November 2011

AcademicClinicalPatient CarePediatrics

Dr. Shen Responds to Kernicterus Letters

True rates of kernicterus have been difficult to calculate for a variety of reasons, yet we must get a handle on “who” gets kernicterus if we are to appropriately decide which infants receive phototherapy. The letters we received highlight a critical need to delve deeper into the epidemiology of kernicterus, a journey that must begin with accurate reporting of this disease.

ClinicalPatient CarePediatrics

Kernicterus Is Observable, Predictable, Curable

Doctors seem to take on a lackadaisical, roll-of-the-dice type of approach to the prevention of kernicterus. Since the numbers are so low, they are not providing the vigilant watch and, therefore, allowing newborns to slip from hyperbilirubinemia to actual kernicterus.

ClinicalLiterature ReviewsPatient Care

In the Literature: The latest research you need to know

Atelectasis and fever; heparin dosing frequency for VTE prophylaxis; perioperative cardiac risk calculator; diagnosing subarachnoid hemorrhage without an LP; model to predict risk of bleeding on warfarin; risk of death with tiotropium use in COPD; BNP to predict perioperative mortality; beta-blockers and COPD.

ClinicalInnovationPatient SafetyQI InitiativesQuality

Seven-Day Schedule Could Improve Hospital Quality, Capacity

A new study evaluating outcomes for hospitals participating in the American Heart Association’s Get with the Guidelines program found no correlation between high performance on adhering to measures and care standards for acute myocardial infarction and for heart failure despite overlap between the sets of care processes (J Am Coll Cardio. 2011;58:637-644). A total of… [Read More]

InnovationPatient SafetyQI InitiativesQuality

Intermountain Risk Score Could Help Heart Failure Cases

A risk measurement model created by the Heart Institute at Intermountain Medical Center in Murray, Utah, may one day be a familiar tool to HM groups. Known as the Intermountain Risk Score (http://intermountainhealthcare.org/IMRS/), the tool uses 15 parameters culled from complete blood counts (CBC) and the basic metabolic profile (BMP) to determine risk. The model,… [Read More]

InnovationQI InitiativesQualityTransitions of Care

New Jersey Hospital Funds Care-Transitions “Coach”

Robert Wood Johnson University Hospital in Hamilton, N.J., has partnered with Jewish Family and Children’s Services of Greater Mercer County to support care transitions for 350 chronically ill older patients. Patients will receive a transitions coach following hospital discharge for education, support, and encouragement to keep appointments with their physicians. This “coach” will develop a… [Read More]

ClinicalInnovationQuality

‘Smoothing’ Strategies in Children’s Hospitals Reduce Overcrowding

A report published online May 24 in the Journal of Hospital Medicine found that smoothing inpatient occupancy and scheduled admissions in 39 children’s hospitals helped reduce midweek overcrowding. Evan S. Fieldston, MD, MBA, MSHP, of the University of Pennsylvania School of Medicine in Philadelphia and colleagues previously demonstrated occupancy variability and midweek crowding weekends (J… [Read More]

Quality

By the numbers – 0.5%

The reduction President Obama has proposed to a formula used by the Independent Payment Advisory Board (IPAB), created last year by the Affordable Care Act to cut Medicare costs without affecting quality. The formula IPAB currently uses as a baseline for growth estimates is GDP per capita, plus 1%. The president has proposed to reduce… [Read More]

QI InitiativesQualityRIV

“Teachback” Reduces Readmissions for CHF Patients

A sking “teachback” questions to hospitalized chronic heart failure (CHF) patients at Lehigh Valley Health Network in Allentown, Pa., helps them better understand their condition, treatment, and post-discharge care—thereby impacting readmissions. In an abstract presented at HM11 in Dallas in May, CHF patients who received teachback had a 7.3% readmission rate in the first three… [Read More]

Health ITInnovationTechnology

Bayes Theorem? There’s an App for That

A hospitalist at Beth Israel Deaconess Medical Center in Boston has created an iPhone application to help give academic HM groups fingertip access to Bayesian nomograms and real-time research. Hospitalist Elizabeth Farrell, MD, says an app dubbed Medicine Toolkit (www.medicinetoolkit.com) should be available for download in a matter of weeks. The app has two components…. [Read More]

ClinicalIn the LiteratureLiterature ReviewsPatient Care

In the Literature: The latest research you need to know

Care-transitions intervention and rates of hospital readmission; Post-pneumonia CXR and rates of lung cancer identification; Hospitalist outcomes during and after hospitalization; Timing of smoking cessation and surgical outcomes