Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital. ⋯ Hyperglycemia is present in one-fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in-hospital mortality.
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The use of specialized orthopedic surgery (SOS) units in total knee arthroplasty (TKA) patients is well established. The number and costs of arthoplasty surgeries continue to increase, requiring institutions to reexamine their existing practices for financial sustainability. ⋯ Patients on SOS units following elective TKA have a reduced LOS and decreased total and hospital costs. Our results should encourage hospitals to reevaluate postoperative patient flow to optimize resource utilization.
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The "Swiss cheese model" of systems accidents is commonly applied to patient safety, implying that many "holes" must align before an adverse event occurs. The Accreditation Council for Graduate Medical Education (ACGME) instituted work hour limitations to fill one such hole by reducing resident fatigue. ⋯ Our focus group participants perceived that the ACGME work hour limitations had minimized the impact of resident fatigue on patient care errors. Other contributors to errors remained and were often exacerbated by methods to maintain compliance with the rules.