Posts by Danielle Scheurer

Hospitalist work volume and perceived effects on patient care

In this large survey of hospitalists, 40% reported that their patient volume exceeded safe levels at least once a month, the that high volume often affected their ability to fully discuss treatment options, delayed admits or discharges, affected their ability to safely cross cover patients, or affected their ability to adequately hand off patients. Many also reported high volumes affected their utilization of tests, readmission rates, patient satisfaction, and quality of care. Hospital medicine programs need to continue to monitor workload, to ensure too high workloads do not result in care detriments for patients (abstract).

Trach weaning modalities

In this trial of trach patients weaning from the ventilator, they were randomized to weaning via pressure support, or by unassisted breathing through the trach. Those randomized to unassisted breathing weaned much earlier than the pressure support group (15 versus 19 days) with no difference in mortality between the groups (abstract).

Modern day impact of smoking cessation

This large cohort found for those age 25-79, current smoking increased the risk of death from any cause by 3 times, compared to nonsmokers, and reduced life expectancy by 10 years, compared to nonsmokers. These modern day statistics are sobering and should be used to enhance smoking cessation advice for all smoking patients (abstract).

Oscillator more harm than good for ARDS

In this large randomized trial of patients with ARDS, who were randomized to traditional ventilation with low volumes and high PEEP or high frequency oscillator ventilation (HFOV), the trial was stopped early due to higher mortality in the HFOV group. This ventilatory support can not be recommended for patients with ARDS (abstract)