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160 results on '"Blecker, Saul"'

13. Understanding provider use of a new clinical decision support tool aimed at reducing excess telemetry in an academic health system: A retrospective study.

Author

Hatley, Maya, Korostoff‐Larsson, Olivia, Malik, Tahir, Blecker, Saul, and Eaton, Kevin P.

Subjects
MEDICAL care use, ACADEMIC medical centers, CORONARY care units, CLINICAL decision support systems, RETROSPECTIVE studies, BEHAVIOR, BIOTELEMETRY, MEDICAL records, ACQUISITION of data, PHYSICIAN practice patterns, CONFIDENCE intervals, STROKE, PHYSICIANS, PATIENT monitoring, TIME
Abstract

Rationale: Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. Aims and Objectives: In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. Methods: We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. Results: There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%−57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. Conclusion: The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Clinical Decision Support for Hypertension Management in Chronic Kidney Disease: A Randomized Clinical Trial.

Author

Samal, Lipika, Kilgallon, John L., Lipsitz, Stuart, Baer, Heather J., McCoy, Allison, Gannon, Michael, Noonan, Sarah, Dunk, Ryan, Chen, Sarah W., Chay, Weng Ian, Fay, Richard, Garabedian, Pamela M., Wu, Edward, Wien, Matthew, Blecker, Saul, Salmasian, Hojjat, Bonventre, Joseph V., McMahon, Gearoid M., Bates, David W., and Waikar, Sushrut S.

Published
2024
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28. Evaluating Whether an Inpatient Initiative to Time Lab Draws in the Evening Reduces Anemia.

Author

Zaretsky, Jonah, Eaton, Kevin P, Sonne, Christopher, Zhao, Yunan, Jones, Simon, Hochman, Katherine, and Blecker, Saul

Subjects
ANEMIA, HEMOGLOBINS, POSTURE, MORNING
Abstract

Background: Hospital acquired anemia is common during admission and can result in increased transfusion and length of stay. Recumbent posture is known to lead to lower hemoglobin measurements. We tested to see if an initiative promoting evening lab draws would lead to higher hemoglobin measurements due to more time in upright posture during the day and evening. Methods: We included patients hospitalized on 2 medical units, beginning March 26, 2020 and discharged prior to January 25, 2021. On one of the units, we implemented an initiative to have routine laboratory draws in the evening rather than the morning starting on August 26, 2020. There were 1217 patients on the control unit and 1265 on the intervention unit during the entire study period. First we used a linear mixed-effects model to see if timing of blood draw was associated with hemoglobin level in the pre-intervention period. We then compared levels of hemoglobin before and after the intervention using a difference-in-difference analysis. Results: In the pre-intervention period, evening blood draws were associated with higher hemoglobin compared to morning (0.28; 95% CI, 0.22–0.35). Evening blood draws increased with the intervention (10.3% vs 47.9%, P > 0.001). However, the intervention floor was not associated with hemoglobin levels in difference-in-difference analysis (coefficient of −0.15; 95% CI, −0.51–0.21). Conclusions: While evening blood draws were associated with higher hemoglobin levels, an intervention that successfully changed timing of routine labs to the evening did not lead to an increase in hemoglobin levels. [ABSTRACT FROM AUTHOR]

Published
2023
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46. Development of an Electronic Trigger to Identify Delayed Follow-up HbA1c Testing for Patients with Uncontrolled Diabetes.

Author

Knoll, Brianna, Horwitz, Leora I., Garry, Kira, McCloskey, Jeanne, Nagler, Arielle R., Weerahandi, Himali, Chung, Wei-yi, and Blecker, Saul

Subjects
GLYCOSYLATED hemoglobin, PEOPLE with diabetes, TYPE 2 diabetes, DYSLIPIDEMIA
Abstract

Diabetes is a major source of morbidity and mortality in the USA with over 1.5 million new cases diagnosed every year.[1] Diabetes is monitored using hemoglobin A1c (HbA1c) as it correlates with burden of disease.[2]-[4] Clinical practice guidelines recommend HbA1c be repeated every 3 months if a patient's value is above 7%, because a higher HbA1c correlates with worse outcomes.[5]-[9] Complications are particularly high in patients with an HbA1c above 10% and even a 1% reduction in HbA1c can reduce complications by 21%.[5] Thus, while regular monitoring of above-goal HbA1c levels is recommended, ensuring patients with an HbA1c over 10% have timely follow-up testing is especially important. Using this trigger, we found that delayed follow-up HbA1c testing is extremely common among those with poorly controlled diabetes, with 45% of patients with an HbA1c over 10% not receiving follow-up testing within 6 months. The initial numerator, representing patients without an appropriate follow-up HbA1c result, was defined as patients without a follow-up clinic visit within 3 months of the index HbA1c test. [Extracted from the article]

Published
2022
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