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Hospitalist procedures

Trevor P Jensen, Nilam J Soni, David M Tierney, Brian P Lucas
Many hospitalists are routinely granted hospital privileges to perform invasive bedside procedures, but criteria for privileging are not well described. We conducted a survey of 21 hospitalist procedure experts from the Society of Hospital Medicine Point-of-Care Ultrasound Task Force to better understand current privileging practices for bedside procedures and how those practices are perceived. Only half of all experts reported their hospitals require a minimum number of procedures performed to grant initial (48%) and ongoing (52%) privileges for bedside procedures...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Nobuhiro Ariyoshi, Masayuki Nogi, Damon Sakai, Eiji Hiraoka, Daniel Fischberg
BACKGROUND: The interpretation of do-not-resuscitate orders (DNRs) may vary in nonarrest situations. To reduce ambiguity, many hospitals allow patients to elect partial DNRs. OBJECTIVE: To investigate the effect of partial DNRs on physicians' willingness to perform cardiopulmonary resuscitation (CPR) and nonarrest procedures. DESIGN: Cross-sectional study using scenario-based questionnaires between October 2015 and March 2016. A partial DNR was identified as a DNR with Adult Emergency Protocols (AEP) order...
July 31, 2017: Journal of Palliative Medicine
Robert Robinson, Tamer Hudali
INTRODUCTION: Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Validated risk assessment tools such as the HOSPITAL score and LACE index 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. This study aims to evaluate the utility of HOSPITAL score and LACE index for predicting hospital readmission within 30 days in a moderate-sized university affiliated hospital in the midwestern United States...
2017: PeerJ
Dominic Frimberger, Maria-Gisela Mercado-Deane
The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux. The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency department physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985...
November 2016: Pediatrics
Dominic Frimberger, Stuart B Bauer, Mark P Cain, Saul P Greenfield, Andrew J Kirsch, Faridali Ramji, Maria-Gisela Mercado-Deane, Christoper S Cooper
The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux (VUR). The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency room physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985...
December 2016: Journal of Pediatric Urology
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
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
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
Richard S Hoehn, Dennis J Hanseman, Derek Go, Koffi Wima, Alex Chang, Audrey E Ertel, Shimul A Shah, Daniel E Abbott
BACKGROUND: We have previously shown that inferior outcomes at safety-net hospitals are largely dependent on hospital factors. We hypothesized that hospitals providing "high value" care (low cost and better outcomes) would have advantages in human and financial resources. METHODS: The University HealthSystems Consortium Clinical Database and the American Hospital Association Annual Survey were used to examine hospitals performing eight complex surgical procedures from 2009 to 2013...
July 2016: Journal of Surgical Research
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
Cynthia Kay, Erica M Wozniak, Aniko Szabo, Jeffrey L Jackson
OBJECTIVES: Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes. METHODS: This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014. RESULTS: Of a total of 399 procedures, 335 (84%) were referred to a service other than the primary team for completion...
July 2016: Southern Medical Journal
Jeffrey H Barsuk, Elaine R Cohen, Mark V Williams, Jordan Scher, Joe Feinglass, William C McGaghie, Kelly O'Hara, Diane B Wayne
Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians...
November 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Sarah E Hartley, Latoya Kuhn, Staci Valley, Laraine L Washer, Tejal Gandhi, Jennifer Meddings, Michelle Robida, Salas Sabnis, Carol Chenoweth, Anurag N Malani, Sanjay Saint, Scott A Flanders
OBJECTIVE Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention. DESIGN Prospective, interventional trial. SETTING Two community hospitals and a tertiary-care academic center. PATIENTS Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection...
