Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Observational Study
Inpatient safety outcomes following the 2011 residency work-hour reform.
The impact of the 2011 residency work-hour reforms on patient safety is not known. ⋯ In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety.
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Medical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population. ⋯ Despite high mortality, patients with medical emergency team-implemented do not resuscitate orders had a relatively low utilization of end-of-life resources, including palliative care consultation and home hospice services. Coordinated care between medical emergency teams and inpatient palliative care services may help to improve end-of-life care.
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Dysnatremia may predispose to falls and fractures, and serum sodium may influence bone health. Little is known of the association of perioperative dysnatremia and clinical outcomes in those undergoing major orthopedic surgery. ⋯ Dysnatremia is relatively common in the hospitalized orthopedic population and associated with greater length of stay and 30-day mortality. Future studies should address potential mechanisms underlying these associations and whether correction of perioperative dysnatremia may improve patient outcomes.
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Little is currently known regarding physicians' opinions on the relative appropriateness of inpatient management of medical conditions unrelated to the reason for admission. ⋯ Physicians are more likely to rate inpatient medication changes as appropriate when they are related to the reason for admission. Our results suggest that opportunities for meaningful medical interventions may be underutilized in current systems that adhere to a strict dichotomy of inpatient and outpatient roles.Medicine.