Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Hospitalized patients who develop severe sepsis have significant morbidity and mortality. Early goal-directed therapy has been shown to decrease mortality in severe sepsis and septic shock, though a delay in recognizing impending sepsis often precludes this intervention. ⋯ Readily available data can be employed to predict non-ICU patients who develop septic shock several hours prior to ICU admission.
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In-hospital antimicrobial approval policies are designed to curb the indiscriminant use of antimicrobials. These policies usually require written forms and/or direct requests to an Infectious Disease specialist (or surrogate) prior to release of the antimicrobial. We hypothesized that the approval processes at our institution results in delayed antimicrobial administration. ⋯ Statistically significant delays in stat antimicrobial administration occur in our institution when antimicrobials require preapproval. These findings illustrate the importance of considering clinical efficiency when restrictions are put in place for time-sensitive therapies such as antimicrobials.
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Delivery of critical care by intensivists has been recommended by several groups. Our objective was to understand the delivery of critical care physician services in Michigan and the role of intensivists and nonintensivist providers in providing care. ⋯ The closed intensivist-led model of intensive care delivery is not in widespread use in Michigan. In the absence of intensivists, alternate models of care, including the hospitalist model, are frequently used.
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It is uncertain whether ED-calculated risk scores can predict required intensity of care upon hospital admission. This investigation examines whether versions of the Modified Early Warning Score (MEWS) predict high level of care utilization among patients admitted from the ED. ⋯ The MEWS Max has moderate ability to predict the need for higher level of care. Addition of ED length of stay and other variables to MEWS Max may identify patients at both low and high risk of requiring a higher level of care.
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Infectious diseases are commonly encountered by hospitalists in their day-to-day care of patients. Challenges involved in caring for patients with infectious diseases include choosing the correct antibiotic, treating patients with a penicillin allergy, interpreting blood cultures, and caring for patients with human immunodeficiency virus (HIV). The evidence-based pearls in this article will help hospitalists avoid common pitfalls in the recognition and treatment of such disorders and guide their decision about when to consult an infectious diseases specialist.