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Inpatient teaching unit

Savannah Norman, Frank DeCicco, Jennifer Sampson, Ian M Fraser
OBJECTIVES: Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN: Quality improvement before-after unblinded trial. SETTING: 430-bed Canadian community teaching hospital. PARTICIPANTS: All admitted adult medical-surgical patients in a before-after 12-month interventional study...
December 14, 2018: BMJ Open
Ruchika Goel, Eshan U Patel, Jodie L White, Meera R Chappidi, Paul M Ness, Melissa M Cushing, Clifford M Takemoto, Beth H Shaz, Steven M Frank, Aaron A R Tobian
BACKGROUND: Demographic and hospital-level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized. METHODS: We conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally-representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes...
December 12, 2018: Transfusion
Thomas S Metkus, Steven P Schulman, Joseph E Marine, Shaker M Eid
BACKGROUND: The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established. METHODS: To determine the current incidence of pericardial complications and the outcomes of patients undergoing TTP, we performed an analysis using the National Inpatient Sample (NIS), which is a US national database of hospital admissions. We identified all patients who underwent TTP using ICD-9 codes. We constructed a multivariate logistic regression model for a primary outcome of pericardial tamponade and another for a primary outcome of in-hospital mortality...
December 10, 2018: Chest
Zubair Shah, Venkat Vuddanda, Aniket S Rali, Hema Pamulapati, Reza Masoomi, Kamal Gupta
AIM: The aim of this study is to report recent trends in the performance of endomyocardial biopsy (EMB) and its in-hospital complications (and their predictors) in the United States (US). METHOD: We analyzed Nationwide Inpatient Sample (NIS) database from years 2007 through 2014 to identify patients who underwent EMB. Once identified, the patients were subdivided into those with no history of heart transplant (HT) (cohort 1) and those with history of HT (cohort 2)...
December 5, 2018: Cardiology
Koray K Demir, Matthew P Cheng, Todd C Lee
INTRODUCTION AND OBJECTIVE: Diagnostic testing for Clostridioides difficile infection (CDI) by nucleic acid amplification test (NAAT) cannot distinguish between colonization and infection. A positive NAAT may therefore represent a false positive for infection, since diarrhea due to various aetiologies may occur in hospitalized patients. Our objective was to help answer the question: "does this medical inpatient with diarrhea have CDI?" DESIGN: We conducted a retrospective cohort study (n = 248) on the Clinical Teaching Units of the Royal Victoria Hospital (Montréal, Canada)...
2018: PloS One
Martha Quinn, Jane Forman, Molly Harrod, Suzanne Winter, Karen E Fowler, Sarah L Krein, Ashwin Gupta, Sanjay Saint, Hardeep Singh, Vineet Chopra
Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication. Methods We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis...
November 29, 2018: Diagnosis
Martha Rider Sleutel, Barbara True, Heidi Gustus, Kathy Baldwin, Brandi Early
PURPOSE: To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative. DESIGN AND METHODS: This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs...
November 2018: Journal of Pediatric Nursing
Jeffrey Cheng, Beiyu Liu, Alfredo E Farjat, Jonathan Routh
OBJECTIVE: Identify risk factors associated with airway foreign bodies in children in the United States and report observed trends over time. DATA SOURCE: KID database (2000-2009). METHODS: ICD-9-CM codes for airway foreign bodies were used to identify patients. Risk factors were used for univariate analysis and a multivariate model to identify any increased risk of mortality. These factors were then also trended over time. RESULTS: Children with airway foreign bodies demonstrate similar risk factors as previously reported, such as male gender, age less than five years old, and lack of private insurance...
November 18, 2018: Clinical Otolaryngology
Gil Shechter Maor, Nicholas Czuzoj-Shulman, Andrea R Spence, Haim Arie Abenhaim
BACKGROUND: As the age at first pregnancy continues to rise in the United States so does the incidence of breast cancer diagnosed during pregnancy. Our objective was to evaluate temporal trends in the incidence of pregnancy-associated breast cancer (PABC) and to measure neonatal outcomes associated with PABC. METHODS: We conducted a population-based cohort study using the 1999-2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from the United States...
November 12, 2018: Breast Journal
Tomo Ando, Oluwole Adegbala, Pedro A Villablanca, Alexandros Briasoulis, Hisato Takagi, Cindy L Grines, Theodore Schreiber, Tamim Nazif, Susheel Kodali, Luis Afonso
OBJECTIVES: To assess the in-hospital outcomes of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in non-teaching hospitals. BACKGROUND: TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non-teaching hospitals are largely under explored. METHODS: We queried the Nationwide Inpatient Sample database from 2011 to September 2015 to identify those who were 50 years or above and underwent either trans-arterial TAVR or SAVR at non-teaching hospital...
November 8, 2018: Catheterization and Cardiovascular Interventions
Lauren M Foster, Monica M Cuddy, David B Swanson, Kathleen Z Holtzman, Maya M Hammoud, Paul M Wallach
PURPOSE: An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined. METHOD: An online survey about health record use within the inpatient component of six core clerkships was administered to medical students after they completed Step 2 Clinical Knowledge of the United States Medical Licensing Examination...
