Journal of hospital medicine : an official publication of the Society of Hospital Medicine
-
Calcium channel blockers (CCBs) are some of the most commonly used medications in clinical practice to treat hypertension, angina, cardiac arrhythmias, and some cases of heart failure. Recent data show that CCBs are the most common of the cardiovascular medications noted in intentional or unintentional overdoses.(1) Novel treatment approaches in the form of glucagon, high-dose insulin therapy, and intravenous lipid emulsion therapies have been tried and have been successful. However, the evidence for these are limited to case reports and case series. We take this opportunity to review the various treatment options in the management of CCB overdoses with a special focus on high-dose insulin therapy as the emerging choice for initial therapy in severe overdoses.
-
Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine. ⋯ NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs.
-
Goals of care discussions, including those focused on code status, are meant to foster autonomous decision making. Unfortunately, these discussions often conflate decisions regarding the use of cardiopulmonary resuscitation for cardiac arrest and mechanical ventilation for prearrest respiratory failure. ⋯ In doing so, they may fail in their intention of extending patient autonomy. Journal of Hospital Medicine 2014;9:669-670. © 2014 Society of Hospital Medicine.
-
Specialty hospitals are a subset of acute-care hospitals that provide a narrower set of services than general medical hospitals (GMHs), predominantly in areas such as cardiac disease and surgery. Although specialty hospitals also advertise high patient satisfaction, this has not been examined using national data. We examined the differences in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) satisfaction scores in a national sample. ⋯ Specialty hospitals have a significantly higher overall HCAHPS patient satisfaction score than GMHs, although more than half of this difference disappears when adjusted for survey response rate. Comparisons among healthcare organizations should take into account survey response rates.
-
Hospitals devote significant human and capital resources to eliminate hospital readmissions, prompted most recently by the Centers for Medicare and Medicaid Services (CMS) financial penalties for higher-than-expected readmission rates. Implicit in these efforts are assumptions that a significant proportion of readmissions are preventable, and preventable readmissions can be identified. ⋯ In this article, we examine strengths and limitations of the CMS readmission metric, explore how preventable readmissions have been defined and measured, and discuss implications for readmission reduction efforts. Drawing on our clinical, research and operational experiences, we offer suggestions to address the key challenges in moving forward to measure and reduce preventable readmissions.