Archive for September 2011

Higher death rates after 2 non-dialysis days

In this large analysis of US dialysis patients, mortality rates were analyzed by day of week, and were found to be highest on the day after the 2 day "dialysis holiday" (eg Monday in a Mon/Wed/Fri schedule). Longer inter-dialysis duration is associated with higher rates of death. The typical long-standing 3 day-a-week dialysis schedule may need to be re-examined (abstract)

Continuous admissions reduce LOS better than bolus admissions

This pre-post analysis of a general medical teaching service found that smooth daily admissions reduced LOS by 0.3 days, compared to non-daily "bolus" admissions. Although this study analyzed a teaching service, the same is likely true of non-teaching services. Operationally, continuous service admissions are better for throughput than bolus admissions (abstract)

ACOG guidelines issued on VTE prevention/treatment during pregnancy

A lengthy guideline has been published by ACOG, on the prevention and treatment of VTE during pregnancy. In short, they conclude that for suspected PE, either V/Q scan or CT PE are acceptable diagnostic studies during pregnancy, and that for prevention and treatment, both heparins and low-molecular weight heparins are acceptable. Those with high-risk thrombophilias should be treated with prophylaxis during pregnancy and postpartum. They recommend cessation of anti-coagulants for delivery / epidurals, with resumption 6-12 hours after delivery, or 12 hours after epidural removal (guidelines)

Hip fracture mortality; just get them through the first year

In this large analysis of elderly patients with hip fractures, overall mortality was twice as high as those without hip fractures in the first year, but mortality rates were similar (in most age groups) after the first year, even in those >age 80. Improving the care of those in the first year after a hip fracture may prolong life for many future years (abstract).

Care quality in US territories

This large analysis of Medicare FFS recipients found both process and mortality measures were worse in US territories than US states, for the 3 core inpatient measures (CHF, AMI, pneumonia). Closing quality gaps in US territories should be a priority, but will likely require time and resources (abstract)