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Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine

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https://www.readbyqxmd.com/read/30156583/beyond-reporting-early-warning-score-sensitivity-the-temporal-relationship-and-clinical-relevance-of-true-positive-alerts-that-precede-critical-deterioration
#1
Meredith C Winter, Sherri Kubis, Christopher P Bonafide
BACKGROUND: Clinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts. OBJECTIVE: (1) Evaluate the timing of pRI alerts and clinicians recognizing deterioration or escalating care prior to critical deterioration events (CDEs) and (2) determine whether the parameters triggering alerts were clinically related to deterioration...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156582/who-consults-us-and-why-an-evaluation-of-medicine-consult-comanagement-services-at-academic-medical-centers
#2
Emily S Wang, Christopher Moreland, Michael Shoffeitt, Luci K Leykum
Although general medicine consultation is an integral component of inpatient medical care and a requirement of internal medicine training, little is known about current consultative practice. We used a cross-sectional, prospective survey design to examine current practices at 11 academic medical centers over four two-week periods from July 2014 through July 2015. Out of 11 consult services, four had comanagement agreements with surgical services, primarily with orthopedic surgery. We collected data regarding 1,264 consultation requests...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156581/a-model-to-improve-hospital-based-palliative-care-the-palliative-care-redistribution-integrated-system-model-prism
#3
Nauzley C Abedini, Vineet Chopra
Many hospitalized patients have unmet palliative care needs that are exacerbated by gaps in the palliative care subspecialty workforce. Training frontline physicians, including hospitalists, to provide primary palliative care has been proposed as one solution to this problem. However, improving palliative care access requires more than development of the physician workforce. Systemlevel change and interdisciplinary approaches are also needed. Using task shifting as a guiding principle, we propose a new workforce framework (the Palliative care Redistribution Integrated System Model, or PRISM), which utilizes physician and nonphysician providers and resources to their maximum potential...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156580/routine-chest-radiographs-after-uncomplicated-thoracentesis
#4
Michael J Lenaeus, Amanda Shepard, Andrew A White
No abstract text is available yet for this article.
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156579/identifying-observation-stays-in-medicare-data-policy-implications-of-a-definition
#5
Ann M Sheehy, Fangfang Shi, Amy J H Kind
Observation stays are increasingly common, yet no standard method to identify observation stays in Medicare claims is available, including events with status change. To determine the claims patterns of Medicare observation stays, define comprehensive claims-based methodology for future Medicare observation research and data reporting, and identify policy implications of such definition, we identified potential observation events in a 2014 20% random sample of Medicare beneficiaries with both Part A and B claims and at least 1 acute care stay (1,667,660 events)...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156578/smoking-cessation-after-hospital-discharge-factors-associated-with-abstinence
#6
Joanna M Streck, Yuchiao Chang, Hilary A Tindle, Susan Regan, Elyse R Park, Douglas E Levy, Daniel E Singer, Thomas Ylioja, Nancy A Rigotti
Hospitalization offers tobacco smokers an opportunity to quit smoking, but factors associated with abstinence from tobacco after hospital discharge are poorly understood. We analyzed data from a multisite, randomized controlled trial testin a smoking cessation intervention for 1,357 hospitalized cigaretts smokers who planned to quit. Using multiple logistic regression, we assessed factors identifiable in the hospital that were independently associated with biochemically confirmed tobacco abstinence 6 months after discharge...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156577/electronic-order-volume-as-a-meaningful-component-in-estimating-patient-complexity-and-resident-physician-workload
#7
Nicole Van Groningen, Priya A Prasad, Nader Najafi, Alvin Rajkomar, Raman R Khanna, Margaret C Fang
BACKGROUND: Though patient census has been used to describe resident physician workload, this fails to account for variations in patient complexity. Changes in clinical orders captured through electronic health records may provide a complementary window into workload. We aimed to determine whether electronic order volume correlated with measures of patient complexity and whether higher order volume was associated with quality metrics. METHODS: In this retrospective study of admissions to the internal medicine teaching service of an academic medical center in a 13-month period, we tested the relationship between electronic order volume and patient level of care and severity of illness category...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156576/an-electronic-health-record-tool-designed-to-improve-pediatric-hospital-discharge-has-low-predictive-utility-for-readmissions
#8
Mark S Brittan, Sara Martin, Leslie Anderson, Angela Moss, Michelle R Torok
We developed an electronic health record tool to improve pediatric hospital discharge. This tool flags children with three components that might complicate discharge: home health, polypharmacy (greater than or equal to 6 medications), or nonEnglish speaking caregiver. The tool tallies components and displays them as a composite score of 0-3 points. We describe the tool's development, implementation, and an evaluation of its predictive utility for 30-day unplanned readmissions in 29,542 discharged children. Of these children, 28% had a composite score of 1, 8% a score greater than or equal to 2, and 4% were readmitted...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156575/estimating-the-accuracy-of-dobutamine-stress-echocardiography-and-single-photon-emission-computed-tomography-among-patients-undergoing-noncardiac-surgery
#9
Matthew A Pappas, Andrew D Auerbach
When cardiac stress testing is ordered prior to noncardiac surgery, the optimal test modality is unknown. Therefore, we conducted this study to compare the diagnostic accuracy of dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) in a representative sample of patients undergoing noncardiac surgery without an existing diagnosis of coronary artery disease (CAD). The predicted accuracy of DSE was greater than that of SPECT in around 60.5% of cases above the current guideline-recommended risk threshold...
