic as well as smoking and work history information was obtained. Chest radiographs were interpreted according to the International Labor Organization classification scheme to determine if criteria for rapidly progressive pneumoconiosis were confirmed. Pathology slides were scored by three expert pulmonary pathologists using a standardized nomenclature and scoring system. Measurements and Main Results: Thirteen cases were reviewed, many of which had features of accelerated silicosis and mixed dust lesions. Twelve had progressive massive fibrosis, and 11 had silicosis. Only four had classic lesions of simple coal workers' pneumoconiosis. Four had diffuse interstitial fibrosis with chronic inflammation, and two had focal alveolar proteinosis. Polarized light microscopy revealed large amounts of birefringent mineral dust particles consistent with silica and silicates; carbonaceous coal dust was less prominent. On the basis of chest imaging studies, specimens with features of silicosis were significantly associated (P = 0.047) with rounded (type p, q, or r) opacities, whereas grade 3 interstitial fibrosis was associated (P = 0.02) with the presence of irregular (type s, t, or u) opacities. Conclusions: Our findings suggest that rapidly progressive pneumoconiosis in these miners was associated with exposure to coal mine dust containing high concentrations of respirable silica and silicates.
Novell M.J.,Auburn University |
Morreale C.A.,Charleston Area Medical Center
Annals of Pharmacotherapy | Year: 2010
BACKGROUND: Limited evidence suggests there may be a link between fluoroquinolone use and Clostridium difficile-associated diarrhea (CDAD), but such an association remains unclear due to conflicting data. OBJECTIVE: To determine the relationship between inpatient fluoroquinolone use and CDAD; secondary objectives included the relationship between CDAD and fluoroquinolone selection, duration of therapy, and route of administration, as well as the association between fluoroquinolones and CDAD complications. METHODS: We conducted a retrospective, case-control study of adult inpatients diagnosed with CDAD during the period of July 2007-July 2008. In total, 174 case patients were matched on a 1:1 basis with controls. A thorough assessment of all inpatient antibiotic use was conducted, including regimens administered at our institution within the previous 8 weeks. Odds ratios were calculated using univariate logistic-regression analysis. RESULTS: Use of fluoroquinolones was not significantly different between patients with CDAD and matching controls (OR 1.36; 95% CI 0.09 to 2.10; p = 0.16). No relationship was found between CDAD and the individual fluoroquinolones: ciprofloxacin (OR 1.36; 95% CI 0.87 to 2.12; p = 0.18), levofloxacin (OR 1.17; 95% CI 0.62 to 2.22; p = 0.63), and moxifloxacin (OR 1.34; 95% CI 0.81 to 2.20; p = 0.25). Fluoroquinolone route of administration did not differ significantly between groups for patients receiving intravenous (OR 1.20; 95% CI 0.74 to 1.94; p = 0.46) or oral (OR 0.79; 95% CI 0.44 to 1.44; p = 0.45) therapy. Complications from CDAD were not significantly increased by fluoroquinolone use (OR 1.37; 95% CI 0.72 to 2.61; p = 0.35). CONCLUSIONS: Inpatient administration of fluoroquinolones was not associated with CDAD at our institution. Fluoroquinolone use in patients who developed CDAD was not related to higher incidences of CDAD-related complications.
Elkins L.J.,Charleston Area Medical Center
AANA Journal | Year: 2010
Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. Literature searches were performed with the terms brain death, organ donor, organ procurement, anesthesia and organ donor, anesthesia and brain death, anesthesia and organ procurement, inhalational anesthetics and organ procurement, and inhalational anesthetics and brain dead. Additional resources were obtained from reference lists of published articles. The literature review showed there is a lack of published studies researching the use of inhalational anesthetics in organ procurement. No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs.
