Munson Medical Center (MMC) is a 442-bed regional referral hospital in Traverse City, Michigan Its primary service area includes Antrim, Benzie, Grand Traverse, Kalkaska, and Leelanau counties.The hospital also serves as a regional referral center for 24 counties in northern Michigan. It is one of two Level II Trauma Centers, north of Grand Rapids, with the other being UP Health System - Marquette. It also has the only Neonatal Intensive Care Unit in northern Michigan. Munson Medical Center has been designated as a Primary Stroke Center by the Joint Commission, and is a Bariatric Surgery Center of Excellence. Munson also offers the only inpatient Behavioral Health services in northern Michigan.Munson Medical Center is the largest of nine Munson Healthcare system hospitals located throughout northern Michigan. It has a medical staff of 420 physicians representing more than 50 specialty services and employs 3,700 people. As part of Munson Healthcare, it is the largest employer north of US 10.In addition to Munson Healthcare system hospitals, Munson Medical Center works closely with Helen Devos Children's Hospital in Grand Rapids, the University of Michigan Health System, in Ann Arbor, MidMichigan Medical Center - Alpena in Alpena, and War Memorial Hospital in Sault Ste. Marie.[citation needed]Munson Medical Center is a teaching hospital, and partners with Michigan State University College of Human Medicine and College of Osteopathic Medicine to provide training to third and fourth year medical students. Munson Medical Center also operates a residency program for Family Practice specialists.
BACKGROUND:The impact of intravenous (IV) thrombolysis on the outcomes of aspiration thrombectomy as the primary endovascular approach to stroke in patients with large vessel occlusion is unknown. METHODS:The Imperative Trial was a prospective, investigational device exemption, multicenter trial of first-line aspiration thrombectomy that assessed the safety and efficacy of the Zoom System, including a novel 0.088 inch aspiration catheter in patients with stroke within 8 hours of onset. We compared procedural, technical, and clinical outcomes of aspiration thrombectomy based on whether patients had received IV thrombolytics prior to the intervention. RESULTS:Among the 260 patients treated with front-line aspiration thrombectomy using the Zoom System, 125 (48%) received IV thrombolysis prior to aspiration. Rates of modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b achieved with the Zoom System were higher in the aspiration-only group than in the combined group (92% vs 81%, P=0.016). Rates of mTICI ≥2c and first pass effect were similar. The use of rescue devices to achieve mTICI ≥2b was less frequent in the aspiration-only group than in the combined group (2% vs 10%, P=0.008). The rates of functional independence (modified Rankin Scale (mRS) score 0-2) in the aspiration-only group and the combined group were 50% and 59%, respectively (P=0.16). Univariate (P=0.30) and multivariate (P=0.47) ordinal regression analyses showed no significant correlation of mRS 0-2 with IV thrombolysis. Both groups had similar safety outcomes including rates of symptomatic intracranial hemorrhage and 90-day mortality. CONCLUSIONS:Aspiration thrombectomy alone may result in higher rates of successful reperfusion and reduce the need for rescue devices compared with the combined approach with IV thrombolysis.
β-lactam allergy (BLA) labels in the preoperative setting often lead to avoidance of cefazolin in favor of alternative agents, increasing the risk of surgical site infections, adverse events, antimicrobial resistance, and healthcare costs. Although recent literature supports preoperative cefazolin use in BLA-labeled patients, data on implementing sustainable, scalable system-wide changes to increase cefazolin use remains limited. This multi-center, retrospective cohort study included adults with complete allergy data who underwent initial surgery with preoperative antibiotics at one of three Munson Healthcare sites (MMC, MHC, MHG) between 1/1/2020, and 12/31/2024. Outcomes were compared before and after a revision to the preoperative antibiotic prophylaxis guidelines on 2/28/2023, promoting cefazolin use for all patients except those with a cefazolin allergy or a BLA-label consistent with a type II-IV reaction. The primary outcome was rate of prophylactic cefazolin use among BLA-labeled patients, with a subgroup analysis comparing two sites (MMC, MHC) with pharmacy-to-dose (PTD) antibiotic prophylaxis protocols to one site (MHG) without such a protocol. Secondary outcomes included rates of alternative prophylactic antibiotic use and new cefazolin allergies within 24 hours. Among 39,104 included patients, BLA-label rates were similar pre- and post-intervention (21.0% vs. 20.8%; p=0.56). Following implementation of the revision, cefazolin usage among BLA-labeled patients increased from 69.9% to 90.8% (p< 0.001), while alternative antibiotic use declined from 30.2% to 8.5% (p< 0.001). All sites saw significant increases in cefazolin use among patients with a BLA-label (p< 0.001); however, usage remained higher at PTD sites compared to the non-PTD site both pre- (71.5% vs. 48.1%) and post-implementation (92.6% vs. 65.6%), with a larger absolute increase at PTD sites (p< 0.001). The incidence of new cefazolin allergies within 24 hours remained unchanged (0.01% vs. 0.03%; p=0.26). Implementing revised cefazolin use criteria within a PTD antimicrobial prophylaxis protocol increased cefazolin use while reducing alternative antibiotic use among BLA-labeled patients, without increasing new cefazolin allergies within 24 hours. All Authors: No reported disclosures
Purpose: A large body of research has studied various fractionation regimens for radiation therapy (RT) targeting bone metastases, with evidence that courses of 5 or fewer fractions are isoeffective compared with longer courses. We analyzed practice patterns within a statewide quality consortium following the implementation of quality measures promoting single-fraction RT (SFRT) for uncomplicated metastases and ≤5 fractions for all metastases. Methods and Materials: Consecutive patients receiving RT for bone metastasis from primary breast, lung, melanoma, prostate, or renal cancer(s) between March 1, 2018, and December 31, 2024, were prospectively enrolled in a statewide quality consortium. SFRT and ≤5-fraction quality metrics were implemented on January 1, 2020, and January 1, 2022, respectively. Patient, treatment, physician, and facility characteristics were collected, and multivariable logistic regression, with and without random center intercepts, was used to account for clustering by center and to assess associations with metric adherence. Results: In total, 4477 patients were enrolled and received 6733 RT treatment plans, with 1105 patients receiving 1465 plans for uncomplicated metastases and 3247 patients receiving 4832 nonstereotactic body RT plans. The use of SFRT and ≤5-fraction RT for uncomplicated and any metastases increased from 17.8% to 38.8% and from 44.2% to 63.9%, respectively, after the implementation of quality measures. In both models, later years of treatment, longer distance to the treating facility, higher baseline fatigue, treatment site other than the spine, and fewer physician years in practice predicted shorter treatment courses. Patients with >1 site treated for uncomplicated metastases had lower odds of receiving SFRT. Forward planning, uncomplicated metastasis, retreatment, palliative intent, age ≥80 years, and an Eastern Cooperative Oncology Group performance status ≥2 independently predicted receipt of ≤5 fractions. Conclusions: Our efforts to shorten treatment courses for bone metastases have been successful. The number and variety of factors that predict the use of shorter courses reflect the complexity of clinical decision-making in the treatment of bone metastases.
