13123 E 16Th Ave
Aurora CO 80045
Medical School: Albert Einstein College Of Medicine Of Yeshiva University - 1986
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 47204
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Dr. Daniel Hyman is associated with these group practices
Medical Malpractice Cases
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A trigger tool to detect harm in pediatric inpatient settings. - Pediatrics
An efficient and reliable process for measuring harm due to medical care is needed to advance pediatric patient safety. Several pediatric studies have assessed the use of trigger tools in varying inpatient environments. Using the Institute for Healthcare Improvement's adult-focused Global Trigger Tool as a model, we developed and pilot tested a trigger tool that would identify the most common causes of harm in pediatric inpatient environments.After formal training, 6 academic children's hospitals used this novel pediatric trigger tool to review 100 randomly selected inpatient records per site from patients discharged during the month of February 2012.From the 600 patient charts evaluated, 240 harmful events ("harms") were identified, resulting in a rate of 40 harms per 100 patients admitted and 54.9 harms per 1000 patient days across the 6 hospitals. At least 1 harm was identified in 146 patients (24.3% of patients). Of the 240 total events, 108 (45.0%) were assessed to have been potentially or definitely preventable. The most common patient harms were intravenous catheter infiltrations/burns, respiratory distress, constipation, pain, and surgical complications.Consistent with earlier rates of all-cause harm in adult hospitals, harm occurs at high rates in hospitalized children. Availability and use of an all-cause harm identification tool will establish the epidemiology of harm and will provide a consistent approach to assessing the effect of interventions on harms in hospitalized children.Copyright Â© 2015 by the American Academy of Pediatrics.
Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. - The journal of sexual medicine
Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men.This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol.The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years.Acute CVD event rate reduction and associated cost savings were modeled over 20 years.The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years.Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.Â© 2015 International Society for Sexual Medicine.
Structural and biochemical analyses of alanine racemase from the multidrug-resistant Clostridium difficile strain 630. - Acta crystallographica. Section D, Biological crystallography
Clostridium difficile, a Gram-positive, spore-forming anaerobic bacterium, is the leading cause of infectious diarrhea among hospitalized patients. C. difficile is frequently associated with antibiotic treatment, and causes diseases ranging from antibiotic-associated diarrhea to life-threatening pseudomembranous colitis. The severity of C. difficile infections is exacerbated by the emergence of hypervirulent and multidrug-resistant strains, which are difficult to treat and are often associated with increased mortality rates. Alanine racemase (Alr) is a pyridoxal-5'-phosphate (PLP)-dependent enzyme that catalyzes the reversible racemization of L- and D-alanine. Since D-alanine is an essential component of the bacterial cell-wall peptidoglycan, and there are no known Alr homologs in humans, this enzyme is being tested as an antibiotic target. Cycloserine is an antibiotic that inhibits Alr. In this study, the catalytic properties and crystal structures of recombinant Alr from the virulent and multidrug-resistant C. difficile strain 630 are presented. Three crystal structures of C. difficile Alr (CdAlr), corresponding to the complex with PLP, the complex with cycloserine and a K271T mutant form of the enzyme with bound PLP, are presented. The structures are prototypical Alr homodimers with two active sites in which the cofactor PLP and cycloserine are localized. Kinetic analyses reveal that the K271T mutant CdAlr has the highest catalytic constants reported to date for any Alr. Additional studies are needed to identify the basis for the high catalytic activity. The structural and activity data presented are first steps towards using CdAlr for the development of structure-based therapeutics for C. difficile infections.
