Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Hospitalized patients often experience disrupted sleep due to nighttime patient-staff interactions (PSIs). This study evaluates how PSIs impact sleep opportunities in neurology inpatients using electronic health record (EHR) data and introduces surrogate measures of sleep such as longest uninterrupted sleep opportunity (LUSO) and interruptive episodes. ⋯ This study demonstrates the utility of LUSO and interruptive episodes as EHR-based measures to link PSIs to sleep opportunities. While vital signs and medications were the most frequent PSIs, neurological checks and off-unit testing were associated with the largest impact on reducing LUSO. The predominance of single-PSI interruptive episodes underscores that the bundling of PSIs is not occurring. These findings highlight that PSIs impact sleep opportunities in distinct ways, supporting the use of this methodology to evaluate and address EHR-linked disruptions to patient sleep.
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Radiologic imaging is routinely performed to aid in diagnosis for hospitalized children. Identifying and reducing variability in imaging practices can improve care while reducing harms and costs. ⋯ To reduce imaging overuse in hospitalized children, conditions with frequent imaging, high imaging-related costs, and high hospital-level variation in imaging practices should serve as priorities for future evidence generation, guideline development, and/or improvement initiatives.
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Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans. ⋯ Rural VHA hospitals have a higher proportion of patients admitted with AUD-related diagnoses and higher readmission rates, but lower mortality rates. Approximately, one in three patients admitted with an AUD-related diagnosis died within the 5-year follow-up period. The mortality rates observed are extraordinary and deserve urgent attention. A comprehensive plan to address AUD in the Veteran population, including how we approach and engage patients in treatment during hospitalizations with any primary or secondary AUD diagnoses, is needed.