Daily Round Checklists in ICU Setting Don't Reduce Mortality - The Hospitalist
The U.S. Food and Drug Administration has recommended avoidance of fluoroquinolone drugs, which are often used for patients ... Initiation of pulmonary rehabilitation after admission for COPD exacerbation decreases rehospitalizations. August 26, 2016. Ms ... Clinical question: Do checklists, daily goal assessments, and clinician prompts change in-hospital mortality for ICU patients? ... Analyses were adjusted for patients severity of illness and the ICUs adjusted mortality ratio. There was no significant ...
Eli Zimmerman | MDedge
Inpatient antiviral treatment reduces ICU admissions among influenza patients Author:. Eli Zimmerman Publish date: December 14 ... Majority of influenza-related deaths among hospitalized patients occur after discharge Author:. Eli Zimmerman Publish date: ... FVC deterioration signals increasing risk in rib fracture patients Author:. Eli Zimmerman Publish date: January 12, 2018 ... MSQC quality recommendations improve SSI in colectomy patients Author:. Eli Zimmerman Publish date: January 8, 2018 ...
Adult congenital heart disease guideline gets 10-year update, new classification system - The Hospitalist
"I think that is a more clinically relevant way to think about patients and patient evaluation management, and I commend the ... Rising meth-related heart failure admissions a crisis, costly for society. August 16, 2018. Theyre not going to die from it ... A normotensive patient with repaired coarctation of the aorta would be classified as IIA if she had normal end-organ function ... For example, one patient who has undergone a Fontan procedure may be fully functional, whereas another with nearly identical ...
Firearms and the Pediatrician - The Hospitalist
The Great Debate: ED vs Direct Admission. July 5, 2023. Each year, two million children are admitted to the hospital. Drs. ... Lee defined value as the sum of quality of care, equity, patient outcome, and experience divided by costs of care and ... Clinicians should actively screen all patients and families for access to firearms, and counseling should be focused on secure ... Leyenaar and McDaniel debated whether these patients should be admitted through the emergency department (ED) or directly. They ...
Adjustment for characteristics not used by Medicare reduces hospital variations in readmission rates - The Hospitalist
Bottom line: Hospitals serving higher-risk patients may be penalized because of the patients they serve rather that the quality ... Synopsis: Using Medicare claims for admission and linked U.S. census data, the study assessed several clinical and social ... Clinical question: Can differences in hospital readmission rates be explained by patient characteristics not accounted for by ... A sample of 1,169,014 index admissions among 1,003,664 unique beneficiaries was analyzed. The study compared rates with and ...
Treatment of heart failure with preserved ejection fraction is a work in progress | The Hospitalist
... in patients without diabetes and 9% in those with diabetes. ... "In patients with diabetes, there was a similar pattern. If you ... Most of the hospital admissions were because of chest infections, falls, and other frailty-linked causes. "This link between ... nor a difference in heart rate between the nondiabetic patients and patients with diabetes. However, among patients with heart ... "All 959 patients accounted for 20,517 days in the hospital over 5 years, which is the equivalent of 1 patient occupying a ...
Consent and DNR orders - The Hospitalist
Average cost savings per hospital admission were $3,237 overall and were even greater for cancer patients. ... A competent patients decision to forgo CPR is an example of self-determination or autonomy, which means that patients with ... Where a patient lacks capacity, a duly designated surrogate can legally make the medical decision on the patients behalf. ... When a terminally ill patient with a DNR order undergoes surgery, how should physicians deal with the patients no-code status ...
More Americans hospitalized, readmitted for heart failure | The Hospitalist
A single primary HF admission occurred in 5,092,626 unique patients and 1,269,109 had two or more HF hospitalizations. The mean ... Rates of unique patient visits for HF were also on the way down - falling from 3.4 in 2010 to 3.2 in 2013 and 2014 - before ... Half of all patients had coronary artery disease at both time points. Renal disease shot up from 45.9% to 60.6% by 2017. ... Patient race and ethnicity data also were not available.. "Future studies are needed to verify our findings to better develop ...
In those with obesity, will losing weight cut COVID-19 severity? - The Hospitalist
Patients were a mean age of 51 years, had a mean BMI of 29.4, and 39% had obesity. Patients who required hospitalization were ... Obesity was a significant risk factor for hospitalization (odds ratio, 1.7), ICU admission (OR, 1.8), and intubation (OR, 1.8; ... Jirapinyo said she is not aware of any such studies, but anecdotally, two of her patients who had endoscopic sleeve ... "Recently, some metabolic and bariatric centers have seen an increase in patients considering surgery," he said. "Some say that ...
