Sustained Reduction in Lab Ordering After Implementing Mindful Ordering Initiatives
This study included 86 to 92 residents and 17 to 20 faculty per year, rotating through a general-medicine inpatient teaching service between 2016 and 2019. Interventions were implemented in five phases, which included resident education, promotion of faculty-resident communication, optimization of EMR by expanding lab ordering frequency options, adjusting the medicine admission order set, and reducing the frequency of lab collection default settings.
Survey data showed an increase in the percentage of residents who perceived themselves as ordering labs mindfully from 40% at week 31 to 91% at week 127 (P <.05). Total lab...
Source: The Hospitalist - September 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Clinical Guidelines In the Literature Source Type: research
Prioritizing Discharging Patients While Rounding Didn ’t Result in Earlier Discharge Times or Reduced LOS
Dr. Klein
Clinical question: Does a physician rounding style prioritizing discharging patients lead to earlier discharges or reduced length of stay (LOS)?
Background: Delayed discharges can adversely affect patient flow throughout the hospital, leading to delays of care, increased LOS, higher cost, and potentially increased mortality. Prioritizing discharges by a specific time has shown mixed results in prior studies. There have been no previous randomized studies to assess the efficacy of a rounding style prioritizing discharges.
Study design: Prospective, multicenter, randomized, controlled trial
Setting: Three large a...
Source: The Hospitalist - September 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Clinical Guidelines In the Literature Source Type: research
Real-world Application of Oral Therapy for Infective Endocarditis
Dr. Chadwick
Clinical question: Does oral transitional antibiotic therapy have similar outcomes to intravenous (IV)-only antibiotic treatment for infective endocarditis (IE)?
Background: There has been a longstanding belief, not supported by strong evidence, that deep infections such as IE require prolonged IV antibiotics, although it is known that long-term IV therapy is associated with adverse events. Despite previous evidence suggesting oral transitional therapy for IE to be at least as effective as IV-only treatment, this practice has yet to be adopted into the standard of care, possibly due to an absence of real-worl...
Source: The Hospitalist - September 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology Drug Therapy In the Literature Source Type: research
ODS in Hospitalized Patients with Hyponatremia
Dr. Mohoney
Clinical question: Of the patients who are admitted with hyponatremia, how many develop osmotic demyelination syndrome (ODS)?
Background: ODS is a rare but serious complication associated with hyponatremia. Previous studies demonstrated rates of ODS that ranged from 0.28 to 0.5%, with rapid sodium correction occurring in the majority but not all patients with ODS. Guidelines recommend slowly correcting serum sodium by no more than 8 mmol/L in 24 hours. Because there can be drawbacks associated with this approach, this study sought to further characterize the proportion of ODS in patients hospitalized with hypo...
Source: The Hospitalist - September 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Hematology In the Literature Source Type: research
Acetazolamide in Acute Decompensated Heart Failure With Volume Overload
This study included 519 patients admitted for acute decompensated heart failure who were randomly assigned to receive either acetazolamide 500 mg IV daily (259 patients) or placebo (260 patients) in addition to standardized IV loop diuretics. The primary outcome was complete decongestion at 72 hours, defined as the absence of any clinical sign of fluid overload using a congestion scoring system. Successful decongestion rates were significantly higher in the treatment group (42%) versus the placebo group (31%). Of relevance to hospital medicine, patients treated with acetazolamide had shorter lengths of stay (8.8 days, vers...
Source: The Hospitalist - September 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
