Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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In intensive care unit (ICU) patients, signs of infection and inflammation are similar, making diagnosis of bacterial infections difficult. Antimicrobials may therefore be overused, contributing to development of antimicrobial-resistant bacteria. ⋯ Antimicrobial therapy is probably overused in the ICU, possibly resulting from difficulties in diagnosis and the perceived greater risk of untreated infection when compared to the risks of potentially unnecessary antimicrobial therapy. Efforts to improve antimicrobial-related decision-making should be mandatory.
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Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR. ⋯ The adapted OTAS instrument demonstrated acceptable reliability for assessing teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership.
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Hospital leaders have had mixed success reducing readmissions Little is known about the readmitted patient's perspective. ⋯ Patients reported transition challenges which they believe contribute to illness relapse and readmission. Interventions designed to address these challenges, and tailored for patient characteristics such as SES, may better address the root causes of readmission.
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Patterns of clinical symptoms and outcomes of perioperative myocardial infarction (PMI) in elderly patients after hip fracture repair surgery are not well defined. ⋯ Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI-associated mortality.
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Sepsis is a major cause of death in hospitalized patients. Early goal-directed therapy is the standard of care. When primary intensive care units (ICUs) are full, sepsis patients are cared for in overflow ICUs. ⋯ Patients with sepsis admitted to the primary ICU and overflow ICU at our institution were managed similarly. Overflowing sepsis patients to non-primary intensive care units may not affect guideline-concordant care delivery or length of stay.