Antibiotics are often prescribed for patients diagnosed with Tier 3 viral respiratory infections (e.g., acute bronchitis, upper respiratory tract infections), despite strong recommendations against their use. The aim of this study was to assess if the implementation of a viral care package plus a one-time provider education (VCP+E) was associated with a reduction in antibiotic prescriptions for Tier 3 infections in the urgent care (UC) setting. Viral care packages (VCPs) with over-the-counter products were made for one Munson Healthcare UC and developed into four age-appropriate packages for patients 2 years and older. They were dispensed from 11/1/2024-1/31/2025 following a provider education session on the appropriate use of antibiotics for Tier 3 infections. Patients diagnosed with a Tier 3 infection only were eligible to receive a VCP. Outcomes were assessed pre (10/1/2023-4/30/2024) and post (2/1/2025-4/30/2025) VCP+E implementation. The primary outcome assessed antibiotic prescription rate for patients with Tier 3 infections, compared to a combined group of 3 UCs without VCP+E. Secondary outcomes assessed antibiotic prescription rate for all encounters, rate of antibiotic prescriptions within 7 days of receiving a VCP, and patient and provider satisfaction through a survey. 379 VCPs were dispensed during the study timeframe. The rate of antibiotic prescriptions for Tier 3 infections was lower after VCP+E implementation (13.9 vs. 9.1%, p< 0.001), with no change in the group without VCP+E during the same time period (35.2 vs. 37.2%, p=0.529). This change was largely driven by a reduction in prescriptions for acute bronchitis in the VCP+E group (44.1 vs. 25%, p< 0.001). Overall rate of antibiotic prescriptions for any indication was higher in both groups after implementation (VCP+E= 30.4 vs. 34.1%, p < 0.001; no E+VCP= 41.8 vs. 45.9%, p< 0.001). Within 7 days of receiving a viral care package, 7.9% of patients received an antibiotic. Approximately 10% (n=36) of patients who received a VCP responded to a survey with average patient satisfaction being 9.6/10. A provider-driven VCP intervention plus a one-time provider education was associated with a decrease in antibiotic prescriptions for Tier 3 respiratory infections in the UC setting. All Authors: No reported disclosures
Purpose Discharge antibiotic prescriptions are infrequently monitored by hospital antimicrobial stewardship programs but are often guideline-discordant. Leveraging pharmacist expertise may optimize discharge antibiotic prescribing, benefiting the individual patient and public health. Methods This is a multicenter, quasi-experimental study of an intervention in which a pharmacist reviewed, documented and communicated standardized discharge antibiotic recommendations to the primary inpatient medical team. Patients were compared prior to intervention implementation (the preintervention group) to those after intervention implementation (the postintervention group). The primary outcome was overall discharge antibiotic appropriateness, defined as the prescription having an appropriate duration, agent, and dose. Clinical outcomes, including adverse drug events, 30-day hospital or emergency department readmission, and 30-day infection recurrence were compared. The pharmacist interventions in the postintervention group were classified and evaluated for provider acceptance. Results A total of 157 patients from 4 community hospitals across 3 health systems were included (87 in the preintervention group and 70 in the postintervention group). Common infection sources were the urinary tract (53.5%) and lower respiratory tract (36.3%). In the postintervention group, pharmacists made 57 interventions, most commonly proactive discharge regimen recommendations (43.9%), therapy discontinuation (26.3%), and duration adjustments (17.5%). Overall, 63.1% of interventions were accepted. Compared to the preintervention group, postintervention patients had a significantly higher frequency of discharge with an appropriate antibiotic regimen (50.0% vs 21.8%, P < 0.001). No significant between-group differences were observed in any 30-day clinical outcomes. Conclusion A pharmacist-driven discharge antibiotic intervention significantly improved the appropriateness of antibiotic prescribing in community hospitals. These findings support the role of pharmacists in enhancing antimicrobial stewardship at important care transitions.
