|
 |
|
|
 |
| |
 |
| June 28, 2013 |
| STROKE PREVENTION |
| 1. Dual therapy for TIA patients? |
| Chinese researchers publishing in NEJM have found that dual therapy with clopidogrel and aspirin for patients suffering a minor stroke or TIA reduce patients' relative risk of stroke within 90 days by one-third. Nearly 5,200 patients were randomized within 24 hours of symptom onset to either clopidogrel-aspirin therapy or placebo-aspirin therapy. Stroke occurred in 8.2% of those taking dual therapy vs. 11.7% of patients taking aspirin alone. While those taking dual therapy had a trend toward more bleeding events, the rate of hemorrhagic stroke was similar between both groups. An accompanying editorial pointed out, however, that all the patients enrolled were Chinese and that results may not apply to non-Chinese populations because of genetic differences in metabolizing clopidogrel. The editorial concluded that more non-Chinese patients should be enrolled in trials testing dual and triple therapy and that new antiplatelets and anticoagulants should be tested as well for stroke prevention. Read more in NEJM. |
|
| |
| ED ADMISSIONS |
| 2. Admission rates vary by ED, physician |
| When it comes to admissions from the ED, not all hospitals and ED doctors are equal. That's the conclusion of a study that appears in the Annals of Emergency Medicine, with researchers looking at retrospective data for three EDs in one health care system. The review covered nearly 390,000 ED visits with 89 attending ED doctors. After data were adjusted for patient and clinical factors, the study found that hospital-level admission rates across the three hospitals ranged from 27% to 41%, while physician-level rates varied from 21% to 49%--a greater than two-fold variation. Read more in the Annals of Emergency Medicine. |
|
| |
| CARDIAC CARE |
| 3. Study: one-third of telemetry days not needed |
| Researchers analyzing the use of telemetry at several teaching hospitals found that 35% of telemetry days at those hospitals were not indicated. Publishing online in the American Journal of Managed Care, authors in 2008 compared indications for patients in telemetry units in four Massachusetts hospitals to guidelines. They found that the incidence of arrhythmias in patients on nonindicated days was low (3.1 per 100 days) and that the arrhythmias detected were not clinically significant. Estimating that each nonindicated telemetry day costs hospitals $53 per patient, investigators estimated that a 400-bed hospital could eliminate 5,000 nonindicated patient days per year, saving the hospital $250,000. Read more in the American Journal of Managed Care. |
|
| |
| VTE PREVENTION |
| 4. How many patients actually receive VTE prophylaxis? |
| Johns Hopkins researchers reviewing electronic records on how many hospitalized patients who were ordered VTE prophylaxis actually received all doses have learned that, overall, 12% of those doses were not administered. However, records indicated that compliance varied significantly across floors, with patients on some medical floors missing far more doses than those on surgery floors or in the ICU. The authors, publishing online in PLOS ONE, examined seven months' of data on more than 103,000 patients at Johns Hopkins Hospital. While records indicated that close to 60% of patients received all ordered doses of VTE prophylaxis, 8% missed more than half. Patient or family-member refusal was the cause for more than half of the missing doses. Authors recommended that hospitals use electronic records to learn in real time which patients are refusing VTE prophylaxis and to intervene. One intervention at the hospital to encourage greater compliance was to begin using a less painful method of injection. Read more in PLOS ONE. |
|
| |
| PATIENT SATISFACTION |
| 5. Is food the key to better satisfaction scores? |
| According to Kaiser Health News, some hospitals are ditching their Jell-O molds in favor of growing their own vegetables, doing their own brining and fermenting, and offering much better meals that patients can order like room service. Going upscale with to-order offerings—like banana nut pancakes—not only improves patient satisfaction scores, the article reports, but saves hospitals money. Hospitals upgrading the food they prepare are also enjoying increased revenue, as better food brings in more business in hospital cafeterias. Administrators in one hospital in the University of North Carolina Health System featured in the article believe the improved food service is at least partly responsible for the hospital being recommended by 84% of patients surveyed, compared to only 71% nationwide. That hospital won a culinary competition in 2012 for health care food services. Read more in Kaiser Health News. |
|
|
|
|
|
|
