Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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COVID-19 represents a grave risk to residents in skilled nursing facilities (SNFs). ⋯ Implementing a review committee to assess for appropriateness of SNF use after a hospitalization during the COVID-19 pandemic is highly effective. There was no negative impact on safety or efficiency of hospital care, and reduced SNF use likely prevented several cases of COVID-19. This model could serve as a template for other hospitals to reduce the risks of COVID-19 in SNFs and as part of a value-based care strategy.
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We sought to determine whether census tract poverty, race, and insurance status were associated with the likelihood and severity of diabetic ketoacidosis (DKA) hospitalization among youth with type 1 diabetes (T1D). ⋯ Youth with T1D living in high poverty areas and on public insurance were significantly more likely to be admitted for DKA. Severity upon presentation was similar across exposures. Understanding contextual mechanisms by which disparities emerge will inform changes aimed at equitably improving care.
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During the COVID-19 pandemic, hospitals published physical-distancing guidance and created dedicated respiratory isolation units (RIUs) for patients with COVID-19. The degree to which such distancing occurred between clinicians and patients is unknown. In this study, heat sensors from an existing hospital hand-hygiene monitoring system objectively tracked room entries as a proxy for physical distancing in both RIUs and general medicine units before and during the pandemic. ⋯ General medicine units that cared for patients under investigation for COVID-19 and other patients experienced a 14.7% reduction in entries per room per day (from 76.9 to 65.1). While gradual extinction was observed in both units as COVID-19 cases declined, the RIUs had a higher degree of physical distancing. Although the optimal level of physical distancing is unknown, sustaining physical distancing in the hospital may require re-education and real-time monitoring.
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We aimed to determine the percentage of COVID-19- associated hospitalizations reported to Los Angeles County (LAC) Public Health that might have been misclassified because of incidentally detected SARS-CoV-2. We retrospectively reviewed medical records from a randomly selected set of hospital discharges reported to LAC Public Health from August to October 2020 for a clinical diagnosis of COVID-19 or a positive SARS-CoV-2 test result. ⋯ SARS-CoV-2 detection was incidental to the reason for hospitalization in 12% (95% confidence limit, 9%-16%) of COVID-19 classified hospital discharges. Adjusting COVID-19-associated hospitalization rates to account for incidental SARS-CoV-2 detection could help public health policymakers and emergency preparedness personnel improve resource planning.