• A Comparison of 3 Methods of Neonatal Intensive Care Unit (NICU) Mortality and Morbidity Risk Scoring Assessments (CRIB, SNAPPE-II, NTISS): A Systemic Analysis

      Ul-Haque, Anum; Baskaran, Vikraman (2021)
      The NICU aims to provide real-time updates on the medical status of its infant patients. Along with medical techniques, the use of mortality risk scoring systems is necessary in enabling the medical team to make better predictions about the conditions of its patients. Currently, there are many scoring systems used in the NICU, each of which focus on different characteristics to assist the physicians and determine the best course of action and treatment plans. A few common NICU mortality scoring systems are CRIB, SNAPPE-II, and NTISS. CRIB and SNAPPE-II assess infant morbidity at different timepoints post-birth in a cross-sectional methodology. NTISS conducts continuous observations in a longitudinal methodology to record patient healthcare outcomes after different treatments are applied. To conduct thorough research on these NICU patient mortality and morbidity scoring systems, literature searches will be conducted to determine the prevalence of these NICU scoring systems. Specific keywords will be utilized to search multiple databases related to the NICU by focusing on patient categorizations, successful variables, and ineffective scoring systems. After this preliminary research, the evolution of these systems over the past 20 years will also be studied, to learn how the scoring techniques were modified for different clinical scenarios. Finally, a new NICU scoring system will be proposed for future implementation, and a systematic analysis will be written with these results.
    • Assessment of Current Opioid Stewardship Activities and Evaluation of Health Informatics Tools to Reduce Opioid Prescribing

      Parker, Julie; Baskaran, Vikraman (2021)
      Background: Overprescribing opioids has become a public health emergency in which 128 people in the United States die every day after overdosing on opioids. This also poses a problem in the acute care setting, as many institutions do not continually monitor daily opioid administrations. Currently, opioid use in the hospital setting can be tracked using morphine milligram equivalents (MME) calculators. Several studies have shown that monitoring MMEs can help identify patients at risk for overdose death. In particular the CDC recommends using caution when increasing to >50 MME per day, and to avoid or carefully justify increasing doses to >90 MME per day. The CDC has also outlined high risk conditions for opioid related harm including patients >65 years, pre-disposing conditions such as mental health or substance abuse disorders, and previous naloxone use. Through this research project, we will be able to assess our current opioid stewardship activities through a survey presented to pharmacy staff and then discussing health informatics-based options for the monitoring of MMEs in an acute care hospital system. Objective: The primary objective of this study is to assess the current opioid stewardship activities and to discuss the need to implement clinical decision support tools to provide EHR-based opioid prescribing guidelines. Methods: A voluntary survey will be administered to pharmacy staff to assess how pharmacists current screen patients� profiles for pain medication administration and how they currently approach avoiding pain duplication and overprescribing of opioids. Through this survey, we will be able to address: � PDMP review � MEDD calculator use � Long-acting opioid appropriateness � Interdisciplinary communication with provider � Chart review for naloxone use or respiratory depression � PRN opioid order monitoring This survey will provide information for how pharmacists are performing opioid stewardship activities. This information will also be used to discuss current health informatics tools that could be utilized to provide an EHR-based approach to this real-time monitoring for the development of a process to integrate into workflow. Results & Conclusions: In progress
    • Benefits of Telemedicine and Telehealth for Small Practices

      Kamra, Channu; Baskaran, Vikraman (2021)
      As the world has drastically changed due to the impacts of COVID-19, the healthcare industry is now adopting telemedicine a lot more. This heavy adoption rate has caused a lot of changes to how patient received their care. Smaller practices that once did not use telemedicine are now using it to keep their workers and patients safe. This research aims to understand the impacts these changes have on the patients and providers. Perspectives from both groups can yield results that allow telemedicine to grow more and create a more considerable impact on the healthcare industry. Before this can happen, telemedicine must prove to provide benefits to the groups being examined. This research looks to survey both the patients and the providers to see if telemedicine can benefit smaller practices. Data will also be collected to see the difference in costs between in-person and telemedicine visits. The practice where the research study will be taking place is called Lifeline Primary Care. Two different surveys will be used for this research. One survey will focus on the patients and gauging their interaction with the telemedicine visit. This survey will also grab some patient demographics to help understand any indirect costs associated with them. Information such as work, and distance traveled to receive care will be used to determine these indirect costs. The second survey will be provider-based and focus more on the questions that will show telemedicine's advantages and disadvantages. These surveys will be created on survey monkey and sent to patients via text or email, same for providers. Direct costs data will be collected from the providers for two months. These costs will help determine the cost-effectiveness of telemedicine. With all the information put together, a better case can be made for the future of telemedicine post-pandemic. Research articles mentioned in this proposal have run similar studies on telemedicine. So, the results should be similar to these studies. This research aims to see if telemedicine provides benefits to smaller practices today that are rapidly adopting it. These benefits could potentially allow for advancement or at least lead to improvements where telemedicine is currently lacking. It allows patients and providers to become more accustomed and make it part of their routine when visiting. Telemedicine has so much potential in providing quality care for patients in so many ways that understanding its benefits can help the healthcare industry go a long way.
    • Improving Nursing Documentation in Patients With Sudden Cardiac Arrest Requiring Cardiopulmonary Resuscitation (CPR) in Long Term Acute Care