Mortality higher in older adults hospitalized for IBD | The Hospitalist
"Given the high prevalence of IBD patients that require inpatient admission, as well as the rapidly aging nature of the U.S. ... In their study, the researchers identified 162,800 hospital admissions for Crohns disease and 96,450 admissions for ulcerative ... The total hospital length of stay was significantly longer for geriatric patients, compared with younger patients with Crohns ... The total charges also were significantly higher among geriatric Crohns disease patients, compared with younger patients ( ...
JOHN NELSON: Morning Discharges and Length of Stay - Page 2 of 2 - The Hospitalist
Example: "The patient has fever and low sats, so I know hes going to be admitted. Why should I keep him in the ED to do a ... Well, wont this increase marginal or unnecessary admissions and readmissions, and lead to overall increased hospital ... In fact, I think we should move away from using the ED as a triage unit and send some patients directly from ED triage to the ... So the time of day a discharge order is written, arguably the most important determinant of when a patient will vacate a room, ...
Eye of the Storm - Page 4 of 5 - The Hospitalist
Our hospital census during this period was at 60% of usual and the admission was running at 40% of normal. We decreased the ... We had never been so proud of the efforts of every individual in our institution for maintaining this facility for patient care ... During the Sunday ad-hoc church service at Ochsner, doctors, nurses, employees, patients, and families came together in ... we hospitalists unanimously agreed to care for our patients 24/7 in weekly rotation. ...
COVID-19 mortality rates declined, but vary by hospital | The Hospitalist
Overall, 3179 patients (8.25%) died, and 1433 patients (3.7%) were referred to hospice. Risk-standardized mortality or hospice ... In addition, variation between hospitals could reflect differences in quality or different admission thresholds, they continue. ... "Steroids may decrease mortality in patients with respiratory failure. Remdesivir may shorten hospitalizations of patients with ... In a subset of 398 hospitals that had at least 10 patients admitted for COVID-19 during early (January 1 through April 30) and ...
ONLINE EXCLUSIVE: Weighing the Costs of Palliative Care - The Hospitalist
... decided to see the patient in person and review his charts. He found that the patient had severe dementia, hadnt walked in ... Do physician orders for life-sustaining treatment correlate with ICU admissions and invasive life-sustaining treatment at the ... Mitchell called the patients son and explained the situation, then asked whether the son thought his father would want to ... Hospitalists, he says, are in an ideal position to step up and play a pivotal role in providing the kind of patient-centered ...
Azithromycin for COPD exacerbations may reduce treatment failure - The Hospitalist
In the study, 301 COPD patients hospitalized with an acute exacerbation were randomized within 48 hours of admission to ... In patients with COPD, "azithromycin initiated in the acute setting and continued for 3 months appears to be safe and ... PARIS - In patients with a chronic obstructive pulmonary disease (COPD) exacerbation, initiating azithromycin at the time of ... It is notable that the design for the BACE trial called for 500 patients. When enrollment was slow, the design was changed on ...
Physician Dashboards, Pay-for-Performance Deliver Better VTE Prophylaxis Rates - The Hospitalist
The study analyzed 3,144 inpatient admissions at a tertiary-care medical center from 2009 to 2012. During the dashboard-only ... Michtalik, associate faculty and international consultant at the Armstrong Institute for Patient Safety and Quality at Johns ...
Better Reporting Needed to Accurately Estimate Medical Error as Cause of Death in U.S. | The Hospitalist
Hospital Admission, Stroke Clinic Follow-up Improve Outcomes for Patients with Transient Ischemic Attack, Minor Ischemic Stroke ... Background: Medical error can contribute to patient mortality. Currently, the annual list of the most common causes of death in ... Chronically interrupted: The importance of communication with patient and family during the COVID-19 pandemic Publish date: ... Chronically interrupted: The importance of communication with patient and family during the COVID-19 pandemic Publish date: ...
10 Things Hospitalists Need to Know about Palliative Care - Page 4 of 4 - The Hospitalist
High-flow nasal cannula improves dyspnea in palliative care patients with respiratory failure. October 19, 2016. Does a high- ... Do physician orders for life-sustaining treatment correlate with ICU admissions and invasive life-sustaining treatment at the ... Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. ... Does palliative care consultation improve perception of care for high-risk surgery patients? ...
COVID-19: Another study links colchicine to better results | The Hospitalist
Patients in the colchicine group needed supplemental oxygen for less time: Their median time of need was 4.0 days ( ... "evaluate the capacity of colchicine to avoid admission to ICU and reduce mortality." ... Most patients, about two-thirds in both groups, also received methylprednisolone because they needed higher amounts of ... 47% in the colchicine group, P = .34). All 72 patients received the same COVID-19 treatment at the time of the trial: ...
