In the Literature

The Hospitalist. 2010 May;2010(05):

May 1, 2010 | The Hospitalist

Sameer Badlani, MD ; Stacy S. Banerjee, MD ; Alan J. Jung, MD ; Elizabeth Marlow, MD, MPP ; Valerie G. Press, MD, MPH ; Milda R. Saunders, MD, MPH ; Nilam J. Soni, MD Srilaxmi Tumuluri, MD ; University Of Chicago

Bottom line: Incidental findings requiring followup were more than twice as common as PE (24% vs. 9%) in CTAs ordered to evaluate for PE in an ED.

Citation: Hall WB, Truitt SG, Scheunemann LP, et al. The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med. 2009;169(21):1961-1965.

Clinical Shorts

MORTALITY RELATED TO HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS VARIES WITH ADMISSION DIAGNOSIS

Retrospective cohort study found that hyperglycemia increased mortality risk in critically ill patients independent of severity of illness, LOS in the ICU, or diabetes diagnosis, but differs based on admission diagnosis.

Citation: Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML. Hyperglycemia-related mortality in critically-ill patients varies with admission diagnosis. Crit Care Med. 2009;37(12):3001-3009.

Patients Don’t Penalize for Adverse-Outcome Disclosure

Clinical question: What patient or clinical characteristics affect the likelihood of physician reporting of an adverse outcome, and how does adverse-outcome disclosure affect patient perceptions of quality of care?

Background: Harmful adverse events (AE), injuries caused by medical management rather than by the underlying condition of the patient, are common in the U.S. Previous studies have focused on physician and provider attitudes about disclosure. Little is known about how characteristics of the AE affect disclosure, and how disclosure affects patients’ perceptions of quality of care.

Study design: Retrospective cohort study.

Setting: Acute-care hospitals in Massachusetts.

Synopsis: Of 4,143 eligible patients, 2,582 (62%) agreed to a telephone interview that asked about patient experiences with adverse events during their hospital stay. Respondents reporting an AE were asked about disclosure by medical staff, effects of adverse events on their hospital course, and the quality of their hospital care.

Of the 845 AEs reported by 608 patients, only 40% were disclosed, defined as “anyone from the hospital explaining why the negative effects occurred.” The majority of the AEs were related to newly prescribed medications (40%) and surgical procedures (34%). Researchers determined that 31% of the AEs were preventable and 75% were severe. In multivariate analysis, disclosure was less likely if the AE was preventable or if patients had long-term effects from the AE. Patients with an AE were more likely to rate the quality of their hospitalization higher if there had been disclosure.

Bottom line: Disclosure of adverse events by medical personnel is low (40%) in hospitalized patients, even though disclosure of adverse events increases patients’ ratings of quality of care.

Citation: López L, Weismann JS, Schneider EC, Weingart SN, Cohen AP, Epstein AM. Disclosure of hospital adverse events and its association with patients’ ratings of the quality of care. Arch Intern Med. 2009;169(20):1888-1894.

Clinical Shorts

PATIENTS ADMITTED TO THE ICU DURING ROUNDS HAVE HIGHER MORTALITY RATES

Retrospective study of nearly 50,000 patients admitted to the ICU showed that patients admitted during morning rounds had higher hospital mortality rates than those admitted during nonround hours.

Citation: Afessa B, Gajic O, Morales IJ, Keegan MT, Peters SG, Hubmayr RD. Association between ICU admission during morning rounds and mortality. Chest. 2009;136(6).1489-1495.

PSYCHIATRIC MEDICATIONS AND BENZODIAZEPINES ASSOCIATED WITH FALLS IN ELDERLY

A meta-analysis of more than 79,000 elderly patients examining an association between falls and medication classes found a significantly increased risk with antidepressants, benzodiazepines, and sedatives and hypnotics.

Citation: Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952-1960.

Comanagement of Hip-Fracture Patients by Geriatricians Decreases Time to Surgery, LOS, and Complications

Clinical question: Does comanagement of hip-fracture patients by geriatricians and orthopedic surgeons improve short-term outcomes?