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30156574/the-continued-quest-for-pediatric-readmission-risk-prediction
#10
Lauren G Solan, Katherine A Auger
No abstract text is available yet for this article.
August 29, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29964278/impact-of-clinical-specialty-on-attitudes-regarding-overuse-of-inpatient-laboratory-testing
#11
Deborah Korenstein, Solomon Husain, Renee L Gennarelli, Cilian White, James N Masciale, Benjamin R Roman
Routine laboratory testing is common among hospitalized patients, with associated harm. Attitudes toward testing and drivers across clinical specialties have not been described. We performed a cross-sectional study and anonymously surveyed inpatient clinicians (nurses, advanced practice providers, and physicians) at a tertiary cancer center regarding attitudes toward unnecessary laboratory testing and its drivers across clinical specialties. A total of 837 providers completed surveys (response rate 53%). Most respondents agreed with daily testing of hospitalized patients and that daily labs generally enhance safety, and those from pediatric and surgical specialties generally valued testing less than others...
June 27, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29964277/pediatric-hospitalist-workload-and-sustainability-in-university-based-programs-results-from-a-national-interview-based-survey
#12
H Barrett Fromme, Christina O Chen, Bryan R Fine, Craig Gosdin, Erin E Shaughnessy
Wide variability exists in the clinical workload of pediatric hospitalists without an accepted standard for benchmarking purposes. By using data obtained from interviews of pediatric hospital medicine (PHM) program leaders, we describe the clinical workload of university-based programs and report on the program sustainability perceived by PHM program leaders. The median clinical hours reported for a full-time pediatric hospitalist were 1800 hours per year, with a median of 15 weekends worked per year. Furthermore, program leaders reported an ideal number of clinical hours as 1700 hours per year...
June 27, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29964276/the-association-of-inpatient-occupancy-with-hospital-acquired-clostridium-difficile-infection
#13
Mahshid Abir, Jason Goldstick, Rosalie Malsberger, Claude M Setodji, Sharmistha Dev, Neil Wenger
Few studies have evaluated the relationship between high hospital occupancy and hospital-acquired complications. We evaluated the association between inpatient occupancy and hospital-acquired Clostridium difficile infection (CDI) using a novel measure of hospital occupancy. We analyzed administrative data from California hospitals from 2008-2012 for Medicare recipients aged 65 years with a discharge diagnosis of acute myocardial infarction, heart failure, or pneumonia. Using daily census data, we constructed patient-level measures of occupancy on admission day and average occupancy during hospitalization (range: 0-1), which were split into 4 groups...
June 27, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30157287/things-we-do-for-no-reason-the-default-use-of-hypotonic-maintenance-intravenous-fluids-in-pediatrics
#14
Alan M Hall, Juan C Ayus, Michael L Moritz
No abstract text is available yet for this article.
September 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30157286/a-tough-egg-to-crack
#15
Rabih M Geha, Gurpreet Dhaliwal, Marion G Peters, Reza Manesh
No abstract text is available yet for this article.
September 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30157285/fyi-this-message-will-interrupt-you-texting-impact-on-clinical-learning-environment
#16
Irsk Anderson, Vineet M Arora
No abstract text is available yet for this article.
September 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/30157284/healthy-skepticism-and-due-process
#17
Kevin T Powell, Lisa B Zaoutis
No abstract text is available yet for this article.
September 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29694460/development-of-hospitalization-resource-intensity-scores-for-kids-h-risk-and-comparison-across-pediatric-populations
#18
Troy Richardson, Jonathan Rodean, Mitch Harris, Jay Berry, James C Gay, Matt Hall
BACKGROUND: In the Medicare population, measures of relative severity of illness (SOI) for hospitalized patents have been used in prospective payment models. Similar measures for pediatric populations have not been fully developed. OBJECTIVE: To develop hospitalization resource intensity scores for kids (H-RISK) using pediatric relative weights (RWs) for SOI and to compare hospital types on case-mix index (CMI). DESIGN/METHODS: Using the 2012 Kids' Inpatient Database (KID), we developed RWs for each All Patient Refined Diagnosis Related Group (APR-DRG) and SOI level...
September 1, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29694456/a-matter-of-urgency-reducing-clinical-text-message-interruptions-during-educational-sessions
#19
Arielle Mendel, Anthony Lott, Lisha Lo, Robert Wu
BACKGROUND: Text messaging is increasingly replacing paging as a tool to reach physicians on medical wards. However, this phenomenon has resulted in high volumes of nonurgent messages that can disrupt the learning climate. OBJECTIVE: Our objective was to reduce nonurgent educational interruptions to residents on general internal medicine. DESIGN, SETTING, PATIENTS: This was a quality improvement project conducted at an academic hospital network...
September 1, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29578550/training-residents-in-hospital-medicine-the-hospitalist-elective-national-survey
#20
Steven Ludwin, James D Harrison, Sumant Ranji, Bradley A Sharpe, Patrick Kneeland
As the field of hospital medicine expands, internal medicine residency programs can play a role in preparing future hospitalists. To date, little is known of the prevalence and characteristics of hospitalist-focused resident rotations. We surveyed the largest 100 Internal Medicine Residency Programs to better understand the prevalence, objectives, and structure of hospitalist-focused rotations in the United States. Residency leaders from 82 programs responded (82%). The prevalence of hospitalist-focused rotations was 50% (41/82) with an additional 9 programs (11%) planning to start one...
September 1, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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