Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Observational Study
Shared Decision-Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication.
Shared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM. ⋯ Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.
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Apparent increase in mortality associated with being admitted to hospital on a weekend compared to weekdays has led to controversial policy changes to weekend staffing in the United Kingdom. Studies in the United States have been inconclusive and diagnosis specific, and whether to implement such changes is subject to ongoing debate. ⋯ Differences in mortality of weekend admissions may be attributed to underlying differences in patient characteristics and severity of illness and is subject to large between-diagnoses heterogeneity. Increasing weekend services may not result in desired reduction in inpatient mortality rate.
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Multicenter Study
A Prescription for Note Bloat: An Effective Progress Note Template.
United States hospitals have widely adopted electronic health records (EHRs). Despite the potential for EHRs to increase efficiency, there is concern that documentation quality has suffered. ⋯ The bundled intervention for progress notes significantly improved the quality, decreased the length, and resulted in earlier note completion across 4 academic medical centers.
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Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. Growing evidence supports portal use in ambulatory settings; however, only recently have portals been used with hospitalized patients. Our objective was to review the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care. ⋯ Included studies indicated providers had concerns about using inpatient portals; however, the extent to which these concerns have been realized remains unclear. Inpatient portal research is emerging. Further investigation is needed to optimally design inpatient portals to maximize potential benefits for hospitalized patients and caregivers while minimizing unintended consequences for healthcare teams.
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Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. ⋯ We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy.