Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Multicenter Study
Prevalence of Staphylococcus aureus and Use of Antistaphylococcal Therapy in Children Hospitalized with Pneumonia.
Within a cohort of >2,000 children hospitalized with community-acquired pneumonia, staphylococcal pneumonia was rare (1%) but associated with adverse in-hospital outcomes. Despite this low prevalence, use of antistaphylococcal antibiotics was common (24%). Efforts are needed to minimize overuse of antistaphylococcal antibiotics while also ensuring adequate treatment for pathogen-specific diseases.
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A small subset of patients account for a substantial proportion of hospital readmissions. Programs to reduce utilization among this subset of frequently hospitalized patients have the potential to improve health and reduce unnecessary spending. PURPOSE: To conduct a systematic review of interventions targeting frequently hospitalized patients. DATA SOURCES: PubMed MEDLINE; Embase (embase.com); and Cochrane Central Register of Controlled Trials, January 1, 1980 to January 1, 2018. STUDY SELECTION: Four physicians screened 4762 titles and abstracts for inclusion. Authors reviewed 116 full-text studies and included 9 meeting criteria. DATA EXTRACTION: Study characteristics, outcomes, and details regarding interventions were extracted. Risk of bias was assessed by the Downs and Black Scale. DATA SYNTHESIS: Out of the nine included studies, three were randomized controlled trials, three were controlled retrospective cohort studies, and three were uncontrolled pre-post studies. Inclusion criteria, interventions used, and outcomes assessed varied across studies. While all nine studies demonstrated reduced utilization, studies with lower risk of bias generally found similar reductions in utilization between intervention and control groups. Interventions commonly consisted of interdisciplinary teams interacting with patients across health care settings. ⋯ Interventions targeting high need, high-cost patients are heterogeneous, with many studies observing a regression to the mean. More rigorous studies, using multifaceted interventions which can adapt to patients’ unique needs should be conducted to assess the effect on outcomes relevant to both providers and patients.
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To inform resource allocation toward a continuum of care for youth at risk of suicide, we examined unplanned 30-day readmissions after pediatric hospitalization for either suicide ideation (SI) or suicide attempt (SA). ⋯ Dr. Zima received funding from the Behavioral Health Centers of Excellence for California (SB852).
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Few studies have evaluated the relationship between high hospital occupancy and hospital-acquired complications. We evaluated the association between inpatient occupancy and hospital-acquired Clostridium difficile infection (CDI) using a novel measure of hospital occupancy. We analyzed administrative data from California hospitals from 2008-2012 for Medicare recipients aged 65 years with a discharge diagnosis of acute myocardial infarction, heart failure, or pneumonia. ⋯ The 0.76-1.00 admission occupancy group had 0.87 odds of CDI (95% CI 0.75-1.01). With regard to average occupancy, intermediate levels of occupancy 0.26-0.50 (odds ratio [OR] = 3.04, 95% CI 2.33-3.96) and 0.51-0.75 (OR = 3.28, 95% CI 2.51-4.28) had over 3-fold increased adjusted odds of CDI relative to the low occupancy group; the high occupancy group did not have signifcantly different odds of CDI compared to the low occupancy group (OR = 0.96, 95% CI 0.70-1.31). These findings should prompt exploration of how hospitals react to occupancy changes and how those care processes translate into hospital-acquired complications in order to inform best practices.
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Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings. ⋯ Diagnosis in teaching hospitals is a unique process that requires improvement. Contextual insights gained from this ethnography may be used to inform future interventions.