Browsing by Author "Webber, Emily C."

Now showing 1 - 6 of 6
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    A Unique Use of Regional Information Exchange by a Statewide Health System Serving Refugees: "Operation Allies Welcome"
    (Thieme, 2023) Webber, Emily C.; Peterson, Rachel J.; Lory, Katie; Kanis, Jessica; Saysana, Michele; Schneider, Kimberly S.; Pediatrics, School of Medicine
    Background: In September 2021, a military camp in the United States was identified for an initial relocation of over 6,600 Afghanistan refugees. This case report describes a novel use of existing health information exchange to expedite and provide health care for a large refugee population throughout the state during the duration of their entry into the United States. Methods: Medical teams of the health systems and military camp partnered to provide a scalable, reliable mechanism for clinical data exchange leveraging an existing regional health information exchange. Exchanges were evaluated for clinical type, originating source, and closed loop communication with the refugee camp and personnel military camp. Results: Approximately 50% of the camp residents were under the age of 18 years. Over 20 weeks, approximately 4.51% of the refugee camp residents were cared for in participating health systems. A total of 2,699 clinical data messages were exchanged, 62% of which were clinical documents. Conclusion: All health systems participating in care were offered support to utilize the tool and process set up using the regional health information exchange. The process and guiding principles may be applied to other refugee health care efforts to provide efficient, scalable, and reliable means of clinical data exchange to health care providers in similar situations.
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    Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments' providers
    (Springer, 2017-12) Zee-Cheng, Janine E.; Webber, Emily C.; Abu-Sultaneh, Samer; Department of Pediatrics, IU School of Medicine
    Background: Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines. Methods: We performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA. Results: A total of 100 patients were included in the analysis. Thirty-seven percent of patients with DKA were managed according to all six guideline parameters. Only 39% of patients received the recommended hourly blood glucose checks. Thirty percent of patients received intravenous insulin bolus, which is not recommended. Conclusions: Non-adherence to pediatric DKA guidelines still exists in the state of Indiana. Further, larger studies are needed to reveal the etiology of non-adherence to pediatric DKA guidelines and strategies to improve that adherence.
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    Before the Flood: Impact of Coordination of Care and Direct Admissions on Emergency Department Volumes
    (Lippincott, Williams, & Wilkins, 2015) Webber, Emily C.; Bauer, Benjamin D.; Marcum, Chrissy K.; Nitu, Mara E.; Walthall, Jennifer D.; Saysana, Michele S.; Department of Pediatrics, IU School of Medicine
    Background: Transfers of pediatric patients occur to access specialty and subspecialty care, but incur risk, and consume resources. Direct admissions to medical and surgical wards may improve patient experience and mitigate resource utilization. Objective: We sought to identify common elements for direct admissions, as well as the pattern of disposition for patients referred to our emergency department (ED). Design: A retrospective qualitative analysis of patients transferred to our pediatric hospital for 12 months was performed. Different physician groups were evaluated for use of direct admissions or evaluation in the ED. Patients referred to the ED were additionally tracked to evaluate their eventual disposition. Results: A total of 3982 transfers occurred during the 12-month analysis period. Of those, 3463 resulted in admission, accounting for 32.55% of all admissions. Transfers accepted by nonsurgical services accounted for 82% of the transfers, whereas 18% were facilitated by one of the surgical services. Direct admissions accounted for 1707 (44.8%) of all referrals and were used more often by nonsurgical services. Of patients referred to the ED (2101 or 55.2% of all referrals), most patients were admitted and 343 (16% of those referred to the ED) were discharged home. Conclusions: The direct admission process helped avoid ED assessments for some patients; however, some patients referred to the ED were able to be evaluated, treated, and discharged. Consistent triage of the patients being transferred as direct admissions may improve ED throughput and potentially improve the patient's experience, reduce redundant services, and expedite care.
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    Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017)
    (AMIA, 2018) Bell, Douglas S.; Baldwin, Kevin; Bell, Elijah J.; Lehmann, Christoph U.; Webber, Emily C.; Mohan, Vishnu; Leu, Michael G.; Hoffman, Jeffrey M.; Kaelber, David C.; Landman, Adam B.; Hron, Jonathan; Silverman, Howard D.; Levy, Bruce; Elkin, Peter L.; Poon, Eric; Luberti, Anthony A.; Finnell, John T.; Safran, Charles; Palma, Jonathan P.; Forman, Bruce H.; Kileen, James; Arvin, David; Pfeffer, Michael; Pediatrics, School of Medicine
    We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented minority groups.
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    Comparison of Antibiotic Dosing Before and After Implementation of an Electronic Order Set
    (Thieme, 2019-03) Nichols, Kristen R.; Petschke, Allison L.; Webber, Emily C.; Knoderer, Chad A.; Pediatrics, School of Medicine
    Background: To maximize resources, the antimicrobial stewardship program at a pediatric tertiary care hospital made pediatric dosing specific guidance within the electronic health record available to all hospitals within the health system. Objective: The objective of this study was to compare the appropriateness of antibiotic dosing before and after the implementation of an electronic intravenous (IV) antibiotic order set. Methods: This was a retrospective cohort study evaluating orders from patients younger than 18 years who received cefepime, piperacillin-tazobactam, tobramycin, or gentamicin at 12 health-system hospitals. Antibiotic dosing regimens and order set use were evaluated in patients who received the specified antibiotics during the 6-month time frame prior to and following electronic order set availability at each hospital. Results: In the before and after implementation periods, 360 and 387 total antibiotic orders were included, respectively. Most orders were gentamicin (55.8% in the before implementation period and 54.5% in the after implementation period) followed by piperacillin-tazobactam (22.5% in the before period and 22.2% in the after period). Overall, 663 orders were classified as appropriate (88.8%). Appropriateness was similar in the before or after implementation periods (87.8 vs. 89.7%, p = 0.415). There was a significant difference in appropriateness if a blank order versus the electronic IV antibiotic order set was used (82.8 vs. 90.5%; p = 0.024). Conclusion: No difference in antibiotic appropriateness overall was found in the before and after implementation periods. However, when specifically compared with the appropriateness of dosing when blank order forms were used, dosing was more appropriate when electronic antibiotic order sets were used.
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    Measuring success: perspectives from three optimization programs on assessing impact in the age of burnout
    (Oxford University Press, 2020-12) Lourie, Eli M.; Stevens, Lindsay A.; Webber, Emily C.; Pediatrics, School of Medicine
    Electronic health record (EHR) optimization has been identified as a best practice to reduce burnout and improve user satisfaction; however, measuring success can be challenging. The goal of this manuscript is to describe the limitations of measuring optimizations and opportunities to combine assessments for a more comprehensive evaluation of optimization outcomes. The authors review lessons from 3 U.S. healthcare institutions that presented their experiences and recommendations at the American Medical Informatics Association 2020 Clinical Informatics conference, describing uses and limitations of vendor time-based reports and surveys utilized in optimization programs. Compiling optimization outcomes supports a multi-faceted approach that can produce assessments even as time-based reports and technology change. The authors recommend that objective measures of optimization must be combined with provider and clinician-defined value to provide long term improvements in user satisfaction and reduce EHR-related burnout.