Publications by authors named "Christopher Whinney"

15 Publications

  • Page 1 of 1

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.

Mayo Clin Proc 2021 06 10;96(6):1655-1669. Epub 2021 Mar 10.

Division of General Internal Medicine, Mayo Clinic, Rochester, MN.

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2020.10.002DOI Listing
June 2021

The hospitalized patient with COVID-19 on the medical ward: Cleveland Clinic approach to management.

Cleve Clin J Med 2020 Nov 3. Epub 2020 Nov 3.

Chairman, Department of Hospital Medicine, Cleveland Clinic Community Care, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.

SARS-CoV-2-infected inpatients who are admitted to a noncritical care medical ward require a standardized approach that is based on evidence if available, and effective supportive and respiratory care. Outcomes are better when patients receive standardized care, in special COVID-19 wards in the hospital, from clinical teams with expertise. Available evidence and guidelines should be continuously appraised and integrated into clinical protocols for all domains of treatment, including isolation, and personal protective measures, pharmacologic therapy, and transitions of care. Inpatient pharmacologic therapy at this time consists primarily of dexamethasone and remdesivir, along with thromboprophylaxis, given the coagulopathy associated with COVID-19. This article summarizes current practices in our organization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.87a.ccc064DOI Listing
November 2020

The relationship between the follow-up to discharge ratio and length of stay.

Am J Manag Care 2020 09;26(9):396-399

Cleveland Clinic Indian River Hospital, 1000 36th St, Vero Beach, FL 32960. Email:

Objectives: Average length of stay (ALOS) is used as a measure of the effectiveness of care delivery and therefore is an important operational measure when evaluating both the hospitalist group and individual hospitalist performance. No metric within the control of the individual hospitalist has been identified to support the individual hospitalist's contribution to the hospitalist group's ALOS goals. This study's objective was to evaluate the correlation between the follow-up to discharge ratio (F:D ratio) and ALOS and assess the relationship between F:D ratio and hospitalist experience.

Study Design: We systematically evaluated the relationship between hospitalist-level billing data for daily inpatient follow-up encounters and discharge visits (F:D ratio) and the attributed ALOS across consecutive hospitalist encounters at a tertiary care center.

Results: Over the study period of 10 quarters from 2017 to 2019, there were 103,080 follow-up or discharge inpatient encounters. The mean (SD) provider F:D ratio and ALOS were 3.94 (0.36) and 4.45 (0.24) days, respectively. The mean (SD) case mix index (CMI) was 1.68 (0.04). There was a strong linear relationship between the F:D ratio and both ALOS and CMI-adjusted ALOS (r = 0.807; P = .014; and r = 0.814; P = .001, respectively). The mean (SD) F:D ratio for hospitalists with 1 year or less of experience compared with those with more than 1 year of experience was 4.23 (0.80) vs 3.88 (0.39), respectively (P = .012).

Conclusions: A strong linear relationship exists between the F:D ratio and ALOS. Additionally, the F:D ratio improves with experience. Provider-level billing data applied as the F:D ratio can be used as a hospitalist management and assessment tool.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.37765/ajmc.2020.88490DOI Listing
September 2020

Clinical Progress Note: Myocardial Injury After Noncardiac Surgery.

J Hosp Med 2020 07 17;15(7):412-415. Epub 2020 Jun 17.

Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12788/jhm.3448DOI Listing
July 2020

Should we stop aspirin before noncardiac surgery?

Cleve Clin J Med 2019 Aug;86(8):518-521

Chairman, Department of Hospital Medicine Cleveland Clinic, Cleveland, OH, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.86a.18075DOI Listing
August 2019

Hospital Medicine and Perioperative Care: A Framework for High-Quality, High-Value Collaborative Care.

J Hosp Med 2017 04;12(4):277-282

Rush University, Chicago, IL, USA.

Background: Hospitalists have long been involved in optimizing perioperative care for medically complex patients. In 2015, the Society of Hospital Medicine organized the Perioperative Care Work Group to summarize this experience and to develop a framework for providing optimal perioperative care.

Methods: The work group, which consisted of perioperative care experts from institutions throughout the United States, reviewed current hospitalist-based perioperative care programs, compiled key issues in each perioperative phase, and developed a framework to highlight essential elements to be considered. The framework was reviewed and approved by the board of the Society of Hospital Medicine.

Results: The Perioperative Care Matrix for Inpatient Surgeries was developed. This matrix characterizes perioperative phases, coordination, and metrics of success. Additionally, concerns and potential risks were tabulated. Key questions regarding program effectiveness were drafted, and examples of models of care were provided.

Conclusions: The Perioperative Care Matrix for Inpatient Surgeries provides an essential collaborative framework hospitalists can use to develop and continually improve perioperative care programs. Journal of Hospital Medicine 2017;12:277-282.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12788/jhm.2717DOI Listing
April 2017

Impact of throughput optimization on intensive care unit occupancy.

Am J Med Qual 2015 Jul-Aug;30(4):317-22. Epub 2014 Apr 22.

Cleveland Clinic, Cleveland, OH.

