In the Literature: HM-Related Research You Need to Know

The Hospitalist. 2011 April;2011(04):

April 1, 2011|The Hospitalist

Elizabeth Schulwolf, MD, MA;Sean Greenhalgh, MD;Aziz Ansari, DO, FHM;Nathan Derhammer, MD, FAAP;Paula Marfia, MD;Elizabeth Wantuch, MD, MS;Division OF

In This Edition

Literature at a Glance

A guide to this month’s studies

Early ambulation and LOS in geriatric patients
Patient-safety movement and hospital harm rates
Lifestyle modification and weight loss
Outcomes of transcatheter aortic-valve implantation
Tool for predicting mortality in advanced dementia
Residents’ opinion of new duty-hour regulations
Renal ultrasound predictor for acute kidney injury
Romiplostim use in immune thrombocytopenia

Increasing Ambulation within 48 Hours of Admission Decreases LOS by Two Days

Clinical question: Is there an association between an early increase in ambulation and length of stay (LOS) in geriatric patients admitted with an acute illness?

Background: Early ambulation leading to better recovery in such illnesses as pneumonia and myocardial infarction is well known, as is early ambulation after hip fracture surgery to prevent complications. However, no specific guidelines exist in regard to ambulation in older patients.

Study design: Prospective, nonblinded study.

Setting: Acute-care geriatric unit in an academic medical center.

Synopsis: A total of 162 patients 65 or older were studied. Data were collected during a four-month period in 2009. A Step Activity Monitor (SAM) was placed on admission. Patients were instructed to walk as usual. Investigators measured the number of steps taken per day and change in steps between the first and second day.

Patients averaged 662.1 steps per day, with a mean step change of 196.5 steps. The adjusted mean difference in LOS for patients who increased their total steps by 600 or more between the first and second day was 2.13 days (95% CI, 1.05-3.97). Patients who had low or negative changes in steps had longer LOS. The 32 patients who walked more than 600 steps were more likely to be men (P=0.02), independently ambulate (P<0.01), and have admitting orders of “ambulate with assist” (P=0.03).

One limitation of this study is that patients who walked more might have been less ill or very functional on admission.

Bottom line: Increasing ambulation early in a hospitalization (first two days) is associated with a decreased LOS in an elderly population.

Citation: Fisher SR, Kuo YF, Graham JE, Ottenbacher KJ, Ostir GV. Early ambulation and length of stay in older adults hospitalized for acute illness. Arch Intern Med. 2010;170(21):1942-1943.

Clinical Short

USING SHOCK INDEX (SI) MIGHT BE A USEFUL TOOL IN PREDICTING ILLNESS SEVERITY AND PATIENTS AT RISK FOR AN UNPLANNED TRANSFER TO THE ICU

This retrospective study used the shock index (heart rate/systolic blood pressure, reference value 0.54) to predict illness severity. An SI of >0.85 was associated with unplanned ICU transfers.

Citation: Keller AS, Kirkland LL, Rajasekaran SY, Cha S, Rady MY, Huddleston JM. Unplanned transfers to the intensive care unit: the role of the shock index. J Hosp Med. 2010;5(8):460-465.

Despite Efforts to Improve Patient Safety in Hospitals, No Reduction in Longitudinal Rates of Harm

Clinical question: As hospitals focus more on programs to improve patient safety, has the rate of harms decreased?

Background: Since the Institute of Medicine published a groundbreaking report (To Err is Human) a little more than a decade ago, policymakers, hospitals, and healthcare organizations have focused more on efforts to improve patient safety with the goal of reducing harms. It is not clear if these efforts have reduced harms.

Study design: Retrospective chart review.

Setting: Ten hospitals in North Carolina.

Synopsis: Ten charts per quarter were randomly selected from each hospital from January 2002 through December 2007. Internal and external reviewers used the IHI Global Trigger Tool for Measuring Adverse Events to identify rates of harm. Harms were classified into categories of severity and assessed for preventability.