Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Prior studies have found that outpatients are frequently unaware of their chronic kidney disease (CKD). Little is known about CKD awareness in hospitalized patients. We conducted a retrospective study of general medicine inpatients with CKD, ascertained through International Classification of Diseases, Ninth Revision codes for non-dialysis-dependent CKD (585.0-585.9) in their first 20 admission diagnoses (n = 590). ⋯ In multivariable analysis, factors significantly associated with patient self-report of CKD included advanced CKD stage, other race (nonwhite, non-African American), and increasing Mini-Mental State Exam score (all P < 0.05). CKD awareness increased, but remained low, in patients with advanced CKD who would benefit from referral to multidisciplinary nephrology care. Hospitalization provides an opportunity to educate patients with CKD and link them to care.
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Observational Study
Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards.
Obstructive sleep apnea (OSA) has been associated with clinical deterioration in postoperative patients and patients hospitalized with pneumonia. Paradoxically, OSA has also been associated with decreased risk of inpatient mortality in these same populations. ⋯ After adjustment for important confounders, OSA was not associated with clinical deterioration on the wards and was associated with significantly decreased in-hospital mortality.
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Standardized Clinical Assessment and Management Plans (SCAMPs) are tools to facilitate learning and discovery in a rapid iterative fashion. SCAMPs aim to reduce practice variation, improve patient outcomes, and identify unnecessary resource utilization. ⋯ These data are then analyzed to change and improve the SCAMP algorithm itself. The purpose of this article is to describe the general SCAMPs methodology and to compare SCAMPs to traditional tools like clinical practice guidelines.
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The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions. ⋯ Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources.
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Multicenter Study
Variation in printed handoff documents: Results and recommendations from a multicenter needs assessment.
Handoffs of patient care are a leading root cause of medical errors. Standardized techniques exist to minimize miscommunications during verbal handoffs, but studies to guide standardization of printed handoff documents are lacking. ⋯ Wide variation exists in the content of printed handoff documents. Standardizing printed handoff documents has the potential to decrease omissions of key data during patient care transitions, which may decrease the risk of downstream medical errors.