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https://www.readbyqxmd.com/read/27898253/establishing-equipoise-national-survey-of-the-treatment-of-pediatric-para-pneumonic-effusion-and-empyema
#1
Morgan K Richards, Jarod P Mcateer, Todd C Edwards, Lucas R Hoffman, Matthew P Kronman, Dennis W Shaw, Adam B Goldin
BACKGROUND: Despite six randomized trials of various treatments for pediatric para-pneumonic effusion (PPE), management approaches differ. The purpose of this study was to gain insight into opinions on PPE treatment with the goal of designing a definitive trial to generate consensus intervention guidelines. METHODS: To evaluate physician opinions regarding PPE management, we developed a survey based on input from a nationwide, multi-disciplinary advisory group that established content validity...
November 29, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27811162/pediatric-medication-safety-in-adult-community-hospital-settings-a-glimpse-into-nationwide-practice
#2
Francisco Alvarez, Lana Ismail, Allison Markowsky
BACKGROUND AND OBJECTIVES: Most children in the United States are treated in adult settings. Studies show that the pediatric population is vulnerable to medication errors. It can be extrapolated that children cared for in adult settings are at equal or higher risk for errors. The goal of this study was to assess the existing pediatric medication safety infrastructure within adult hospitals. METHODS: Questionnaire developed through Research Electronic Data Capture (REDCap) and distributed to pediatric hospitalist programs listed on the American Academy of Pediatrics, Section on Hospital Medicine web site and members of the American Academy of Pediatrics Quality Improvement Innovation Networks listserv...
November 3, 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27805799/early-detection-of-critical-illness-outside-the-intensive-care-unit-clarifying-treatment-plans-and-honoring-goals-of-care-using-a-supportive-care-team
#3
Russ Granich, Zoe Sutton, Yan S Kim, Megan Anderson, Helen Wood, John E Scharf, Arona Ragins, Gabriel J Escobar
Given the high mortality experienced by patients who deteriorate outside the intensive care unit, issues related to patient preferences around escalation of care are common. However, the literature on early warning systems (EWSs) provides limited information on how respecting patient preferences can be incorporated into clinical workflows. In this report, we describe how we developed workflows for integrating supportive care with an automated EWS in the context of a 2-hospital pilot. We used the Institute for Healthcare Improvement's Plan-Do-Study-Act approach to achieve consensus with clinicians and administrators...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27805798/incorporating-an-early-detection-system-into-routine-clinical-practice-in-two-community-hospitals
#4
B Alex Dummett, Carmen Adams, Elizabeth Scruth, Vincent Liu, Margaret Guo, Gabriel J Escobar
Efforts to improve outcomes of patients who deteriorate outside the intensive care unit have included the use of rapid response teams (RRTs) as well as manual and automated prognostic scores. Although automated early warning systems (EWSs) are starting to enter clinical practice, there are few reports describing implementation and the processes required to integrate early warning approaches into hospitalists' workflows. We describe the implementation process at 2 community hospitals that deployed an EWS. We employed the Institute for Healthcare Improvement's iterative Plan-Do-Study-Act approach...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27805795/piloting-electronic-medical-record-based-early-detection-of-inpatient-deterioration-in-community-hospitals
#5
Gabriel J Escobar, Benjamin J Turk, Arona Ragins, Jason Ha, Brian Hoberman, Steven M LeVine, Manuel A Ballesca, Vincent Liu, Patricia Kipnis
Patients who deteriorate in the hospital outside the intensive care unit (ICU) have higher mortality and morbidity than those admitted directly to the ICU. As more hospitals deploy comprehensive inpatient electronic medical records (EMRs), attempts to support rapid response teams with automated early detection systems are becoming more frequent. We aimed to describe some of the technical and operational challenges involved in the deployment of an early detection system. This 2-hospital pilot, set within an integrated healthcare delivery system with 21 hospitals, had 2 objectives...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27798226/development-of-a-high-value-care-culture-survey-a-modified-delphi-process-and-psychometric-evaluation
#6
Reshma Gupta, Christopher Moriates, James D Harrison, Victoria Valencia, Michael Ong, Robin Clarke, Neil Steers, Ron D Hays, Clarence H Braddock, Robert Wachter
BACKGROUND: Organisational culture affects physician behaviours. Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists. We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by healthcare leaders and training programmes to target future improvements in value-based care. METHODS: We conducted a two-phase national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds...
