Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. ⋯ In doing so, we seek to improve the safety and share the science of vascular access with frontline clinicians. To aid decision-making, we conclude by operationalizing the available data through algorithms that outline appropriate vascular access for the hospitalized patient.
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Multicenter Study Observational Study
The july effect: an analysis of never events in the nationwide inpatient sample.
Prior studies examining the impact of the "July effect" on in-hospital mortality rates have generated variable results. In 2008, the Centers for Medicare & Medicaid Services published a series of high-cost, high-volume, nonreimbursable hospital-acquired complications (HACs). These events were believed to be preventable and indicate deficiencies in healthcare delivery. ⋯ July admissions are associated with increased likelihood of HAC occurrence. This trend may represent breakdowns in organization structure distinct from traditional quality measures, requiring novel transition protocols dedicated to improving HACs.
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Multicenter Study
The association of patient complexities with antibiotic ordering.
Antibiotic treatment decisions for medically complex patients are complicated, as the risk of undertreatment may be severe, whereas overtreatment may be associated with adverse effects and the emergence of antibiotic resistant pathogens. ⋯ In 3 vignettes depicting common clinical scenarios among hospitalized adults, inappropriate antibiotic use was prevalent and occurred more often for patients with medical complexities. Treatment guidelines should consider addressing medically complex patients in the context of infection management.
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High utilizers are medically and psychosocially complex, have high rates of emergency department (ED) visits and hospital admissions, and contribute to rising healthcare costs. ⋯ Individualized care plans developed by a multidisciplinary team and integrated with the existing healthcare workforce and EMR reduce hospital admissions, 30-day readmissions, and hospital costs for complex, high-utilizing patients.