Main Causes of Costly Inappropriate Hospital Admissions are Premature Admission and the Potential for Outpatient Management
Clinical question: How prevalent and costly are inappropriate hospital admissions and are patients’ intrinsic risk factors (IRFs) or comorbidities associated with inappropriate hospital admissions?
Background: Health care resource overuse (inappropriate hospital admissions) has a significant economic impact on U.S. health care spending. While previous studies have focused on the frequency and non-clinical patient factors linked to improper hospital admissions, this article explores the economic consequences of such admissions and the connection between IRFs or comorbidities and inappropriate hospital admissions using the...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine In the Literature Source Type: research
Use of Amiodarone with Apixaban or Rivaroxaban Increases Risk for Bleeding-related Hospitalizations
This study was observational, and the Medicare data lacked information on several potential confounding factors, thereby limiting the ability to establish a causal relationship. However, hospitalists who are initiating antiarrhythmic drugs for atrial fibrillation should consider the potential increased risk for bleeding-related hospitalization in patients concurrently taking apixaban or rivaroxaban.
Bottom line: Amiodarone, when used in conjunction with apixaban or rivaroxaban, increases the risk of bleeding-related hospitalization when compared to the use of flecainide or sotalol.
Citation: Ray WA, et al. Risk for bleedin...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Hematology (blood) In the Literature Source Type: research
Initial Aggressive Diuresis in Patients Hospitalized with Acute HF
Clinical question: For patients admitted with acute heart failure, is early and aggressive diuresis associated with improved dyspnea without an associated worsening in renal function?
Background: Acute heart failure is one of the leading causes of hospitalization in the U.S. and intravenous loop diuretics are considered the mainstay of therapy. Data and guidelines regarding diuretic goals and the safety of early aggressive diuresis are lacking.
Study design: Retrospective, pooled-cohort analysis
Setting: Merged data from the DOSE, ROSE, and ATHENA-HF trials
Synopsis: A pooled cohort of 807 patients admitted with acute hear...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Periprocedural Management of Patients with AF Receiving a DOAC Undergoing a Digestive Endoscopy
This study established a standardized periprocedural DOAC management strategy based on medication pharmacokinetics, including creatinine clearance and procedure risk. The authors analyzed outcomes for 556 adult patients with AF who were treated with DOACs, undergoing an elective digestive endoscopy, and who were able to adhere to the defined DOAC interruption protocol. The mean duration of DOAC interruption was 3.9 ±1.6 days. There were low rates of thromboembolism (0.7%) and GI bleeding (2.5%).
Procedure details were unavailable for those with bleeding complications and most complications occurred around 10 days post-pro...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology Gastroenterology In the Literature Source Type: research
DOACs Versus LMWH and Recurrent VTE in Patients with Cancer
Clinical question: Are direct oral anticoagulants (DOACs) acceptable compared to low-molecular-weight heparin (LMWH) for preventing venous thromboembolism (VTE) with a safe bleeding risk in cancer patients?
Background: LMWH has long been the standard of care in cancer patients with VTE and for future VTE prevention. Are DOACs now a viable option?
Study design: Randomized clinical trial
Setting: 67 U.S. member centers of the Alliance for Clinical Trials in Oncology research network
Synopsis: 671 participants were randomized to either the DOAC or LMWH group. Rates of VTE were 6.1% in the DOAC group and 8.8% in the LMWH group...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Oncology Pulmonology Source Type: research
Opioids Confer Risk without Improved Pain Control
Clinical question: How effective and safe are opioids for the treatment of acute, non-specific low back and neck pain?
Background: Despite the lack of evidence of the effectiveness of opioids for the treatment of low back and neck pain, patients presenting with these symptoms are often prescribed opioid analgesics. This is the first placebo-controlled, randomized trial to measure the short- and long-term efficacy and side effects associated with opioid use for spinal pain.
Study design: Triple-blinded, randomized controlled trial
Setting: Primary care and emergency department sites in Sydney, Australia
Synopsis: A total of...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Addiction Medicine In the Literature Pain Management Source Type: research
Reducing Use of NPO After Midnight for Inpatient Diagnostic and Therapeutic Procedures
Clinical question: Can an interprofessional quality improvement team reduce the use of nil per os (NPO) after midnight orders prior to inpatient diagnostic and therapeutic procedures requiring anesthesia or sedation?
