Hospital practice (1995)
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Hospital practice (1995) · Apr 2011
Retrospective administrative database study of the time period of venous thromboembolism risk during and following hospitalization for major orthopedic or abdominal surgery in real-world US patients.
To assess the incidence and time course of symptomatic venous thromboembolism (VTE) events in patients during and following hospitalization for major orthopedic or abdominal surgery. ⋯ The time course of VTE in major surgery patients suggests that VTE risk is highest during the first 19 days after admission and that considerable VTE risk extends into the period after discharge.
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Hospital practice (1995) · Apr 2011
Implementation of a medical intensive care unit acute-care nurse practitioner service.
Demands for critical care services are increasing, but the supply of qualified physicians is not. Moreover, there are mounting national expectations for continuous on-site, senior providers and for adherence to quality and safety practices. In teaching institutions, manpower shortages are exacerbated by shrinking trainee duty hours, and there is a growing desire to recoup the revenue lost when a non-credentialed provider delivers a service. ⋯ Acute-care nurse practitioners also provide 40% of the daily resident core lectures and a monthly staff nurse conference. Insufficient data exist at this time, however, to report accurate billing or collection results. Specific areas discussed within this article include service structure, hiring and training, implementation, scheduling, supervision, problems encountered, productivity, monitoring, and future plans.
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Hospital practice (1995) · Feb 2011
Rapid response team interventions for severe hyperkalemia: evaluation of a patient safety initiative.
This study evaluates outcomes and process measures associated with a rapid response team (RRT) intervention for patients with severe hyperkalemia. ⋯ Hyperkalemia occurs frequently in inpatient settings. Rapid response team intervention for this condition facilitates timely correction of critical laboratory test results and consistent treatment through use of a standardized protocol. Benefit of the intervention on mortality could not be reliably demonstrated in this study due to event rarity and challenges with case ascertainment. Further research with a prospective, multi-site cluster design using electronic medical records and larger sample sizes could demonstrate which RRT hyperkalemia intervention components warrant widespread adoption.
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Hospital practice (1995) · Feb 2011
The relationship between Elder Risk Assessment Index score and 30-day readmission from the nursing home.
Preventable early readmission to the hospital is expensive, and identification of patients at risk is an important task for health care providers. The objective of this study was to determine the relationship between a high score on the Elder Risk Assessment (ERA) Index and 30-day readmission to the hospital in older patients discharged to a nursing home. ⋯ Those with the highest ERA Index score, the top quartile, were not at risk for early hospital readmission. The ERA Index does not predict readmissions from the nursing home to the hospital. There is a need to develop a unique index to predict rehospitalizations in nursing home residents.
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Hospital practice (1995) · Feb 2011
Effect of adding nitroglycerin to early diuretic therapy on the morbidity and mortality of patients with chronic kidney disease presenting with acute decompensated heart failure.
Loop diuretics are considered first-line therapy for patients with acute decompensated heart failure (ADHF). Adding nitroglycerin (NTG) to diuretic therapy for alleviation of acute shortness of breath has been advocated in our institution. We evaluated the benefits of adding NTG to diuretics in the emergency department for patients with ADHF and chronic kidney disease (CKD). ⋯ There is a role for early administration of NTG in addition to diuretic therapy in patients admitted to the emergency department with ADHF, with resultant decreased length of stay and a trend toward a decrease in the composite endpoint of all-cause mortality and ADHF readmission. The mortality benefit at 2 years reported in our study is thought-provoking and raises a premise to be proven in randomized clinical trials.