Stasis dermatitis as a complication of recurrent levofloxacin-associated bilateral leg edema. - Dermatology online journal
Several drugs have been associated with the development of peripheral edema. Leg edema can result in dermatitis of the lower extremities. We describe levofloxacin-induced peripheral leg edema, which progressed to stasis dermatitis.A 76-year-old man with a history of esophageal adenocarcinoma was administered intravenous vancomycin and a combination of piperacillin and tazobactam by injection for treatment of aspiration pneumonia. Prior to discharge, the patient's antibiotic therapy was switched to oral levofloxacin. The patient developed drug-associated bilateral peripheral leg edema and stasis dermatitis. Both the dermatitis and leg edema resolved after withdrawal of levofloxacin and administration of topical corticosteroid therapy. The patient had a similar reaction to levofloxacin one year prior, which had subsided with discontinuation of the drug.Several medications have been documented to cause leg edema and secondary stasis dermatitis. The timing, recurrence, and resolution of edema and stasis dermatitis with respect to the administration and termination of levofloxacin suggest that the leg edema and stasis dermatitis occurred secondary to levofloxacin administration.Levofloxacin can be added to the list of drugs associated with the development of peripheral leg edema. Stasis dermatitis proceeded by lower extremity edema can be added to the list of adverse events associated with levofloxacin.
A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period. - Joint Commission journal on quality and patient safety / Joint Commission Resources
Handoff protocols from the cardiovascular operating room (CVOR) to the cardiac intensive care unit (CICU) can improve patient outcomes and delivery of care beyond the immediate postoperative period. In a prospective quality improvement study, a structured CVOR-to-CICU handoff protocol was implemented at a university-affiliated children's hospital. As a parallel project, an initiative to reduce unplanned extubations in the CICU was implemented.In a 41-month period, 1,507 neonates, infants, children, and adults were admitted to the CICU from the CVOR after undergoing a surgical procedure. The study was divided into a 17-month prehandoff-protocol period (January 2009-May 2010) and a 24-month posthandoff-protocol period (June 2010-May 2012). The handoff protocol was intended to streamline the handoff process from the CVOR and throughout the transition to the CICU. The specifics of the handoff, as outlined in a bedside laminated flowchart, included patient transport from the CVOR, the cardiovascular surgeon's report, the anesthesiologist's report, and the patient status summary and care plan.After introduction of the handoff protocol, there was a statistically significant and sustained reduction in the mean rate of unplanned extubations from 0.62 to 0.24 per 100 ventilator-days (p = .03). There was a statistically significant reduction in median ventilator time per patient--from 17 hours (interquartile range [IQR]: 5.3 to 57.7) to 12.8 hours (IQR: 4.8 to 31.8); p = .02). The mean rate of unplanned extubations was 0.26 in 2011 and 0.30 in 2012.Implementation of a handoff protocol from the CVOR to the CICU was associated with sustained decrease in unplanned extubations and in mean ventilator times.
Engaging patients and families in system-level improvement: a safety imperative. - Nursing administration quarterly
Health care organizations have focused considerable effort and resources on improving patient safety and health care quality. Yet, despite these efforts, patients continue to experience harm events within our institutions. Family engagement is a powerful and often untapped resource to improve the quality and safety of organizations. While the value patients and families bring as partners in improving the safety and quality of health care is implicitly recognized, the adoption of structures to actively involve health care consumers has been slow, particularly in organizational or overall system work. Patients and families can stimulate and drive improved health care services through their involvement at the clinical/point of care, policy/design, and governance levels of the organization. For successful implementation, organization leaders must establish family engagement as a system-level priority. Roles to support the development of a family engagement program, methods to evaluate the level of family engagement, and strategies to enhance and sustain family engagement are described. Although there is limited evidence-based knowledge related to the best practices for family engagement, opportunities exist to drive the family engagement agenda at a regional and national level through participation in networks such as the Centers for Medicare & Medicaid Services Partnership for Patients campaign Hospital Engagement Networks.
The use of patient pictures and verification screens to reduce computerized provider order entry errors. - Pediatrics
To determine whether an order verification screen, including a patient photograph, is an effective strategy for reducing the risk that providers will place orders in an unintended patient's electronic medical record (EMR).We describe several changes to the EMR/provider interface and ordering workflow that were implemented as one part of a hospital-wide quality improvement effort to improve patient identification and verification practices. We measured the impact by comparing the number of reported incidents of care being provided to any patient other than for whom it was intended before the intervention, and directly after the intervention.For the year before the interventions described herein, placement of orders in the incorrect patient's chart was the second most common cause of care being provided to the wrong patient, comprising 24% of the reported errors. In the 15 months after the implementation of an order verification screen with the patient's photo centrally placed on the screen, no patient whose picture was in the EMR was reported to have received unintended care based on erroneous order placement in his or her chart.The incorporation of patient pictures within a computerized order entry verification process is an effective strategy for reducing the risk that erroneous placement of orders in a patient's EMR will result in unintended care being provided to an incorrect patient.
