Conversion of a Conference Room into a Low-Acuity Inpatient Medical Unit: A Creative Response to Influenza-Related Surge.

The 2017-2018 influenza season was associated with high demand for both emergency department (ED) care and inpatient acute care for influenza-like illness (ILI). This high demand resulted in increased numbers of inpatients and ED patients, including prolonged ED length of stay. A large, urban, academic medical center in a cold-weather region was limited in its ability to expand its footprint to create de novo locations of care, such as temporary outbuildings or tents. As such, a large conference room was rapidly converted and placed in service as a temporary inpatient unit for adults requiring inpatient admission. LOGISTICS AND IMPLEMENTATION: The logistical, infection prevention, safety, information technology, staffing, and other concerns of creating a clinical environment during a high demand scenario is challenging. However, the lessons learned in this study are reproducible despite the complexity of this issue. CONCLUSION: This is believed to be the first published account of successful conversion of a nonclinical area to an operational clinical unit in response to a surge in demand for hospital care and admission. This may be a valid option for hospitals of all sizes as part of a surge or disaster plan.

Impact of pharmacist intervention on influenza vaccine assessment and documentation in hospitalized psychiatric patients.

PURPOSE: Results of an initiative to improve assessment and documentation of the influenza vaccination status of adult psychiatric inpatients are reported. METHODS: A prospective quality-improvement study was conducted at a large, tertiary care academic medical center with the aim of improving compliance with the Influenza Immunization (IMM-2) quality measure, which was added to the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program in 2015 and requires assessment and documentation of influenza vaccination status in specified groups of psychiatric inpatients. The primary objective was to improve the IMM-2 IPFQR compliance rate to 100% during the 2015-16 influenza season from a rate of 55% during the 2014-15 influenza season through pharmacist interventions; secondary objectives included analysis of types of pharmacist interventions, rates of influenza vaccination status assessment and ordering, and rates of vaccine refusal by psychiatric disease state. RESULTS: With pharmacist interventions, the IMM-2 IPFQR compliance rate was increased to 99% during the 2015-16 influenza season. Of the 1,413 patients included in the study population, 45% (n = 646) were targeted for pharmacist intervention. Influenza vaccine was ordered for 61% of the study population (n = 867 patients), with an overall refusal rate of 74% (n = 642). Differences in refusal rates by psychiatric diagnosis were not significant. CONCLUSION: Pharmacist-conducted education of nurses and interventions to ensure completion of influenza vaccine assessments and documentation led to an improved IMM-2 IPFQR compliance rate at the study site.

Reducing Readmission at an Academic Medical Center: Results of a Pharmacy-Facilitated Discharge Counseling and Medication Reconciliation Program.

BACKGROUND: Hospital readmission has been identified as a key quality indicator and a target for reducing health care spending. OBJECTIVE: To evaluate the impact of a pharmacy-facilitated medication reconciliation and patient education model with post discharge follow-up on 30-day readmissions. METHODS: This prospective, historical control study included all patients admitted during a 6-month period to a general medicine unit with the highest 30-day readmission rate at Yale-New Haven Hospital. Patients were excluded if they expired prior to discharge, transferred, left against medical advice, were discharged to hospice, or were previously enrolled in the study. Upon admission, pharmacy technicians compiled the medication reconciliation information. Interventions were made by the pharmacist communicating with the patient's primary team. Medication and disease state counseling and final medication reconciliation were performed by the pharmacist before discharge. The primary outcome measure was 30-day readmission rates during the intervention period compared to the preceding 6 months and the same time period the previous year. Secondary outcomes included the total number of pharmacist-identified medication reconciliation interventions, total pharmacy resource utilization, and identification of patients at high risk for readmission. RESULTS: Study outcomes showed a 27% reduction in readmission during the intervention period. The pharmacist made a total of 546 medication interventions. The average pharmacist and pharmacy technician time per patient were 28.9 and 23.7 minutes, respectively. CONCLUSIONS: Pharmacy-facilitated medication reconciliation and patient education of medicine patients decreased 30-day readmission rates.