Background: Evidence suggests that the aspiration risk is actually quite low for many diagnostic and therapeutic procedures requiring anesthesia or sedation. Current guidelines support reducing fasting durations prior to these procedures, however, the use of NPO after midnight is still common practice. This practice results in unnecessarily long NPO durations and results in adverse effects.
Study design: Singl...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Clinical Guidelines In the Literature Source Type: research
Aspirin Thromboprophylaxis is Non-inferior to LMWH for Prevention of Death and Pulmonary Embolism after Orthopedic Trauma
Clinical question: Is aspirin as effective as low-molecular-weight heparin (LMWH) for thromboprophylaxis in patients with orthopedic trauma?
Background: Studies have outlined the benefits of thromboprophylaxis in patients with traumatic orthopedic injuries to prevent thromboembolic complications and death. Recent studies suggest aspirin may be an effective alternative to LMWH in patients who have undergone total joint arthroplasty. However, similar data in patients with orthopedic trauma is limited.
Study design: Pragmatic, multicenter, randomized, noninferiority trial
Setting: 21 adult trauma centers across the U.S. and C...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Pulmonology Source Type: research
Clinical progress note: ACC/AHA/HFSA 2022 heart failure guideline pearls for hospitalists
(Source: Journal of Hospital Medicine)
Source: Journal of Hospital Medicine - March 1, 2024 Category: Hospital Management Authors: Prateeti Khazanie,
Mel L. Anderson Tags: PROGRESS NOTES Source Type: research
SHM Converge 2024: Message from the Course Director
If you’re anything like me, you need something to look forward to in the spring after the dark days of winter. Enter Converge 2024, in sunny San Diego, April 12-15!
On behalf of the Annual Conference Committee, comprising academic and community physicians, advanced practice practitioners, and the SHM staff, we’re excited to share highlights of the conference with you.
First, we are on the San Diego Harbor with an amazing view. However, we think you’ll be so busy with three days packed with educational content, research competitions, speed mentoring,
Special Interest Forums, exhibitors, and, new for 2024, the MEDTED t...
Source: The Hospitalist - February 23, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: SHM Converge Source Type: research
Things to Do in Sunny San Diego
The historic aircraft carrier, USS Midway Museum moored in Broadway Pier in San Diego.
SHM Converge 2024 is just around the corner, taking place from April 12 to 15. While noting down the sessions you wish to attend and catching up with friends and colleagues (see our editorial board’s recommendations), remember to also enjoy the beautiful city of San Diego.
San Diego is known as the birthplace of California, as it was the first location in the western U.S. where Europeans set foot, specifically Point Loma. It’s also the birthplace of the California burrito, which includes French fries and carne asada. The city is hom...
Source: The Hospitalist - February 23, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: SHM Converge Source Type: research
Editorial Board Picks for Must-Attend Converge 2024 Sessions
If you’re attending SHM Converge 2024 in San Diego in April, you’ve probably already checked out the jam-packed schedule and may have even started circling the sessions you want to attend. We checked in with some of The Hospitalist’s editorial board members to see which sessions they’re most excited about. You can find the full schedule here.
Dr. Hadley
Andrea Hadley, MD, FAAP, FHM, internal medicine and pediatric hospitalist, division chief, acute care pediatrics at Corewell Health/Helen DeVos Children’s Hospital and assistant professor of internal medicine and pediatrics, Michigan State University College o...
Source: The Hospitalist - February 23, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: SHM Converge Source Type: research
Annals for Hospitalists - February 2024
Ann Intern Med. 2024 Feb;177(2):eAWHO202402200. doi: 10.7326/AWHO202402200.NO ABSTRACTPMID:38373320 | DOI:10.7326/AWHO202402200 (Source: Annals of Internal Medicine)
Source: Annals of Internal Medicine - February 19, 2024 Category: Internal Medicine Authors: David A Fried Source Type: research
Annals for Hospitalists - February 2024
Ann Intern Med. 2024 Feb;177(2):eAWHO202402200. doi: 10.7326/AWHO202402200.NO ABSTRACTPMID:38373320 | DOI:10.7326/AWHO202402200 (Source: Annals of Internal Medicine)
Source: Annals of Internal Medicine - February 19, 2024 Category: Internal Medicine Authors: David A Fried Source Type: research
Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility
Am J Phys Med Rehabil. 2024 Mar 1;103(3S Suppl 1):S46-S51. doi: 10.1097/PHM.0000000000002408.ABSTRACTHematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitat...
Source: Cancer Control - February 16, 2024 Category: Cancer & Oncology Authors: Jack B Fu Shinichiro Morishita Source Type: research
