Browsing by Author "Roberts, Scott D."

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    Clinical and Laboratory characteristics of patients with COVID-19 Infection and Deep Venous Thrombosis
    (Elsevier, 2020-10-22) Motaganahalli, Raghu L.; Kapoor, Rajat; Timsina, Lava R.; Gutwein, Ashley R.; Ingram, Michael D.; Raman, Subha; Roberts, Scott D.; Rahman, Omar; Rollins, David; Dalsing, Michael C.; Surgery, School of Medicine
    Objective: Early reports suggest that patients with novel coronavirus disease-2019 (COVID-19) infection carry a significant risk of altered coagulation with an increased risk for venous thromboembolic events. This report investigates the relationship of significant COVID-19 infection and deep venous thrombosis (DVT) as reflected in the patient clinical and laboratory characteristics. Methods: We reviewed the demographics, clinical presentation, laboratory and radiologic evaluations, results of venous duplex imaging and mortality of COVID-19-positive patients (18-89 years) admitted to the Indiana University Academic Health Center. Using oxygen saturation, radiologic findings, and need for advanced respiratory therapies, patients were classified into mild, moderate, or severe categories of COVID-19 infection. A descriptive analysis was performed using univariate and bivariate Fisher's exact and Wilcoxon rank-sum tests to examine the distribution of patient characteristics and compare the DVT outcomes. A multivariable logistic regression model was used to estimate the adjusted odds ratio of experiencing DVT and a receiver operating curve analysis to identify the optimal cutoff for d-dimer to predict DVT in this COVID-19 cohort. Time to the diagnosis of DVT from admission was analyzed using log-rank test and Kaplan-Meier plots. Results: Our study included 71 unique COVID-19-positive patients (mean age, 61 years) categorized as having 3% mild, 14% moderate, and 83% severe infection and evaluated with 107 venous duplex studies. DVT was identified in 47.8% of patients (37% of examinations) at an average of 5.9 days after admission. Patients with DVT were predominantly male (67%; P = .032) with proximal venous involvement (29% upper and 39% in the lower extremities with 55% of the latter demonstrating bilateral involvement). Patients with DVT had a significantly higher mean d-dimer of 5447 ± 7032 ng/mL (P = .0101), and alkaline phosphatase of 110 IU/L (P = .0095) than those without DVT. On multivariable analysis, elevated d-dimer (P = .038) and alkaline phosphatase (P = .021) were associated with risk for DVT, whereas age, sex, elevated C-reactive protein, and ferritin levels were not. A receiver operating curve analysis suggests an optimal d-dimer value of 2450 ng/mL cutoff with 70% sensitivity, 59.5% specificity, and 61% positive predictive value, and 68.8% negative predictive value. Conclusions: This study suggests that males with severe COVID-19 infection requiring hospitalization are at highest risk for developing DVT. Elevated d-dimers and alkaline phosphatase along with our multivariable model can alert the clinician to the increased risk of DVT requiring early evaluation and aggressive treatment
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    Impact of Geographical Cohorting in the ICU: An Academic Tertiary Care Center Experience
    (Wolters Kluwer, 2020-09-25) Kapoor, Rajat; Gupta, Nupur; Roberts, Scott D.; Naum, Chris; Perkins, Anthony J.; Khan, Babar A.; Medicine, School of Medicine
    ICU is a multifaceted organization where multiple teams care for critically ill patients. In the current era, collaboration between teams and efficient workflows form the backbone of value-based care. Geographical cohorting is a widespread model for hospitalist rounding, but its role in ICUs is unclear. This study evaluates the outcomes of geographical cohorting in a large ICU of an Academic Health Center. Design: This is a retrospective analysis of quality metrics collected 12 months pre- and post-implementation of geographical cohorting. Setting: A total of 130 bedded ICU at tertiary academic health center in Midwest. Patients: All patients admitted to the ICU. Interventions: Our institution piloted the geographical cohorting model for critical care physician rounding on September 1, 2018. Measurements: The quality metrics were categorized as ICU harm events and ICU hospital metrics. Team of critical care providers were surveyed 12 months after implementation. Main results: The critical care utilization in the pre- and post-implementation numbers were similar for patient days (pre = 34,839, post = 35,155), central-line days (pre = 17,648, post = 19,224), and Foley catheter days (pre = 18,292, post = 17,364). The ICU length of stay was similar (4.9 d) in both pre- and post-intervention periods. Significant reduction in the incidence of Clostridium difficile infection (relative risk, -0.50; 95% CI, 0.25-0.96; p = 0.039), hospital-acquired pressure injury (relative risk, -0.60; 95% CI, 0.39-0.92; p = 0.020), central line-associated bloodstream infection incidence (relative risk, -0.19; 95% CI, 0.05-0.52; p = 0.008), and catheter-associated urinary tract infection (relative risk, -0.52; 95% CI, 0.29-0.93; p = 0.027). Healthcare providers perceived optimal utilization of their time, reduced interruptions, and improved coordination of care with geographical rounding. Conclusions: Geographical cohorting improves coordination of care, physician workflow, and critical care quality metrics in very large ICUs.