Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Blood product transfusion has not been subject to rigorous clinical study, and great practice variations exist. Of particular concern to hospitalists is the use of red blood cells, plasma, and platelets prior to invasive procedures to correct anemia or perceived bleeding risk. We summarize the known risks associated with periprocedural anemia, prolonged international normalized ratio (INR), and thrombocytopenia, as well as the effects of blood product administration on clinical outcomes. ⋯ Available data do not support the use of prothrombin time/INR to guide prophylactic administration of plasma, and there are scarce data to guide platelet use around the time of an invasive procedure. Therefore, we rely on current consensus expert opinion, which recommends administration of plasma in moderate- to high-risk procedures when INR is >1.5. We recommend platelet transfusion in low-risk procedures when platelet count is <20,000/μL, for average-risk procedures when platelet count is <50,000/μL, and for procedures involving the central nervous system when the platelet count is <100,000/μL.
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Hospitalists are key providers of care to medical inpatients, and sign-out is an integral part of providing safe, high-quality inpatient care. There is little known about hospitalist-to-hospitalist sign-out. ⋯ Overall, we found that attending hospitalists rely heavily on written sign-out to address overnight inquiries, but that those sign-outs are not reliably effective. Future work to better understand the roles of written and verbal components in sign-out is needed to help improve the safety of overnight care.
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Comparative Study
Quality collaboratives and campaigns to reduce readmissions: what strategies are hospitals using?
Reducing hospital readmissions is a national priority, and many hospitals are participating in quality collaboratives or campaigns. ⋯ Substantial opportunity for improvement exists for hospitals engaged in STAAR or H2H quality initiatives.
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Electronic communication between providers occurs daily in clinical practice but has not been well studied. ⋯ Of 25 included studies, all focused on physicians; most were observational (68%). Most (60%) described electronic specialist referral tools. Although overall use has been measured, there were no studies of the effectiveness of intra-EHR messaging. Literature describing the effectiveness of provider-to-provider electronic communications is sparse and narrow in scope. Complex care, such as that envisioned for the Patient Centered Medical Home, necessitates further research.
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Patients with low-risk chest pain are frequently readmitted for evaluation of recurrent chest pain. It is unknown whether stress testing during the first admission for chest pain is a cost-effective means of reducing readmissions. ⋯ Inpatient stress testing reduced subsequent resource utilization in terms of ED visits and resultant readmissions, but the savings were not enough to offset the cost of initial testing.