Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Various strategies have attempted to address increased patient lengths of stay (LOS), but effectiveness varies. Factors related to work design and workforce experience may also play significant roles. ⋯ Physician workload, as measured by note count, was associated with longer LOS with higher CCI, while more years of experience was associated with shorter LOS. Original Clinical Trial Registration: ClinicalTrials.gov number, NCT05370638.
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Diuresis for hospitalized patients with acute decompensated heart failure is a routine clinical practice but one that remains reliant on error-prone and resource-intensive intake and output and weight measurements and is subject to wide provider variation. We sought to use quality improvement approaches to implement a data-driven predictive diuresis protocol based on natriuresis using the electronic health record to titrate dosing. Our initiative did not result in significant reductions in length of stay but did demonstrate a significant increase in the use of urine studies to guide diuresis and signals toward more aggressive diuretic dosing without an increase in adverse outcomes.
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Treatment of alcohol withdrawal syndrome (AWS) in hospitals is inconsistent. Electronic health record (EHR) order sets protocolize care. ⋯ We observed frequent organizational inclusion of guideline-concordant medications and symptom scores but rare and/or poorly defined guidance for evaluating risk of severe AWS, escalation of care, and MAUD.