In the Literature

The Hospitalist. 2009 September;2009(09):

September 1, 2009 | The Hospitalist

Alexander R. Carbo, MD, FHM ; Suzanne Bertisch, MD, MPH ; Lauren Doctoroff, MD ; John Fani Srour, MD ; Caleb Hale, MD ; Nancy Torres-Finnerty, MD, FHM

Citation: Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894-900.

Geriatric Care Coordination at Discharge Reduces Readmission Rates at 30 Days

Clinical question: Does a discharge planning service package affect readmission rates and ED visits?

Background: Elderly patients are at high risk for readmission after a hospitalization. Coordinated care packages, although effective in congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) management, have yielded inconsistent results in terms of decreasing readmission rates for patients with a broader range of medical issues.

Study design: Randomized controlled pilot study.

Setting: A single large academic medical center in Texas.

Synopsis: Forty-one elderly patients at high risk for readmission—because of their age and comorbidities—were enrolled within 72 hours of admission. Patients randomized to the care bundle arm received daily education about medication reconciliation, health conditions, and self-care provided by study pharmacists and nurses. The intervention required approximately 40 minutes per day: 20 to 25 minutes for the care coordinators and 20 minutes for the pharmacists. A post-discharge phone call to review medication and confirm follow-up instructions was included.

Eight patients in the control group and two patients in the intervention arm were readmitted or seen in the ED within 30 days after discharge (38% vs. 10%, P=0.004). At 60 days, the difference between the two groups was no longer significant. The intervention group had a longer time interval before its first readmission (36.2 days vs. 15.7 days). The sample was too small to determine the effect on length of hospitalization.

Limitations of the study include its small sample size and unclear costs of the intervention.

Bottom line: Geriatric discharge bundles might decrease readmission and ED visits after discharge, but larger studies are needed to confirm this finding.

Citation: Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day post-discharge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211-218.

Clinical Shorts

MICROALBUMINURIA INDEPENDENTLY ASSOCIATED WITH INCREASED VTE RISK

This prospective cohort study of 8,574 adults in the Netherlands demonstrated a significant, independent, and direct relationship between levels of microalbuminuria and the risk of venous thromboembolism (VTE).

Citation: Mahmoodi BK, Gansevoort RT, Veeger NJ, et al. Microalbuminuria and risk of venous thromboembolism. JAMA. 2009;301(17):1790-1797.

RED BLOOD CELL DISTRIBUTION WIDTH (RDW) TEST PREDICTS MORTALITY IN ADULTS 45 AND OLDER

Higher RDW is associated with increased mortality in patients with symptomatic cardiovascular disease. This cross-sectional study used NHANES III data to demonstrate that higher RDW is strongly associated with all-cause mortality.

Citation: Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009;169(5):515-523.

CHOLINESTERASE INHIBITORS INCREASE RISK OF SYNCOPE AND RELATED EVENTS IN PATIENTS WITH DEMENTIA

A population-based cohort study showed that hospital visits for syncope, bradycardia, permanent pacemaker placement, and hip fractures increase for elderly patients with dementia receiving cholinesterase inhibitors.

Citation: Gill SS, Anderson GM, Fischer HD, et al. Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Arch Intern Med. 2009;169(9):867-873.

Computer-Assisted Medication Reconciliation Might Reduce Unintentional Drug Discrepancies with Potential for Harm

Clinical question: Does a computerized medication reconciliation intervention reduce unintentional medication discrepancies?

Background: Given the high prevalence of unintentional medication discrepancies in hospitalized patients and the potential for harm, medication reconciliation is a national patient safety goal. Little data exist on the efficacy of medication reconciliation interventions for reducing medication discrepancies.