2011 April 19

Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary.

Apr 192011

Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary.

Clin Infect Dis. 2011 Feb;52(3):285-92

Authors: Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.

PMID: 21217178 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Adherence to Guideline-Directed Venous Thromboembolism Prophylaxis Among Medical and Surgical Inpatients at 33 Academic Medical Centers in the United States.

Am J Med Qual Start a Discussion »

Apr 192011

Adherence to Guideline-Directed Venous Thromboembolism Prophylaxis Among Medical and Surgical Inpatients at 33 Academic Medical Centers in the United States.

Am J Med Qual. 2011 Apr 13;

Authors: Schleyer AM, Schreuder AB, Jarman KM, Logerfo JP, Goss JR

This study's purpose was to describe compliance with established venous thromboembolism (VTE) prophylaxis guidelines in medical and surgical inpatients at US academic medical centers (AMCs). Data were collected for a 2007 University HealthSystem Consortium Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Benchmarking Project that explored VTE in AMCs. Prophylaxis was considered appropriate based on 2004 American College of Chest Physicians guidelines. A total of 33 AMCs from 30 states participated. In all, 48% of patients received guideline-directed prophylaxis-59% were medical and 41% were surgical patients. VTE history was more common among medical patients with guideline-directed prophylaxis. Surgical patients admitted from the emergency department and with higher illness severity were more likely to receive appropriate prophylaxis. Despite guidelines, VTE prophylaxis remains underutilized in these US AMCs, particularly among surgical patients. Because AMCs provide the majority of physician training and should reflect and set care standards, this appears to be an opportunity for practice and quality improvement and for education.

PMID: 21490270 [PubMed - as supplied by publisher]

Link to Article at PubMed

Improving safety and eliminating redundant tests: cutting costs in U.S. hospitals.

Health Aff (Millwood) Start a Discussion »

Apr 192011

Improving safety and eliminating redundant tests: cutting costs in U.S. hospitals.

Health Aff (Millwood). 2009 Sep-Oct;28(5):1475-84

Authors: Jha AK, Chan DC, Ridgway AB, Franz C, Bates DW

High costs and unsafe care are major challenges for U.S. hospitals. Two sources of raised costs and unsafe care are adverse events in hospitals and tests ordered by several different physicians. After reviewing rates of these two occurrences in U.S. hospitals and simulating their costs, we estimated that in 2004 alone, eliminating readily preventable adverse events would have resulted in direct savings of more than $16.6 billion (5.5 percent of total inpatient costs). Eliminating redundant tests would have saved an additional $8 billion (2.7 percent). Addressing these situations could generate major savings to the system while improving patient care.

PMID: 19738266 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Medicare’s policy not to pay for treating hospital-acquired conditions: the impact.

Health Aff (Millwood) Start a Discussion »

Apr 192011

Medicare's policy not to pay for treating hospital-acquired conditions: the impact.

Health Aff (Millwood). 2009 Sep-Oct;28(5):1485-93

Authors: McNair PD, Luft HS, Bindman AB

In 2008 Medicare stopped reimbursing hospitals for treating eight avoidable hospital-acquired conditions. Using 2006 California data, we modeled the financial impact of this policy on six such conditions. Hospital-acquired conditions were present in 0.11 percent of acute inpatient Medicare discharges; only 3 percent of these were affected by the policy. Payment reductions were negligible (0.001 percent, or $0.1 million-equivalent to $1.1 million nationwide) and are unlikely to encourage providers to improve quality. Options to strengthen the incentives include further payment modifications for hospital-acquired conditions or expanding the hospital-acquired condition policy to exclude payment for consequences, additional procedures, and readmissions.

PMID: 19738267 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Occurrence of atrial fibrillation during dobutamine stress echocardiography: incidence, risk factors, and outcomes.

J Am Soc Echocardiogr Start a Discussion »

Apr 192011

Occurrence of atrial fibrillation during dobutamine stress echocardiography: incidence, risk factors, and outcomes.

J Am Soc Echocardiogr. 2011 Jan;24(1):86-90

Authors: Sheldon SH, Askew JW, Klarich KW, Scott CG, Pellikka PA, McCully RB

The reported incidence of atrial fibrillation (AF) occurring during dobutamine stress echocardiography (DSE) ranges from 0.5% to 4%. The aim of this study was to characterize the incidence, risk factors, and outcomes of AF precipitated during DSE.

PMID: 21172598 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge.

J Am Med Inform Assoc Start a Discussion »

Apr 192011

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge.

J Am Med Inform Assoc. 2011 May 1;18(3):309-13

Authors: Schnipper JL, Liang CL, Hamann C, Karson AS, Palchuk MB, McCarthy PC, Sherlock M, Turchin A, Bates DW

Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30&emsp14;days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.

PMID: 21486889 [PubMed - in process]

Link to Article at PubMed

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