A new framework for quality partnerships in Children's Hospitals. - Pediatrics
Children's hospitals and their affiliated departments of pediatrics often pursue separate programs in quality and safety; by integrating these programs, they can accelerate progress. Hospital executives and pediatric department chairs from 14 children's hospitals have been exploring practical approaches for integrating quality programs. Three components provide focus: (1) alignment of quality priorities and resources across the organizations; (2) education and training for physicians in the science of improvement; and (3) professional development and career progression for physicians in recognition of quality-improvement activities. Process and resource requirements are identified for each component, and specific, actionable steps are identified. The action steps are arrayed on a continuum from basic to advanced integration. The resulting matrix serves as an "integration framework," useful to a hospital and its pediatric academic department at any stage of integration for assessing its current state, plotting a path toward further integration, tracking its progress, and identifying potential collaborators and models of advanced integration. The framework contributes to health care's quality-improvement movement in multiple ways: it addresses a basic impediment to quality and safety improvement; it is an implementable model for integrating quality programs; it offers career-advancement potential for physicians interested in quality; it helps optimize investments in quality and safety; and it can be applied both within a single children's hospital and across multiple children's hospitals. Widespread adoption of the integration framework could have a transformative effect on the children's hospital sector, not the least of which is improved quality and safety on a large scale.
Quality improvement and patient safety in the pediatric ambulatory setting: current knowledge and implications for residency training. - Pediatric clinics of North America
The outpatient environment has been the leading edge of improvement work in pediatrics and it has similarly served as an effective locale for the training of pediatric residents in the science of improvement. This review summarizes what is known about the measurement of quality and patient safety in pediatric ambulatory settings. The current Accreditation Council for Graduate Medical Education (ACGME) requirements for resident training in improvement and their application in these settings are discussed. Some approaches and challenges to meeting these requirements are reviewed. Finally, some future directions that this work may follow are presented; the goal is to strengthen the effectiveness of improvement methods and their linkage to professional education.
Implementing a patient safety and quality program across two merged pediatric institutions. - Joint Commission journal on quality and patient safety / Joint Commission Resources
Academic centers are among the health care organizations that have used consolidation as a strategy to improve efficiency and reduce costs. In 1997, the New York Hospital and The Presbyterian Hospital underwent a full-asset merger to become New York City's largest medical center, known as the New York-Presbyterian Hospital (NYPH). In 2006, recognition of the challenges of the Children's Service Line at NYPH led to the formation of a Patient Safety and Quality Program to deliver consistently safe and effective health care.Each campus has a children's quality council, an interdisciplinary group that discusses and prioritizes safety and quality issues. The quality councils from each campus report directly to a bicampus children's quality steering committee formed to ensure that similar safety practices and standards are implemented across both children's hospitals. A safety subcommittee, which primarily coordinates and follows up on leadership safety walk rounds, and a significant-events subcommittee, which reviews morbidities and mortalities, report to each hospital's quality council.The bicampus pediatric quality and safety program is organized around five broad themes: improving the culture of safety, reducing the frequency of health care-acquired infections, reducing harm in the health care setting, using information technology to improve the quality and safety of care provided to patients and families, and measuring the effectiveness of care in key areas. Two sample initiatives--building family engagement and prevention of adverse medication events--illustrate the program's successes and challenges.Developing a pediatric safety and quality program across two campuses has been challenging but has led to important improvements at both organizations.
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13123 E 16Th Ave Aurora, CO 80045
12605 E 16Th Ave
13123 E 16Th Ave