Archive for March 2012

Digital Distractions: Time for a Diet

It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must do everyday. It’s no surprise, then, that reports of problematic doctor interactions with social media are popping up with metronomic regularity. When it comes to the smorgasbord of information coursing through those Internet tubes, increasingly, we all have to eat. And that makes drawing boundaries a challenge. While most early reports on the perils of social media concerned inappropriate postings by physicians, a new hazard has emerged recently: digital distraction. On WebM&M, the AHRQ-sponsored online patient safety journal that I edit, we recently presented a case in which a resident was asked by her attending…

New transfusion guidelines

The AABB has issued updated guidelines on transfusion thresholds, which include a Hb<7 for most ICU patients, and a Hb<8 for most post-surgical patients, with higher thresholds for those with symptoms (such as chest pain or decompensated CHF). The full guidelines are available at (guidelines)

Early detection of deterioration

In this large of hospitalized patients at 14 patients with a comprehensive EMR, a host of predictors automatically pooled from the EMR accurately predicted a patient's risk of ICU transfer or death with a validation c-statistic of 0.77. Automated EMR-based scores such as this can quickly identify patients at risk for clinical deterioration (abstract)

The Same Readmissions Tune Keeps Playing. Not A Pleasant Melody.

Of note, a very nice commentary in today's NEJM regarding our inability to control 30-day readmissions, and the justifications (or lack thereof) for its continued use as a metric in judging inpatient quality.  I suggest everyone who works on the front lines read it: [...]Although a focus on readmissions may have good face validity, we believe that policymakers' emphasis on 30-day readmissions is misguided, for three reasons. First, the metric itself is problematic: only a small proportion of readmissions at 30 days after initial discharge are probably preventable, and much of what drives hospital readmission rates are patient- and community-level factors that are well outside the hospital's control. Furthermore, it is unclear whether readmissions always reflect poor quality: high readmission rates can be the result of low mortality rates or good access to hospital care. Second, although improving discharge planning and care coordination is a laudable goal, there are better, more…

CTA for low risk chest pain

In patients with low risk chest pain (TIMI score 0-2), this large trial randomized patients to usual care, or to CTA imaging. Of those with a negative CTA, none experienced death or MI within 30 days. Those in the CTA group had higher rates of ED discharge (50% vs 23%) and shorter total LOS (18 vs 25 hours). CTA (in experienced centers with low variability in reads, and real-time availability) can be used to expedite safe discharges in low risk ACS (abstract)