Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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There is concern that sodium-glucose cotransporter-2 inhibitors during hospitalization for acute heart failure (aHF) may precipitate diabetic ketoacidosis (DKA). A retrospective study of all hospitalization encounters for aHF defined by a primary HF International Classification of Diseases (ICD)-10 code in 15 Kaiser Permanente Southern California medical centers hospitalized between January 1, 2021 and August 31, 2023 was performed to describe rates of DKA with empagliflozin use. DKA was defined by the presence of either a DKA ICD-10 code or ketoacidosis lab criteria (bicarbonate <18 mmol/L and urine ketone 1+ or more or elevated serum beta-hydroxybutyrate within 12 h) during hospitalization. ⋯ There were 2 (0.1%) probable DKA cases in empagliflozin encounters and 15 (0.1%) in nonexposed encounters. These rates were similar when stratified by diabetes status and ejection fraction. Empagliflozin may be safe during aHF hospitalization.
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Emergency overcrowding is a problem in hospitals worldwide. The expansion of wards has limitations. Hospital administrative leaders are constantly looking for opportunities to improve the efficiency of resource use. ⋯ HDT brought benefits to our hospital, reducing the length of stay and increasing bed turnover. However, there is a need for a team focused on the project and support from managers to overcome resistance and integrate units until they are fully operational.