Providing Effective Palliative Care in the Era of Value | The Hospitalist
An important area to pay particular attention to is the role of future hospitalizations in patients wishes for care ... Identify patients who would benefit from palliative care. The surprise question-"Would I be surprised if this patient died in ... Weisman and Meier suggest using the following in a checklist at the time of hospital admission as "primary criteria to screen ... In one observation from a group of patients with cancer, a "no" answer identified 60% of patients who died within a year.6 The ...
Resident Handoff Program Associated with Improved Inpatient Outcomes - The Hospitalist
18.8 per 100 admissions; P,0.001), a 30% reduction in preventable adverse events (4.7 vs. 3.3 events per 100 admissions; P, ... Background: Communication failure at the time of handoff of patient care from one resident to another is a significant cause of ... Synopsis: The study team evaluated the impact of the I-PASS Handoff Bundle (illness severity, patient summary, action items, ... Clinical question: Does the implementation of a handoff program lead to improved patient safety? ...
GALACTIC-HF: Novel drug most effective in sickest HFrEF patients - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... In GALACTIC-HF, 8,256 HFrEF patients with LVEF 35% or less were randomized to omecamtiv mecarbil or placebo. The primary ... When incidence rate per 100 patient years was graphed against the range of LVEF, the relative advantage of omecamtiv mecarbil ... Importantly, there is a particular need for new treatment options in patients with advanced LVEF, according to Dr. Teerlink, ...
Short Takes - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure. J Am Coll Cardiol. 2017 Jun 27;69 ... This prospective multicenter observational trial showed that if intravenous furosemide was administered to patients with acute ...
Optimizing screening for asymptomatic Afib - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... Synopsis: Patients over the age of 70 years, with at least one stroke risk factor, were monitored over the course of 3 years ... Background: Afib is often asymp-tomatic until a patient presents with an acute stroke. Current screening strategies for Afib ... Comprehensive evaluation of rhythm monitoring strategies in screening for atrial fibrillation: Insights from patients at risk ...
7 Hours of Sleep Can Reduce Heart Disease - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... "For doctors, it can be helpful to evaluate sleep duration and sleep quality when assessing the health status of their patients ...
Lower risk of ICH with dabigatran as compared to warfarin in atrial fibrillation - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... Synopsis: In 25,289 propensity score-matched pairs of commercially insured patients aged 21 years or older starting dabigatran ... Also, subgroup analyses demonstrated higher rates of gastrointestinal bleeding with dabigatran than did warfarin in patients ... in patients with atrial fibrillation; however, few of these have been on populations generalizable to clinical practice. ...
Abnormal exercise EKG in the setting of normal stress echo linked with increased CV risk - The Hospitalist
... more than 6 million Americans are living with heart failure-the leading cause of hospital admission in patients aged 65 and ... Bottom line: Patients with +EKG/-Echo findings appear to be at higher risk of adverse cardiac events, especially in the short ... Of those patients, 8.5% had +EKG/-Echo results, which was associated with annualized event rate of adverse cardiac events of ... Synopsis: 47,944 patients without known coronary artery disease underwent exercise stress echocardiogram (Echo) with stress EKG ...
Short Takes - The Hospitalist
Oxygen therapy in patients with acute myocardial infarction: A systemic review and meta-analysis. Am J Med. 2018 Jun;131(6):693 ... The analysis may have limitations for multiple admissions being counted several times, underestimation of prevalence of acute ... Routine oxygen therapy in patients with acute MI with normal oxygen saturation levels has no benefit ... Digoxin and mortality in patients with atrial fibrillation. J Am Coll Cardiol. 2018 Mar 13;71(10):1063-74. ...
Status Report - The Hospitalist
An annual average of 10 weeks of protected non-direct patient-care time per hospitalist is offered at 52% percent of programs; ... Measures of success include length of stay, relative value units and service workload, teaching evaluations, admission and ... as well as how they are incorporated into patient care and how they are funded by member hospitals. The benchmarking project ... including co-management of surgical patients. The direction of change differed by the age of the program and the hospitalist ...
The AIDS Divide - The Hospitalist
"According to the CDC, a large number of newly diagnosed HIV patients have no risk factor at all [other than sexual contact with ... maybe as an inclusion on a general admission form or as a prompt during computerized physician order entry (CPOE)," Dr. Mathew ... Patients on highly active antiretroviral therapy (HAART) live long enough to develop common age-related illnesses. Those ... There can be certain things in a patients profile that trigger you to think about testing for HIV, such as lymphopenia, ...