Lewis K.R.,West Virginia University |
Clark C.,Access Health |
Velarde M.C.,Charleston Area Medical Center
Clinical Endocrinology | Year: 2014
Objective Diabetic Ketoacidosis (DKA) is a well-known complication in children with type 1 diabetes mellitus (T1DM) with a mortality rate estimated at 2%. A previous study identified that T1DM children of non-Caucasian race with Medicaid insurance had increased incidence of DKA admissions. The aim of this study is to identify the socioeconomic factors associated with DKA admissions in West Virginia (WV). Design and methods Retrospective chart review of patients admitted to the paediatric intensive care unit with DKA in Charleston, WV from January 2007-December 2010. Included subjects were 1-18 years of age and those with type 1 diabetes of >6 months duration. Admission rates were compared with the normal population distribution in WV. The data collection tool included multiple socioeconomic factors and HbA1c. Results We reviewed a total of 167 patients with an admitting diagnosis of DKA; 57% were female, 43% male. Average age was 13·5 years ± 2·7; 56·4% were covered by Medicaid/Chips (WV state insurance) and 43·6% by commercial payers. 11·9% were African American and 88·1% were Caucasian. The average HbA1c was 10·85 ± 2·36%. Higher risks for DKA included those with HbA1c >14%, African American children (OR 17·4, CI 4-73) and children with Medicaid/Chips insurance (OR 9·3, 95% CI 1·1-76·2). Conclusions This study identifies socioeconomic factors associated with children admitted for DKA in WV. Patients at higher risk for DKA include those with elevated HbA1c, African American race and those covered by Medicaid/CHIPS (thereby presumed lower socioeconomic status). Findings can be utilized to identify patients at highest risk for DKA and implementation of prevention strategies. © 2013 John Wiley & Sons Ltd.
Hale N.,Charleston Area Medical Center |
Brown A.,Charleston Area Medical Center
Urology | Year: 2013
Objective: To identify and discuss the mechanistic risk factors associated with genitourinary (GU) trauma in pediatric all-terrain vehicle (ATV) accidents. Materials and Methods: A retrospective analysis of all pediatric trauma admissions to a level 1 trauma center from 2005 to August 2011 was performed. We identified all pediatric patients who presented with GU trauma related to an ATV accident. The demographics, injury data, mechanism of injury, and treatment records of these children were investigated. Results: A total of 304 pediatric patients were admitted with ATV-related injuries during the study period. Of these 304 patients, 10 (3.2%) had experienced GU injuries. An analysis of the mechanism revealed that 9 of the 10 had been thrown from the ATV; 1 event was described as a rollover accident. All 10 patients sustained renal trauma: 9 renal lacerations of various grades and 1 renal pedicle injury. Hematuria was observed in all cases. Spleen and liver lacerations were commonly associated injuries (40% and 30%, respectively). Conclusion: Pediatric ATV-related GU injuries remain an uncommon, yet serious, problem. Renal trauma is the most commonly encountered GU injury and can be suspected by the presence of hematuria. Analysis of the mechanism of injury suggests that ejection from the ATV places pediatric patients at the greatest risk of renal injury. Additional research is recommended concerning the mechanistic relationship of ATV-related GU trauma. © 2013 Elsevier Inc. All Rights Reserved.
Jubelirer S.J.,Charleston Area Medical Center
The West Virginia medical journal | Year: 2011
We reviewed the records of 51 patients with Immune Thrombocytopenia (ITP) who underwent Coronary Artery Bypass Grafting (CABG) at Charleston Area Medical Center between June 1992 and September 2005. There were 41 males and 10 females with a median age of 68 years (range 49-87). Four patients had a previous splenectomy, one of whom had it performed concomitantly with the CABG. Three patients were on chronic corticosteroids on admission. The median pump time was 114 minutes (range: 42-244 minutes). The median cross-clamp time was 62 minutes (range 22-192 minutes). The median total chest tube drainage postoperatively was 1,346 cc (range: 265-9875cc). The mean preoperative and 24 hour postoperative platelet count was 126,000 (range 58,000-323,000) and 99,000/mm3 (range: 27,000-194,000), respectively. Twenty-one (40%) patients received platelet transfusions. Platelets were given intraoperatively or postoperatively in all but two of those patients. The median number of units of platelets given was 10 (range: 6-52). Twenty-seven (53%) received packed red cells intraoperatively or postoperatively. The median number of red cells given was 2 (range: 1-34). Other hemostatic agents given intraoperatively/ postoperatively included aprotinin (8 patients), aminocaproic acid (10 patients), DDAVP (5 patients), and intravenous gammaglobulin (IgG) in 3 patients. Thirteen patients were given corticosteroids preoperatively with little improvement in platelet count. CABG may be successfully performed in ITP patients with moderate thrombocytopenia (> or = 50,000/mm3) using conventional therapies (e.g., transfusions, IV IgG, hematinics) without the need for preoperative splenectomy or prolongation of hospital stay. However, a prospective study on the ideal management of ITP patients undergoing CABG would be beneficial.
