Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Although timely treatment of sepsis improves outcomes, delays in administering evidence-based therapies are common. ⋯ Automated sepsis alerts derived from electronic health data may improve care processes but tend to have poor PPV and do not improve mortality or length of stay.
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We evaluated the performance of time to clinical stability (TCS), a longitudinal outcome measure using 4 physiologic parameters (temperature, heart rate, respiratory rate, and use of supplemental oxygen), among children enrolled in a prospective study of pneumonia hospitalizations. We calculated the time from admission to normalization for each of the 4 parameters individually along with various combinations of these parameters (≥2 parameters). We assessed for agreement between the combined TCS measures and both hospital length of stay and an ordinal severity scale (nonsevere, severe, and very severe). ⋯ The simplest combined measure incorporating only respiratory rate and need for supplemental oxygen performed similarly to more complex measures including additional parameters. Our study demonstrates that longitudinal TCS measures may be useful in children with pneumonia, both in clinical settings to assess recovery and readiness for discharge, and as an outcome measure in research and quality assessments. Additional study is needed to further validate our findings.
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Differences among febrile infant institutional clinical practice guidelines (CPGs) may contribute to practice variation and increased healthcare costs. ⋯ CPG recommendations for febrile infants 29 to 56 days old vary across institutions for CSF testing and ceftriaxone use, correlating with observed practice variation. CPGs were not associated with lower healthcare costs.
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Observational Study
Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital.
Alarm fatigue is reported to be a major threat to patient safety, yet little empirical data support its existence in the hospital. ⋯ Most alarms were nonactionable, and response time increased as nonactionable alarm exposure increased. Alarm fatigue could explain these findings. Future studies should evaluate the simultaneous influence of workload and other factors that can impact response time.
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Little information is available on how active adult patients are during their hospitalization. The purpose of this study is to describe the level of ambulation in hospitalized patients. This was a cohort study of ambulatory patients from 3 hospital medical-surgical units conducted March 2014 through July 2014. ⋯ For patients who had at least 48 hours of monitoring (n = 378), there was an increase from 811 steps in the first 24 hours to 1188 steps in the final 24 hours prior to discharge. More frequent documentation was associated with higher step counts (P ≤ 0.001). We found that a diverse sample of hospitalized adult patients accrued over 1000 steps in the 24 hours prior to discharge home.