November 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Yi-Le Wu, Xi-Yao Yang, Meng-Shu Pan, Ruo-Jie Li, Xiao-Qian Hu, Jing-Jing Zhang, Li-Qi Yang
Healthcare-associated infections (HAIs) are a major worldwide public-health problem, but less data are available on the long-term trends of HAIs and antimicrobial use in Eastern China. This study describes the prevalence and long-term trends of HAIs and antimicrobial use in a tertiary care teaching hospital in Hefei, Anhui, China from 2010 to 2017 based on annual point-prevalence surveys. A total of 12 505 inpatients were included; 600 HAIs were recorded in 533 patients, with an overall prevalence of 4.26% and a frequency of 4...
October 25, 2018: Epidemiology and Infection
Baiju R Shah, Sakina Walji, Alexander Kiss, Jacqueline E James, Julia M Lowe
OBJECTIVES: We sought to develop the Hypoglycemia During Hospitalization (HyDHo) scoring system, to predict the risk for hypoglycemia during hospitalization in patients with diabetes at the time of admission to a general medical unit. METHODS: We randomly selected 300 patients with diabetes who had been admitted to a medical inpatient unit at a teaching hospital. Hypoglycemia was defined as any point-of-care glucose test result ≤3.9 mmol/L. Demographic and clinical predictors of hypoglycemia were identified through review of the hospitalization record...
August 10, 2018: Canadian Journal of Diabetes
Samaher Sweity, Andrew Finlay, Charlotte Lees, Adam Monk, Toshi Sherpa, Derick Wade
OBJECTIVE: To determine the short-term effects of supplying hospital inpatients with earplugs and eye masks, preparatory to a full-scale trial. DESIGN: A single-centre, open-label, two-arm, parallel group, randomized-controlled trial. SETTING: A total of 13 medical and surgical wards in a large teaching hospital in the United Kingdom. PARTICIPANTS: Everyone admitted to hospital aged 18 years or older, who stayed overnight and had the mental capacity and sufficient understanding of English to give consent, the ability to complete the study questionnaire and the ability to use earplugs and eye masks unaided was considered...
October 15, 2018: Clinical Rehabilitation
Sarah Burm, Lisa Faden, Sandy DeLuca, Kathy Hibbert, Noureen Huda, Mark Goldszmidt
Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice-patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds-also play a role in how care is shaped...
October 15, 2018: Journal of Interprofessional Care
Leen Khoury, David A Hill, Melissa Panzo, Melissa Chiappetta, Sachin Tekade, Stephen M Cohn
OBJECTIVE: Upper gastrointestinal (GI) bleeding occurs at a rate of 40-150 episodes per 100,000 persons per year and is associated with a mortality rate of 6%-10%. We sought to determine the need for therapeutic endoscopy or surgical interventions in patients with hematemesis and the association with blood transfusion requirements. METHODS: We queried the database of our large teaching facility for adult patients presenting with obvious upper GI hemorrhage (hematemesis) between 2014 and 2017...
July 23, 2018: Curēus
Michael J Stentz, Mary E Kelley, Craig S Jabaley, Vikas O'Reilly-Shah, Robert F Groff, Vanessa Moll, James M Blum
The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly in recent years. We sought to describe the rate of ECMO use in the United States, regional variation in ECMO use, the hospitals performing ECMO, and the primary payers for ECMO patients. Detailed data were obtained using the Healthcare Cost and Utilization Project (HCUPnet) summaries of State Inpatient Databases from 34 participating states for the years 2011-2014. The ECMO rates over time were modeled, overall and within subcategories of age group, bed size, hospital ownership, teaching status, and payer type...
September 19, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Lorna Renner, Shivani Shah, Nickhill Bhakta, Avram Denburg, Sue Horton, Sumit Gupta
PURPOSE: No published study to date has examined total cost and cost-effectiveness of maintaining a pediatric oncology treatment center in an African setting, thus limiting childhood cancer advocacy and policy efforts. METHODS: Within the Korle Bu Teaching Hospital in Accra, Ghana, costing data were gathered for all inputs related to operating a pediatric cancer unit. Cost and volume data for relevant clinical services (eg, laboratory, pathology, medications) were obtained retrospectively or prospectively...
September 2018: Journal of Global Oncology
Zaid Al-Qurayshi, Sarah M Baker, Meghan Garstka, Christopher Ducoin, Mary Killackey, Ronald L Nichols, Emad Kandil
BACKGROUND: Post-operative infection (POI) is a serious complication in all surgical disciplines and can derail a patient's treatment and recovery course. In this analysis, we examine national trends, risk factors, and costs associated with POI. METHODS: Using the Nationwide Inpatient Sample (NIS) for the years available for data analysis at the time of this study (2003-2010), we performed a cross-sectional study of adult (≥18 years) inpatients with POI and designated Clinical Classification Software (CCS) procedural class codes for the operations performed...
October 2018: Surgical Infections
Adam E M Eltorai, Grayson L Baird, Joshua Pangborn, Ashley Szabo Eltorai, Valentin Antoci, Katherine Paquette, Kevin Connors, Jacqueline Barbaria, Kimberly J Smeals, Barbara Riley, Shyam A Patel, Saurabh Agarwal, Terrance T Healey, Corey E Ventetuolo, Frank W Sellke, Alan H Daniels
Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
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