October 26, 2016: BMJ Quality & Safety
https://www.readbyqxmd.com/read/27777662/rounds-today-a-qualitative-study-of-internal-medicine-and-pediatrics-resident-perceptions
#7
Raphael Rabinowitz, Jeanne Farnan, Oliver Hulland, Lisa Kearns, Michele Long, Bradley Monash, Priti Bhansali, H Barrett Fromme
BACKGROUND : Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. OBJECTIVE : To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. METHODS : In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals...
October 2016: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/27750328/annals-for-hospitalists-inpatient-notes-reducing-diagnostic-error-a-new-horizon-of-opportunities-for-hospital-medicine
#8
Hardeep Singh, Laura Zwaan
No abstract text is available yet for this article.
October 18, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27729677/risk-factors-for-bleeding-in-hospitalized-patients-with-elevated-inr-no-vitamin-k-therapy-received-versus-vitamin-k-received
#9
Monique Mounce, Candace Essel, Tiffany Kim, Che Matthew Harris
BACKGROUND: Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. METHODS: A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K...
November 2015: Hospital Pharmacy
https://www.readbyqxmd.com/read/27664087/current-roles-and-perceived-needs-of-pediatric-hospital-medicine-fellowship-graduates
#10
Jennifer M Oshimura, Benjamin D Bauer, Neha Shah, Eugene Nguyen, Jennifer Maniscalco
OBJECTIVES: Pediatric hospitalists report the need for additional training in clinical and nonclinical domains. Pediatric hospital medicine (PHM) fellowships seek to provide this training and produce leaders in the field. Our objective is to describe current roles and perceived training needs of PHM fellowship graduates. METHODS: In 2014, all PHM fellowship graduates were asked to complete a Web-based survey. Survey questions addressed demographics, past training, current roles, and training needs in clinical care, research, education, and administration...
October 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27579967/collaborative-care-on-the-stroke-unit-a-cross-sectional-outcomes-study
#11
Janet G Wood
OBJECTIVE: The aim of this study was to evaluate the economic and quality outcomes associated with a collaborative advanced practice nurse and hospitalist physician model of care on the inpatient stroke unit as compared with usual hospitalist physician-led care. BACKGROUND: High functioning collaborative teams are anticipated to be essential under value-based reimbursement. METHODS: Hospitalist nurse practitioners were assigned to the stroke unit in collaboration with hospitalist physicians to implement daily hospital management for patients with stroke and transient ischemic attack...
October 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/27527537/screening-for-maternal-postpartum-depression-during-infant-hospitalizations
#12
Margaret J Trost, Kira Molas-Torreblanca, Carol Man, Ernesto Casillas, Hoda Sapir, Sheree M Schrager
BACKGROUND: Postpartum depression is common and adversely affects children of afflicted mothers; postpartum depression recognition and treatment may improve outcomes. Hospitalization represents a potential health encounter for expanding screening and intervention. OBJECTIVE: We aimed to assess for postpartum depression at infant hospitalization and examine postpartum depression risk factors in this population. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective observational study of 310 English- or Spanish-speaking women with an infant aged 2 weeks to 1 year admitted to a pediatric hospitalist service at a large urban freestanding children's hospital...
August 16, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27520481/developing-a-comportment-and-communication-tool-for-use-in-hospital-medicine
#13
Susrutha Kotwal, Waseem Khaliq, Regina Landis, Scott Wright
BACKGROUND: An exceptional experience in a hospital is largely influenced by the quality and performance of the hospitalist physician. We set out to establish a metric that would comprehensively assess hospitalists' comportment and communication to establish norms and expectations. METHODS: The chiefs of hospital medicine divisions at 5 hospitals were asked to identify their "most clinically excellent" hospitalists. An investigator observed each hospitalist during a routine clinical shift and recorded behaviors believed to be associated with excellent comportment and communication using the hospital medicine comportment and communication tool (HMCCOT)...
