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dc.contributor.authorGrzybinski, Sarahen_US
dc.date.accessioned2016-11-16T18:44:54Z
dc.date.available2016-11-16T18:44:54Z
dc.date.issued2016
dc.identifier.urihttps://hdl.handle.net/2144/19176
dc.description.abstractBACKGROUND: Infective endocarditis (IE) is an infectious disease, most often bacterial in etiology, which affects the endocardial tissue layer of the heart. Despite advances in diagnostic technology, surgical technique, and antimicrobial therapy, IE remains a high-mortality disease. OBJECTIVE: This is a proposed quality improvement initiative for the Boston Medical Center (BMC) inpatient medicine service. The initiative aims to identify predictors of mortality in patients with IE, and then use the predictors to create a mortality risk-assessment checklist. The checklist will serve as a clinical tool for medicine service providers to help determine if upgrade to ICU level of care is warranted. With early upgrade to an ICU setting, patients with a high risk of mortality will receive more individualized care and expedited medical intervention. The goal of this quality improvement initiative is to decrease mortality rate in patients with IE at BMC. METHODS: This quality improvement initiative will implement the PDSA (plan, do, study, act) model for quality improvement. The checklist will be integrated into the electronic health record system at BMC and will be implemented over a two-year time period. Each PDSA cycle will last one year, and between PDSA cycles the checklist will be modified according to medical provider feedback. The data will be gathered through chart reviews to determine pre and post-checklist differences in number of transfers to the ICU and overall mortality rates of IE patients at BMC. RESULTS: The literature review of this proposed quality improvement initiative has identified nine independent risk factors for mortality in patients with IE: Staphylococcus aureus as infective organism, New York Heart Association class IV heart failure, left ventricular ejection fraction < 40%, vegetation size ≥ 15 mm, age > 50 years, diabetes mellitus, peripheral dermatologic findings on physical examination, serum neutrophil-to-lymphocyte ratio > 5.45, and serum D-dimer level > 4.0 mg/L. CONCLUSION: If medical providers had access to a risk assessment tool to help identify IE patients with a high risk of mortality, they could more accurately determine appropriate level of care, expedite medical intervention, and possibly reduce rates of in-hospital death in patients with IE.en_US
dc.language.isoen_US
dc.subjectMedicineen_US
dc.subjectCritical careen_US
dc.subjectEndocarditisen_US
dc.subjectInfectious diseaseen_US
dc.subjectInfective endocarditisen_US
dc.titlePrognostic factors in infective endocarditisen_US
dc.typeThesis/Dissertationen_US
dc.date.updated2016-11-03T19:13:24Z
etd.degree.nameMaster of Scienceen_US
etd.degree.levelmastersen_US
etd.degree.disciplinePhysician Assistant Programen_US
etd.degree.grantorBoston Universityen_US


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