      Abdulkadir, Zeinab; Baskaran, Vikraman (2021)
      Healthcare documentation is a very important required task when working in any healthcare setting. From every patient encounter, prescription refill, and laboratory testing; all healthcare providers are required to document. As a Nurse, accurate documentation is vital in improving patient safety and quality of care. In emergency situations, such as a sudden cardiac arrest requiring cardiopulmonary resuscitation, precise documentation is rarely accomplished, due to the hectic nature of the patient's health status. In many circumstances, healthcare providers have witnessed the designated nurse attempting to document interventions on a napkin, whiteboard, or glove. The patient primary nurse is responsible for documenting a narrative note in the patient chart after the incident. The subjective nature of the nursing narrative note after CPR is often inaccurate, incomplete, or lacks details. Several research studies have highlighted the significance of CPR, the assessment of time keeping roles in cardiac arrests, and the evaluation of nursing documentation. This research study will analyze and provide possible solutions to the challenges faced by Nurses in long term acute settings during the documentation process on patients with sudden cardiac arrest requiring CPR. This study will evaluate, anonymous and randomly extracted, narrative notes from patient�s charts. The analysis will identify a CPR documentation template that can be implemented to reconstruct and improve the documentation process. This effort will promote efficiency and accuracy in capturing, analyzing, and reporting of data in resuscitation science to help improve patient outcomes and workflow.
    • Introducing a Mitigation Strategy into EHR Systems for Drug Shortages

      Nisanian, Meetra T.; Baskaran, Vikraman (2021)
      Nationally, hospitals are feeling the effects of the drug shortages on the quality of patient care. These shortages pose strenuous difficulties on patients, clinicians, and healthcare facilities. These shortages can be caused by many factors including, manufacturing problems lack of raw materials, business decisions, regulatory problems, as well as other external factors. The lack of available medications can cause adverse outcomes due to the need for substitution of commonly used medications that can compromise or delay procedures and lead to medication errors. This also places a burden on the hospital and the hospital staff as well. A mitigation strategy needs to be introduced in order to allow the facility in order to act efficiently in the midst of a crisis. The Rehabilitation Hospital of Southern New Mexico, located in the city of Las Cruces, is a specialized facility that provides rehabilitative services to patients recovering from disabilities causes by illnesses, injuries, or chronic medical conditions. This organization is a member of a large hospital network system known as Ernest Health; However, the hospital is managed locally in order to serve the needs of the community. When a drug shortage occurred, the hospital was not prepared. Therefore, introducing a mitigation strategy was vital for the assurance of continuation of quality patient care.
    • The positive impacts on the adoption and advancement of patient portals within a healthcare facility.

      Kamra, Navneet; Baskaran, Vikraman (2021)
      The intention of this research study is to encourage clinical facilities that do not have a patient portal system, to encourage them to adapt one for their facility or to upgrade outdated patient portal when necessary. Patient portal systems, now more than ever, are a powerful tool for patients to be able to keep track of their health. Despite the many reasons to adopt a patient portal system, many practices are still reluctant to provide a patient portal system for their patients, in fear that they may be making the right investment or may be jeopardizing their provider-patient relationship. The question this research will answer is, Is patient turnout and satisfaction positively impacted based on the adoption of a patient portal within a healthcare facility? In order to answer this questions, It is important to research what patients want out of a patient portal and how patient portals can increase patient satisfaction. Ultimately patient satisfaction is correlated to an increased number of patients/new patients.An increased number of patients generally means a potential increase in revenue. To do this research Lifeline Primary Care Clinic was chosen which is a clinic that has switched through three patient portals over the years; e-clinicalworks, Healow app (after merging with eclinicalworks in 2014) and AthenaHealth. The clinic has also expanded into other locations as well. Thus making this clinic an ideal facility for the proposed research. Another factor of choosing this clinic was due to the vast data the clinic has produced that is relevant to this research and health IT overall. In order to start the research process, a literature review was conducted in regards to the patient portal, as well as how they were perceived by both patients and healthcare providers. Upon reviewing the relevant articles on the topic, a methodology was mapped out to be able to collect patient data from each portal implementation and transition to be able to detect whether or not each transition had increased number of current and new patients due to the potential decrease in phone times by the staff with the portals having appointment and messaging systems. The data from these findings would then be compiled in an excel spreadsheet to show upward or stagnant trends in a line graph. Along with this, survey questions were generated through surveymonkey.com to be able to assess patient satisfaction by the current and by past patient portals based on preferences. Another survey was also created for the medical staff as well, in order to see the staff�s perception on patient portals and if the patient portals have impacted their workload in a positive manner or not.