The study may have been underpowered to detect small differences in event rates; however, there was no trend suggesting that subsegmental PE had better outcomes than more proximal PE. Also, the study did not specifically investigate whether any management strategy is preferred based on thrombus location on CTA.
Bottom line: Clinicians should continue to anticoagulate patients with subsegmental PE as the prognosis is similar to those with proximal PE.
Citation: Den Exter PL, van Es J, Klok FA, et al. Risk profile and clinical outcome of symptomatic subsegmental pulmonary embolism. Blood. 2013;122:1144-1149.
Video-Based Educational Workshop for Academic Hospitalists and House Staff May Improve Professionalism
Clinical question: Can video-based education promote professionalism among academic hospitalists and house staff?
Background: Unprofessional behavior by academic hospitalists and residents can negatively impact the learning environment and patient safety. This behavior increases throughout training, and faculty behavior can be influential. There is a paucity of educational materials to train hospitalists and house staff to recognize and ameliorate unprofessional behaviors.
Study design: Educational survey study.
Setting: University of Chicago, Northwestern University, and NorthShore University Health System teaching hospitals.
Synopsis: Three videos were developed displaying three types of unprofessional behavior: disparaging other physicians, “blocking” admissions, and misrepresenting tests to expedite their completion. There were 44 hospitalists and 244 house staff who received a 60-minute workshop in which they watched the videos using a viewing tool and discussed the videos in small groups.
For all three videos, more than three-quarters of both hospitalists and house staff felt the behavior was unprofessional or somewhat unprofessional. Hospitalists and house staff found the workshop useful and effective (65.9% and 77.1%, respectively) and would change their behavior as a result of the workshop (65.9% and 67.2%, respectively). Those who perceived the videos as “very realistic” were more likely to report intent to change behavior (93% vs. 53%, P=0.01).
This study is limited by its small sample size and possible selection bias. Those interested or concerned about unprofessional behavior may have been more likely to attend the workshop.
Bottom line: Video-based professionalism education is a feasible and well-received way to educate hospitalists and residents about unprofessional behavior and may even affect their future behavior.
Citation: Farnan JM, O’Leary KJ, Didwania A, et al. Promoting professionalism via a video-based educational workshop for academic hospitalists and housestaff. J Hosp Med. 2013;8:386-389.
Friday and Weekend Elective Surgeries Have Increased Mortality
Clinical question: How can the association between mortality and the day of elective surgical procedures be assessed?
Background: Several studies have described the “weekend effect” for both surgical and medical patients, with higher mortality and length of stay in patients admitted on the weekend compared to weekdays. Two potential explanations are poorer quality of care being delivered on the weekend or more severely ill patients being operated on or admitted on the weekend.
Study design: Retrospective analysis of national hospital administrative data.
Setting: All acute-care and specialist hospitals in England from 2008 to 2011.
Synopsis: There were 4,133,346 elective, inpatient surgical procedures studied. Friday surgeries had an adjusted odds ratio of death within 30 days and within two days of 1.44 [95% CI, 1.39-1.50] and 1.42 [95% CI, 1.26-1.60], respectively, when compared with Monday. Weekend surgeries had an adjusted odds ratio of death within 30 days and within two days of 1.82 [95% CI, 1.71-1.94] and 2.67 [95% CI, 2.30-3.09], respectively, when compared with Monday. There were significant trends toward higher mortality at the end of the workweek and weekends for four high-risk procedures: esophagus and/or stomach excision, colon and/or rectum excisions, coronary artery bypass graft, and lung excision. For lower-risk procedures, there was a significant increase in mortality for Friday surgeries but not weekend surgeries. As with all studies using administrative data, inherent selection biases could not be adjusted for Friday or weekend procedures.