Journal of hospital medicine : an official publication of the Society of Hospital Medicine
-
There is concern that sodium-glucose cotransporter-2 inhibitors during hospitalization for acute heart failure (aHF) may precipitate diabetic ketoacidosis (DKA). A retrospective study of all hospitalization encounters for aHF defined by a primary HF International Classification of Diseases (ICD)-10 code in 15 Kaiser Permanente Southern California medical centers hospitalized between January 1, 2021 and August 31, 2023 was performed to describe rates of DKA with empagliflozin use. DKA was defined by the presence of either a DKA ICD-10 code or ketoacidosis lab criteria (bicarbonate <18 mmol/L and urine ketone 1+ or more or elevated serum beta-hydroxybutyrate within 12 h) during hospitalization. ⋯ There were 2 (0.1%) probable DKA cases in empagliflozin encounters and 15 (0.1%) in nonexposed encounters. These rates were similar when stratified by diabetes status and ejection fraction. Empagliflozin may be safe during aHF hospitalization.
-
Physicians often hold leadership roles in implementing interdisciplinary rounds (IDR) in clinical settings, thus understanding physician perspectives of bedside IDR is crucial. ⋯ Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy for patients and the interprofessional team. However, sustained leadership support and clearly defined rounds goals and objectives are necessary ingredients to maximize the benefits and address the challenges of bedside IDR.
-
Monitoring the average daily census (ADC) is crucial for managing patient flow and allocating resources. This study analyzed hourly fluctuations in the ADC on a hospital medicine service at an academic medical center. Data from 8342 encounters and 6178 unique patients were collected over a year. ⋯ Understanding how ADC changes throughout the day will help hospital medicine programs to partner with administrators to optimize resource allocation and staffing. Measuring ADC at midnight, as traditionally done, may underestimate workload and therefore contribute to staffing shortages and physician burnout. Hospitals should consider measuring ADC at its peak, between 7 a.m. and 11 a.m., to ensure adequate staffing and high-quality patient care.