September 2016: Infection Control and Hospital Epidemiology
Bassel Nazha, Alex C Spyropoulos
Atrial fibrillation patients often require warfarin interruption for an invasive procedure or surgery. Heparin bridging therapy has been frequently used during warfarin interruption under the premise of providing a theoretical mitigation against thromboembolism that overweighs expected higher rates of bleeding. Up until recently, little definite clinical evidence was available to guide the hospitalist on optimal perioperative anticoagulant management. The landmark BRIDGE (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation) trial provided high-quality evidence that a simple interruption of warfarin in the average atrial fibrillation patient undergoing an elective procedure or surgery is noninferior to bridging therapy for efficacy and superior to bridging therapy in preventing major bleeding...
September 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Sandesh Dev, Trisha K Hoffman, Dio Kavalieratos, Paul Heidenreich, Wen-Chih Wu, Dawn C Schwenke, Sarah J Tracy
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are the most underutilized pharmacotherapy for heart failure. Minimal data are available on the barriers to MRA adoption from the perspective of prescribing clinicians. METHODS AND RESULTS: A mixed-methods study consisting of a survey (n=50), focus groups (n=39), interviews (n=6) with clinicians at a single US Department of Veterans Affairs medical center served to ascertain barriers to optimal use of MRAs...
March 31, 2016: Journal of the American Heart Association
E Allen Liles, Carlton R Moore, Jacob Stein
OBJECTIVES: Readmissions are an increasing area of focus for quality improvement initiatives. Widely variable estimates exist on preventability and impact of multipronged readmission interventions. Given the rotating nature of attending physicians in academic centers, physicians often are unaware of readmissions. We present a before-and-after (uncontrolled) trial evaluating timely feedback of readmissions to hospitalist physicians. METHODS: A daily list of patients (inpatient, observation, procedure, or emergency department) who are registered as receiving care within University of North Carolina hospitals was filtered to include only inpatients within the last 30 days and cared for by a faculty member from the hospital medicine program, and readmissions were tracked...
June 2015: Southern Medical Journal
Jed D Gonzalo, Ethan F Kuperman, Cynthia H Chuang, Erik Lehman, Frendy Glasser, Thomas Abendroth
BACKGROUND: Many academic hospitals have implemented overnight hospitalists to supervise house staff and improve outcomes, but few studies have described the impact of this role. OBJECTIVE: To investigate the effect of an overnight academic hospitalist program on patient-level outcomes. Secondary objectives were to describe the program's revenue generation and work tasks. DESIGN: Retrospective interrupted time-series analysis of patients admitted to the medicine service before and after implementation of the program...
December 2015: Journal of General Internal Medicine
S Burjonrappa, A Theodorus, A Shah, I T Cohen
INTRODUCTION: Hospital readmission rates are used as a metric of the quality of patient care in adults. Readmission data is lacking for pediatric surgical patients. The objective of this study is to evaluate our institution's 30-day unexpected pediatric surgical readmission data to identify potentially preventable readmissions. METHODS: An internal database of all pediatric surgical 30-day readmissions to two tertiary-referral children's hospitals in a single health system was reviewed...
June 2015: Pediatric Surgery International
Mythili Srinivasan, Shobha Bhaskar, Douglas W Carlson
BACKGROUND AND OBJECTIVE: Children often need procedural sedation for painful procedures. There are few data on type of provider, site of sedation, and agents used for procedural sedation in hospitals across the nation. The objective was to determine procedural sedation practices for hospitalized children outside the PICU and emergency department. METHODS: Surveys were sent to 89 pediatric hospitalist (PH) leaders in hospitals belonging to the Child Health Corporation of America or the National Association of Children's Hospitals and Related Institutions...
March 2015: Hospital Pediatrics
Eelam Adil, Roy Xiao, Trevor McGill, Reza Rahbar, Michael Cunningham
IMPORTANCE: Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. OBJECTIVE: To introduce a unique rotating hospitalist inpatient program and assess its clinical, educational, and financial impact. The chief of service (COS) program requires 1 attending physician to rotate weekly as chief of the inpatient service with no conflicting elective duties. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective internal billing data review performed at a tertiary pediatric hospital...
September 2014: JAMA Otolaryngology—Head & Neck Surgery
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