Leaders of the Pack

Who is better at decreasing mortality and length of stay: intensivists or hospitalists? Neither, researchers at Emory University in Atlanta report.

The group, led by Kristin Wise, MD, assistant professor of medicine at Emory, sought to answer this question at a time when an increasing number of hospitals are turning to hospitalists to fill manpower gaps in ICUs. For its timely research, the group is being honored: The Emory team’s abstract was one of three chosen as HM09’s Best of Research, Innovations, and Clinical Vignettes (RIV). The presenting abstracts received the highest scores; 409 abstracts were submitted for this year’s RIV competition.

Emory’s prospective, cohort study of 1,084 patients showed no statistically significant difference in mortality rate between patients treated by the intensivist team and the hospitalist ICU team. "It definitely shows hospitalists can provide high-quality ICU staffing … and can help address future critical-care needs as we’re facing an intensivist shortage," Dr. Wise says.

New Communication Tool

University of Michigan (UM) hospitalists Vineet I. Chopra, MBBS, MD, FACP, and Prasanth Gogineni, MD, together with a team of engineering students at UM, won the best of innovations award for their work on a Web site and iPhone application meant to replace the pager system healthcare teams currently use to communicate.

Using the application, known as MComm, hospitalists and other members of healthcare teams can delegate tasks to other physicians, as well as acknowledge when their own tasks are completed." Medical communication is fundamental to inpatient safety, quality, and cost of care," says Dr. Chopra, clinical assistant professor of medicine at UM. "We believe MComm represents a technological breakthrough in medical communication and the process of improving workflow. The use of electronic technology that organizes patients according to team and priority is unprecedented."

Inspirational Case

Twylla Tassava, MS, MD, administrator of academic consult service at Saint Joseph Mercy Hospital in Ann Arbor, Mich., described a novel way to treat intracranial pressure in patients with diabetes insipidus.

A 17-year-old female whose car was hit by a truck traveling 50 mph presented with a Glasgow coma score of 4 and multiple traumatic injuries. The hospitalist team was consulted on day two, when the patient released 1,790 cc of urine in one hour, an indication of diabetes insipudis (DI). When DI occurs within the first three days of brain injury, research shows the mortality rate to be 86%. Dr. Tassava’s team proposed using permissive hypernatremia to control the patient’s intracranial pressure.

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