Journal of hospital medicine : an official publication of the Society of Hospital Medicine
-
Inappropriate laboratory testing is a contributor to waste in healthcare. ⋯ A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine.
-
Hyperkalemia treatment with intravenous insulin has been associated with hypoglycemia. This single-center, retrospective study compared the effects on hypoglycemia between weight-based insulin dosing (0.1 U/kg of body weight up to a maximum of 10 U) compared to standard flat doses of 10 U among patients weighing less than 95 kg. Of the 132 charts randomly selected for review, hypoglycemic events (blood glucose <70 mg/dL) were reduced from 27.3% in the 10-U group to 12.1% in the weight-based group (P = 0.05). ⋯ Female patients and those with baseline glucose values <140 mg/dL were at increased risk for hypoglycemia. Weight-based insulin dosing (0.1 U/kg) for acute hyperkalemia therapy resulted in less hypoglycemia without impacting potassium lowering. Journal of Hospital Medicine 2016;11:355-357. © 2016 Society of Hospital Medicine.
-
National guidelines for the management of community-acquired pneumonia (CAP) in children were published in 2011. These guidelines discourage most diagnostic testing for outpatients, as well as repeat testing for hospitalized patients who are improving. We sought to evaluate the temporal trends in diagnostic testing associated with guideline implementation among children with CAP. ⋯ Publication of national pneumonia guidelines in 2011 was associated with modest changes in diagnostic testing for children with CAP. However, the changes varied across hospitals, and the financial impact was modest. Local implementation efforts are warranted to ensure widespread guideline adherence. Journal of Hospital Medicine 2016;11:317-323. © 2016 Society of Hospital Medicine.
-
Randomized Controlled Trial
Real-time patient experience surveys of hospitalized medical patients.
Real-time feedback about patients' perceptions of the quality of the care they are receiving could provide physicians the opportunity to address concerns and improve these perceptions as they occur, but physicians rarely if ever receive feedback from patients in real time. ⋯ Real-time feedback, followed by coaching and patient revisits, seem to improve patient experience.
-
This study examined the association between index hospitalization characteristics and the risk of all-cause 30-day readmission among high-risk Medicaid beneficiaries using multilevel analyses. A retrospective cohort with a baseline and a follow-up period was used. The study population consisted of Medicaid beneficiaries (21-64 years old) with selected chronic conditions, continuous fee-for-service enrollment through the observation period, and at least 1 inpatient encounter during the follow-up period (N = 15,806). ⋯ In this study population, 16.7% had all-cause 30-day readmissions. Adults with greater lengths of stay during the index hospitalization were more likely to have 30-day readmissions (adjusted odds ratio [AOR]: 1.03, 95% confidence interval [CI]: 1.02-1.04). Adults who were hospitalized for cardiovascular conditions (AOR: 1.20, 95% CI: 1.08-1.33), diabetes (AOR: 1.23, 95% CI: 1.10-1.39), cancer (AOR: 1.55, 95% CI: 1.26-1.90), and mental health conditions (AOR: 2.17, 95% CI: 1.98-2.38) were more likely to have 30-day readmissions compared to those without these conditions.