Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Multicenter Study
Hospital readmission and healthcare utilization following sepsis in community settings.
Sepsis, the most expensive cause of hospitalization in the United States, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood. ⋯ Postsepsis survival and healthcare utilization were most strongly influenced by patient factors already present prior to sepsis hospitalization.
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The landscape of hospital-based care has shifted to place greater emphasis on improving quality and delivering value. In response, hospitals and healthcare organizations must reassess their strategies to improve care delivery in their facilities and beyond. Although these institutional goals may be defined at the executive level, implementation takes place at local sites of care. ⋯ Hospitalists are well poised to take on the role of the local clinical care improvement leader based on their experiences as direct frontline caregivers and their integral roles in hospital-wide quality and safety initiatives. A unit-based leadership model consisting of a medical director paired with a nurse manager has been implemented in several hospitals to function as an effector arm in response to the changing landscape of inpatient care. We provide an overview of this new model of leadership and describe the experiences of 6 hospitals that have implemented it.
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Multicenter Study
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
The most recent iteration of the Accreditation Council for Graduate Medical Education duty-hour regulations includes language mandating handoff education for trainees and assessments of handoff quality by residency training programs. However, there is a lack of validated tools for the assessment of handoff quality and for use in trainee education. ⋯ Using standardized video-based scenarios highlighting differing levels of performance, we were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance. Future work to validate the tool in clinical settings is warranted.
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The goal of mechanical ventilation in acute hypoxemic respiratory failure is to support adequate gas exchange without harming the lungs. How patients are mechanically ventilated can significantly impact their ultimate outcomes. ⋯ Prompt recognition of ARDS and use of lung-protective ventilation, as well as evidence-based adjunctive therapies, remain the cornerstones of caring for patients with acute hypoxemic respiratory failure. In the absence of contraindications, it is reasonable to consider lung-protective ventilation in non-ARDS patients as well, though the evidence supporting this practice is less conclusive.
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Randomized Controlled Trial
A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team.
Episodes of patient deterioration on hospital units are expected to increasingly contribute to morbidity and healthcare costs. ⋯ Real-time alerts sent to the RRT did not reduce ICU transfers, hospital mortality, or the need for subsequent long term care. However, hospital length of stay was modestly reduced.