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David H Wesorick, Vineet Chopra
No abstract text is available yet for this article.
October 18, 2016: Annals of Internal Medicine
Hardeep Singh, Laura Zwaan
No abstract text is available yet for this article.
October 18, 2016: Annals of Internal Medicine
Vipulkumar Rana, Bipin Thapa, Sumanta Chaudhuri Saini, Pooja Nagpal, Ankur Segon, Kathlyn Fletcher, Geoffrey Lamb
BACKGROUND: Reducing 30-day readmissions is a national priority. Although multipronged programs have been shown to reduce readmissions, the role of the individual hospitalist physician in reducing readmissions is not clear. OBJECTIVES: We evaluated the effect of physicians' self-review of their own readmission cases on the 30-day readmission rate. METHODS: Over a 1-year period, hospitalists were sent their individual readmission rates and cases on a weekly basis...
October 2016: Quality Management in Health Care
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
S Arques, E Roux
Acute heart failure is a common condition that leads to hospital admission, with important mortality and readmission rates. A prompt and accurate diagnosis of this condition by hospitalists is essential for an early and tailored medical management. The use of natriuretic peptide testing (BNP and NT-proBNP) through a two cut-point strategy is currently recommended as the first-line diagnostic complement to the initial clinical evaluation in the acute care setting. Transthoracic Doppler echocardiography is an other noninvasive method that can be used at bedside, especially in patients with intermediate, inconclusive natriuretic peptides levels...
September 29, 2016: Annales de Cardiologie et D'angéiologie
Trevor Jensen, Andrew Lai, Michelle Mourad
No abstract text is available yet for this article.
September 30, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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
Robert Robinson
INTRODUCTION: Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Risk assessment tools have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. One such tool is the HOSPITAL score that uses seven readily available clinical variables to predict the risk of readmission within 30 days of discharge. The HOSPITAL score has been internationally validated in large academic medical centers...
2016: PeerJ
Jamie R Macklin, Michael A Gittelman, Sarah A Denny, Hayley Southworth, Melissa Wervey Arnold
BACKGROUND: Despite American Academy of Pediatrics (AAP) recommendations, many hospitalized infants are not observed in the appropriate safe sleep environment. Caregivers tend to model sleep patterns observed in a hospital setting. This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program. METHODS: The AAP recruited hospitalists from each of the state's children's hospitals and asked them to form "safe sleep teams" within their institutions...
September 14, 2016: Pediatrics
Vivian S Lee, Kensaku Kawamoto, Rachel Hess, Charlton Park, Jeffrey Young, Cheri Hunter, Steven Johnson, Sandi Gulbransen, Christopher E Pelt, Devin J Horton, Kencee K Graves, Tom H Greene, Yoshimi Anzai, Robert C Pendleton
IMPORTANCE: Transformation of US health care from volume to value requires meaningful quantification of costs and outcomes at the level of individual patients. OBJECTIVE: To measure the association of a value-driven outcomes tool that allocates costs of care and quality measures to individual patient encounters with cost reduction and health outcome optimization. DESIGN, SETTING, AND PARTICIPANTS: Uncontrolled, pre-post, longitudinal, observational study measuring quality and outcomes relative to cost from 2012 to 2016 at University of Utah Health Care...
September 13, 2016: JAMA: the Journal of the American Medical Association
Bobby Daly, Andrew Hantel, Kristen Wroblewski, Jay S Balachandran, Selina Chow, Rebecca DeBoer, Gini F Fleming, Olwen M Hahn, Justin Kline, Hongtao Liu, Bhakti K Patel, Anshu Verma, Leah J Witt, Mayumi Fukui, Aditi Kumar, Michael D Howell, Blase N Polite
PURPOSE: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. METHODS: This was a retrospective case series of patients cared for in an academic medical center's ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient's electronic health record from 3 months preceding terminal hospitalization until death...
September 6, 2016: Journal of Oncology Practice
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
Joshua S Shapiro, Michael S Humeniuk, Mustaqeem A Siddiqui, Neelima Bonthu, Darrell R Schroeder, Deanne T Kashiwagi
Little is known about which variables put patients with cancer at risk for 30-day hospital readmission. Comanagement of this often complex patient population by specialists and hospitalists has become increasingly common. This retrospective study examined inpatients with cancer comanaged by hospitalists, hematologists, and oncologists to determine the rate of readmission and factors associated with readmission. Patients in this cohort had a readmission rate of 23%. Patients who were discharged to a skilled nursing facility (odds ratio [OR] = 0...
August 25, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Kara N Radzak, Jennifer J Wages, Kimberly E Hall, Cass K Nakasone
BACKGROUND: Controversy continues regarding the use of powerful anticoagulants for venous thromboembolism prophylaxis in patients undergoing total knee arthroplasty (TKA). To comply with institution-mandated guidelines and pressure from hospitalist intent on complying with conventionally recommended anticoagulation guidelines, we singularly changed our chemoprophylaxis practice from using aspirin to Lovenox and noted that transfusion rates increased substantially. METHODS: A retrospective case review was performed to evaluate transfusion requirement differences in primary TKA patients receiving Lovenox (unilateral TKA: n = 135, bilateral TKA: n = 44) or aspirin (unilateral TKA: n = 153, bilateral TKA: n = 45) for venous thromboembolism prophylaxis...
November 2016: Journal of Arthroplasty
Sushant Govindan, Theodore J Iwashyna
No abstract text is available yet for this article.
August 16, 2016: Annals of Internal Medicine
David H Wesorick, Vineet Chopra
No abstract text is available yet for this article.
August 16, 2016: Annals of Internal Medicine
Raj Mehta, Nila S Radhakrishnan, Carrie D Warring, Ankur Jain, Jorge Fuentes, Angela Dolganiuc, Laura S Lourdes, John Busigin, Robert R Leverence
BACKGROUND: The integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied. OBJECTIVE: We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices. METHODS: This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs...
2016: Applied Clinical Informatics
Neha Patel, James E Siegler, Nathaniel Stromberg, Neil Ravitz, C William Hanson
BACKGROUND: In hospitals, effective and efficient communication among care providers is critical to the provision of high-quality patient care. Yet, major problems impede communications including the frequent use of interruptive and one-way communication paradigms. This is especially frustrating for frontline providers given the dynamic nature of hospital care teams in an environment that is in constant flux. METHODS: We conducted a pre-post evaluation of a commercially available secured messaging mobile application on 4 hospital units at a single institution for over one year...
2016: Applied Clinical Informatics
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
Andre C Kalil, Mark L Metersky, Michael Klompas, John Muscedere, Daniel A Sweeney, Lucy B Palmer, Lena M Napolitano, Naomi P O'Grady, John G Bartlett, Jordi Carratalà, Ali A El Solh, Santiago Ewig, Paul D Fey, Thomas M File, Marcos I Restrepo, Jason A Roberts, Grant W Waterer, Peggy Cruse, Shandra L Knight, Jan L Brozek
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia...
September 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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