August 13, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27520384/residents-self-report-on-why-they-order-perceived-unnecessary-inpatient-laboratory-tests
#14
Mina S Sedrak, Mitesh S Patel, Justin B Ziemba, Dana Murray, Esther J Kim, C Jessica Dine, Jennifer S Myers
Resident physicians routinely order unnecessary inpatient laboratory tests. As hospitalists face growing pressures to reduce low-value services, understanding the factors that drive residents' laboratory ordering can help steer resident training in high-value care. We conducted a qualitative analysis of internal medicine (IM) and general surgery (GS) residents at a large academic medical center to describe the frequency of perceived unnecessary ordering of inpatient laboratory tests, factors contributing to that behavior, and potential interventions to change it...
August 13, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27516413/pediatric-procedural-sedation-using-dexmedetomidine-a-report-from-the-pediatric-sedation-research-consortium
#15
Carmen Sulton, Courtney McCracken, Harold K Simon, Kiran Hebbar, Jason Reynolds, Joseph Cravero, Michael Mallory, Pradip Kamat
OBJECTIVES: Dexmedetomidine (DEX) is widely used in pediatric procedural sedation (PPS) by a variety of pediatric subspecialists. The objective of our study was to describe the overall rates of adverse events and serious adverse events (SAEs) when DEX is used by various pediatric subspecialists. METHODS: Patients from the Pediatric Sedation Research Consortium (PSRC) database were retrospectively reviewed and children that received DEX as their primary sedation agent for elective PPS were identified...
September 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27508924/zero-to-50-000-the-20th-anniversary-of-the-hospitalist
#16
Robert M Wachter, Lee Goldman
Twenty years ago, we described the emergence of a new type of specialist that we called a "hospitalist." Since then, the number of hospitalists has grown from a few hundred to more than 50,000 (see graph) — making this new field substantially larger than any subspecialty of internal medicine (the..
September 15, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27491563/use-of-ultrasound-guidance-for-central-venous-catheterization-a-national-survey-of-intensivists-and-hospitalists
#17
Nilam J Soni, Luis F Reyes, Holly Keyt, Alejandro Arango, Jonathan A Gelfond, Jay I Peters, Stephanie M Levine, Sandra G Adams, Marcos I Restrepo
PURPOSE: The purpose of the study is to evaluate the frequency and barriers to use of ultrasound guidance for central venous catheter (CVC) insertion by physicians specializing in critical care and hospital medicine. MATERIALS AND METHODS: A national cross-sectional electronic survey of intensivists and hospitalists was administered from November 2014 to January 2015. RESULTS: The survey response rate was 5.9% (1013/17 233). Moderate to very frequent use of ultrasound guidance varied by site: internal jugular vein (80%), subclavian vein (31%), and femoral vein (45%)...
December 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27433901/patients-with-adhesive-small-bowel-obstruction-should-be-primarily-managed-by-a-surgical-team
#18
Christopher T Aquina, Adan Z Becerra, Christian P Probst, Zhaomin Xu, Bradley J Hensley, James C Iannuzzi, Katia Noyes, John R T Monson, Fergal J Fleming
OBJECTIVE: To evaluate the impact of a primary medical versus surgical service on healthcare utilization and outcomes for adhesive small bowel obstruction (SBO) admissions. SUMMARY BACKGROUND DATA: Adhesive-SBO typically requires hospital admission and is associated with high healthcare utilization and costs. Given that most patients are managed nonoperatively, many patients are admitted to medical hospitalists. However, comparisons of outcomes between primary medical and surgical services have been limited to small single-institution studies...
September 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27429311/annals-for-hospitalists-inpatient-notes-hospitalists-and-digital-medicine-overcoming-the-productivity-paradox
#19
Robert M Wachter
No abstract text is available yet for this article.
July 19, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27406445/potential-impact-of-a-bedside-procedure-service-on-training-procedurally-competent-hospitalists-in-a-community-based-residency-program
#20
Anthony Montuno, Bijou R Hunt, May M Lee
BACKGROUND: The Society of Hospital Medicine has delineated procedures as one of the core competencies for hospitalists. Little is known about whether exposure to a medical procedure service (MPS) impacts the procedural certification rate in internal medicine trainees in a community hospital training program. OBJECTIVE: To determine whether or not exposure to an MPS would impact both the number of procedures performed and the rate of resultant certifications in a community hospital internal medicine training program...
2016: Journal of Community Hospital Internal Medicine Perspectives
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