Journal of hospital medicine : an official publication of the Society of Hospital Medicine
-
Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR™) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR™ series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
-
Each hospital day of delirium incurs greater healthcare costs, higher levels of care, greater staff burden, and higher complication rates. Accordingly, administrators are incentivized to identify models of care that reduce delirium rates and associated costs. ⋯ Several models of care can prevent delirium. In general, higher quality studies were more likely to demonstrate statistical significance of an effect. The diverse models of care included here explored interventions adapted to specific care settings, especially by addressing setting-specific delirium risk factors. These care models illustrate a range of promising strategies that deserve growing recognition, refinement, and implementation.
-
Gabapentinoid prescriptions are increasing in North America, with frequent off-label use despite limited proven efficacy. This retrospective cohort study describes prescribing trends among hospitalized patients with a focus on dosing and deprescribing. We examined consecutive inpatients between December 2013 and July 2017 on a 52-bed medical unit in Montréal, Canada. ⋯ A minority (94/552, or 17%) were for approved indications. Although it was uncommon for gabapentinoids to be newly prescribed in hospital, preadmission gabapentinoids were also seldom deprescribed (65/495 patients discharged alive, or 13%). Given a high prevalence of use, limited efficacy, and potential harms, gabapentinoids may represent an ideal target for re-evaluation of indication and effectiveness in hospitalized adults, with consideration given to deprescribing.