Aburahma A.F.,West Virginia University |
Alhalbouni S.,West Virginia University |
Abu-Halimah S.,West Virginia University |
Dean L.S.,Charleston Area Medical Center |
Stone P.A.,West Virginia University
Journal of the American College of Surgeons | Year: 2014
Background This study analyzed the impact of chronic renal insufficiency (CRI) on early and late clinical outcomes of carotid artery stenting (CAS) using serum creatinine and glomerular filtration rate (GFR). Study Design There were 313 CAS patients classified into 3 groups: normal (serum creatinine <1.5 mg/dL or GFR ≥ 60 mL/min/1.73 m2); moderate CRI, and severe CRI (serum creatinine ≥3 or GFR < 30 mL/min/1.73 m2). Major adverse events ([MAE] stroke, death, and myocardial infarction) were compared for all groups. Results Using serum creatinine, perioperative stroke rates for normal, moderate, and severe CRI were: 5%, 0%, and 25%, respectively, (p = 0.05) vs 4.6%, 3.7%, and 11.1%, respectively, (p = 0.44) using GFR. The perioperative MAE rates for symptomatic patients were 9.3% and 0% (p = 0.355) and 2% and 5.9% (p = 0.223) for asymptomatic patients for normal and moderate/severe CRI, respectively, using serum creatinine vs 8.1% and 7.8%, respectively, for symptomatic patients and 2.5% and 3%, respectively, for asymptomatic patients using GFR. At a mean follow-up of 21 months, late MAE rates in normal vs moderate/severe CRI patients were 8.2% and 14%, respectively, (p = 0.247) using serum creatinine vs 6.6% and 13.3%, respectively, (p = 0.05) using GFR. Late MAE rates for symptomatic patients in normal vs moderate/severe CRI were: 8.7% vs 27%, respectively, (p = 0.061) using serum creatinine and 5.7% vs 18.8%, respectively, (p = 0.026) using GFR. Late death rate was 0.55% in normal vs 7.6% (p = 0.002) for moderate/severe CRI. Freedom from MAE at 3 years in symptomatic patients was 81% in normal and 46% in moderate/severe CRI (p = 0.0198). A multivariate Cox regression analysis showed that a GFR of < 60 mL/min/1.73 m2 had an odds ratio of 1.6 (p = 0.222) of having a MAE after CAS. Conclusions The GFR was more sensitive in detecting late MAE after CAS. Carotid artery stenting in moderate CRI patients can be done with a satisfactory perioperative outcome; however, late death was significant. © 2014 by the American College of Surgeons.
Bulloch M.N.,Charleston Area Medical Center |
Bulloch M.N.,University Medical Center
Journal of Clinical Pharmacy and Therapeutics | Year: 2011
What is known and Objective: Wangiella dermatitidis is a darkly pigmented fungus that has been isolated from the soil, dead plant material and areas of high humidity. Infection from the pathogen has not been extensively documented and few published cases report survival. Of the antifungal agents used in previous reports, none has been proven to improve outcomes. Voriconazole is known to have in vitro activity against the organism, but clinical experience for the treatment of W. dermatitidis infection is limited. The objective of this case report is to describe the use of voriconazole for the treatment of W. dermatitidis infection. Case summary: An 86-year-old American woman with a past medical history significant only for mild dementia is successfully treated for pulmonary W. dermatitidis infection using oral voriconazole monotherapy with minimal adverse effects. What is new and Conclusion: Voriconazole appears to be effective as monotherapy for the treatment of pulmonary W. dermatitidis infections. A minimum of 3-4 months of antifungal treatment should be given. Adverse effects with prolonged voriconazole use do not appear to be a barrier to treatment. © 2010 Blackwell Publishing Ltd.
Kerr P.L.,West Virginia University |
Muehlenkamp J.J.,University of Wisconsin - Eau Claire |
Turner J.M.,Charleston Area Medical Center
Journal of the American Board of Family Medicine | Year: 2010
Self-injury is a dangerous behavior that is different from suicidal behavior but is associated with increased risk of suicide attempts. Some effective psychological treatments for self-injury exist. Physicians in family medicine and primary care settings play a vital role as a first step in the treatment process for those who self-injure. Physicians can enhance the care provided to those who self-injure via the accurate assessment of risk, the understanding of the functions of the behavior, assisting the patient in identifying motivations for treatment and treatment options, and provision of long-term behavioral and risk monitoring. This article summarizes the current scientific knowledge regarding the clinical features, epidemiology, assessment methods, and existing treatments of self-injury. The role of the primary care physician in the treatment of patients who self-injure is specifically outlined.