Intensive care unit (ICU) resources are scarce, yet demand is increasing at a rapid rate. Optimizing throughput efficiency while balancing patient safety and quality of care is of utmost importance during times of high ICU utilization. Continuous improvement methodology was used to develop a multidisciplinary workflow to improve throughput in the ICU while maintaining a high quality of care and minimizing adverse outcomes. The research team was able to decrease ICU occupancy and therefore ICU length of stay by implementing this process without increasing mortality or readmissions to the ICU. By improving throughput efficiency, more patients were able to be provided with care in the ICU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1062860614531614DOI Listing
December 2016

Perioperative medication management: general principles and practical applications.

Cleve Clin J Med 2009 Nov;76 Suppl 4:S126-32

Department of Hospital Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, , Cleveland, OH 44195, USA.

An extensive medication history, including the use of nonprescription agents and herbal products, is the foundation of effective perioperative medication management. Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, the potential for drug interactions with anesthesia, and the patient's short-term quality of life. In general, medications with withdrawal potential should be continued perioperatively, nonessential medications that increase surgical risk should be discontinued before surgery, and clinical judgment should be exercised in other cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.76.s4.20DOI Listing
November 2009

Surgical comanagement: a natural evolution of hospitalist practice.

J Hosp Med 2008 Sep;3(5):394-7

Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jhm.359DOI Listing
September 2008

Does unrecognized diabetes in the preoperative period worsen postoperative outcomes?

Cleve Clin J Med 2007 Sep;74 Suppl 1:S15-6

Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.74.electronic_suppl_1.s15DOI Listing
September 2007

Outcomes of patients with stable heart failure undergoing elective noncardiac surgery.

Mayo Clin Proc 2008 Mar;83(3):280-8

Department of Hospital Medicine, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

Objective: To evaluate modern surgical outcomes in patients with stable heart failure undergoing elective major noncardiac surgery and to compare the experience of patients with heart failure who have reduced vs preserved left ventricular ejection fraction (EF).

Patients And Methods: We retrospectively studied 557 consecutive patients with heart failure (192 EF less than or equal to 40% and 365 EF greater than 40%) and 10,583 controls who underwent systematic evaluation by hospitalists in a preoperative clinic before having major elective noncardiac surgery between January 1, 2003, and March 31, 2006. We examined outcomes in the entire cohort and in propensity-matched case-control groups.

Results: Unadjusted 1-month postoperative mortality in patients with both types of heart failure vs controls was 1.3% vs 0.4% (P equals .009), but this difference was not significant in propensity-matched groups (P equals .09). Unadjusted differences in mean hospital length of stay among heart failure patients vs controls (5.7 vs 4.3 days; P less than .001) and 1-month readmission (17.8% vs 8.5%; P less than .001) were also markedly attenuated in propensity-matched groups. Crude 1-year hazard ratios for mortality were 1.71 (95% confidence interval [CI], 1.5-2.0) for both types of heart failure, 2.1 (95% CI, 1.7-2.6) in patients with heart failure who had EF less than or equal to 40%, and 1.4 (95% CI, 1.2-1.8) in those who had EF greater than 40% (P less than .01 for all 3 comparisons); however, the differences were not significant in propensity-matched groups (P equals .43).

Conclusion: Patients with clinically stable heart failure did not have high perioperative mortality rates in association with elective major noncardiac surgery, but they were more likely than patients without heart failure to have longer hospital stays, were more likely to require hospital readmission, and had a substantial long-term mortality rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4065/83.3.280DOI Listing
March 2008

Do hip fractures need to be repaired within 24 hours of injury? IMPACT consults. Proceedings of the 2nd Annual Cleveland Clinic Perioperative Medicine Summit.

Cleve Clin J Med 2006 Sep;73 Electronic Suppl 1:S18-9

Section of Hospital Medicine, Department of General Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.73.electronic_suppl_1.s18DOI Listing
September 2006

Managing perioperative risk in the hip fracture patient.

Cleve Clin J Med 2006 Mar;73 Suppl 1:S46-50

Department of Orthopaedic Surgery , Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

Patients with hip fracture benefit from a multidisciplinary team approach for preoperative and postoperative care. Team members, consisting of the orthopedic surgeon, internal medicine consultant, and anesthesiologist, should each have a role in determining a patient's readiness for surgery and communicate with one another about appropriate management. How urgently a hip fracture needs repair depends on the type of injury. In general, most injuries should be repaired as soon as the patient can be medically optimized (preferably 24 to 48 hours), keeping in mind that procedures are often lengthy and maximally invasive, and frequently involve complications. Nondisplaced (impacted) femoral neck fractures, however, should be repaired within 6 hours if possible to avert avascular necrosis of the femoral head and the need for total hip replacement. The following interventions are helpful for preventing complications following hip fracture repair: perioperative prophylaxis against infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.73.suppl_1.s46DOI Listing
March 2006

Do hip fractures need to be repaired within 24 hours of injury?

Cleve Clin J Med 2005 Mar;72(3):250-2

Section of Hospital and Preoperative Medicine, Department of General Internal Medicine, The Cleveland Clinic Foundation, OH 44195, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.72.3.250DOI Listing
March 2005
-->