No abstract

Introduction Febrile neutropenia is an oncologic emergency associated with significant morbidity and mortality. The objective of our study was to assess guideline adherence and clinical outcomes associated with the management of high- and low-risk febrile neutropenia patients presenting to the emergency department. Methods A retrospective observational cohort study was conducted at a 60,000-visit emergency department at an academically-affiliated tertiary referral hospital. Patients were identified as low- or high-risk using the guideline-recommended Multinational Association for Supportive Care in Cancer score. The primary outcome was the proportion of cases in which the management was concordant with applicable febrile neutropenia guidelines. Guideline adherence was defined as hospital admission and intravenous antimicrobial therapy for high-risk patients and discharge home with oral antimicrobial therapy for low-risk patients. Secondary outcomes included appropriate vancomycin administration, hospital length of stay, rates of acute kidney injury, in-hospital Clostridium difficile infection rates, and 30-day mortality. Results Of the 237 patients included, 94 (39.7%) were low-risk patients and 143 (60.3%) were high-risk patients. Guideline adherence occurred in 96.8% of high-risk patients and 0.4% of low-risk patients. Mean hospital length of stay of the low-risk group was 5 ± 5.0 days compared to 7.2 ± 7.3 days in the high-risk group. Vancomycin was often inappropriately given in 69.5% of high-risk patients. Clostridium difficile occurred in 15 (10.3%) adherent and 4 (4.4%) non-adherent patients. By 30 days, 4 (4.3%) low-risk and 15 (10.7%) high-risk patients died. Conclusion Adherence to the febrile neutropenia guidelines was low resulting in unnecessary hospital admissions of low-risk patients and frequent over-prescription of empirical vancomycin.

Background Using prescription opioids for a long period of time or at high doses can increase the risk of developing opioid use disorder (OUD). Whether a patient has an official diagnosis of OUD or not can change medical practice regarding how that individual is treated. It is imperative to be aware of who may have an undiagnosed OUD in order to avoid potential negative events such as infectious diseases associated with intravenous drug use. The purpose of this research project is to identify unique words and phrases healthcare professionals commonly use to describe patients with OUD. Methods We conducted a retrospective chart review at a tertiary care academic medical center. We included all patients with a diagnosis of OUD who had an encounter with a clinician in 2018. The chart notes from a specific appointment were reviewed to identify any unique terms or phrases used by the healthcare professionals in this note. The unique terms found were reported as a number and rate that represents how many chart notes it appeared in overall. Results Overall, 297 encounters in the electronic medical record were analyzed for terms associated with OUD. Of the 297 encounters reviewed, 83 notes had no mention of OUD, and 214 notes were found to have unique terms associated with OUD with a total of 322 unique terms and phrases identified. Opioid use disorder was the most used term occurring in 95 of the 297 (32.0%) encounters. A phrase or term containing the word “opioid” was found in 154 of the 297 (51.9%) notes. Suboxone was the second most common term found in 53 (17.8%) notes. Other common terms included cravings (49, 16.5%), relapse (42, 14.1%), and trigger (26, 8.8%). Conclusions OUD often goes undiagnosed. Knowing these key words and searching for them can assist healthcare professionals in identifying patients with undiagnosed OUD.

Background Using prescription opioids for a long period of time or at high doses can increase the risk of developing opioid use disorder (OUD). Whether a patient has an official diagnosis of OUD or not can change medical practice regarding how that individual is treated. It is imperative to be aware of who may have an undiagnosed OUD in order to avoid potential negative events such as infectious diseases associated with intravenous drug use. The purpose of this research project is to identify unique words and phrases healthcare professionals commonly use to describe patients with OUD. Methods We conducted a retrospective chart review at a tertiary care academic medical center. We included all patients with a diagnosis of OUD who had an encounter with a clinician in 2018. The chart notes from a specific appointment were reviewed to identify any unique terms or phrases used by the healthcare professionals in this note. The unique terms found were reported as a number and rate that represents how many chart notes it appeared in overall. Results Overall, 297 encounters in the electronic medical record were analyzed for terms associated with OUD. Of the 297 encounters reviewed, 83 notes had no mention of OUD, and 214 notes were found to have unique terms associated with OUD with a total of 322 unique terms and phrases identified. Opioid use disorder was the most used term occurring in 95 of the 297 (32.0%) encounters. A phrase or term containing the word “opioid” was found in 154 of the 297 (51.9%) notes. Suboxone was the second most common term found in 53 (17.8%) notes. Other common terms included cravings (49, 16.5%), relapse (42, 14.1%), and trigger (26, 8.8%). Conclusions OUD often goes undiagnosed. Knowing these key words and searching for them can assist healthcare professionals in identifying patients with undiagnosed OUD.

The impact of a pharmacist as a dedicated member of multidisciplinary intensive care unit (ICU) and emergency department (ED) teams has repeatedly been described in the literature for over 20 years. A 2020 position paper published by the Society of Critical Care Medicine and the American College of Clinical Pharmacy recommended the optimal practice model include critical care pharmacists providing direct patient care 24 h a day, 7 days a week. The objective of this paper is to describe the expansion and evolution of clinical pharmacy services provided in the ICU and ED at a large academic health center, beginning in 2015 and accelerated in the face of a global pandemic. This was made possible through a combination of creating new positions and reallocating existing positions to substantially increase ICU and ED clinical pharmacy coverage. Over a 7 year period, the emergency medicine and critical care clinical pharmacy team expanded from six full time equivalent (FTE) employees in 2015 to 16 FTEs in early 2022. This allowed for reduced pharmacist to patient ratios, the expansion of clinical pharmacy services from primarily weekday hours to a 24 h per day coverage model, 7 days a week, and to better support clinical pharmacy specialists providing these services. Rapid expansion of around the clock clinical pharmacy services was only possible through collaboration between clinical and operations pharmacy managers and feedback from members of the multidisciplinary team.