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| July 4, 2014 |
| CARDIAC MONITORING |
| 1. Finding A-fib after cryptogenic stroke, TIA |
| Two new studies found that longer monitoring can help detect unrecognized A-fib in patients suffering cryptogenic stroke. In the first study, patients with cryptogenic stroke or TIA in the previous six months were randomized to receive either 30-days of continuous ECG monitoring or conventional 24-hour monitoring. Researchers detected A-fib lasting 30 seconds or longer in 16.1% of those in the intervention arm vs. only 3.2% of controls. In the second study, researchers randomized cryptogenic stroke patients to either long-term monitoring with an insertable cardiac monitor or episodic ECGs. At 12 months, A-fib had been detected in 12.4% of patients on long-term monitoring vs. 2% of patients in the other study arm. Both studies were published in NEJM. An editorial noted that clinicians don't identify the cause of one-third of ischemic strokes and that patients with cryptogenic stroke or TIA should receive rhythm monitoring for several weeks. The editorial also pointed out that patients should be switched from antiplatelets to anticoagulants when subclinical A-fib is detected. Read more in NEJM. |
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| RECRUITING AND COMPENSATION |
| 2. The surveys say ... |
| A new recruiting and compensation survey finds that hospitalists are still one of the hottest physician searches—and that recruitment for hospital-employed physicians across all specialties is booming. The 2014 survey released by Merritt Hawkins, a national recruiter, found that fewer than 10% of recruiting searches in 2013-14 were for private practices, while 64% were for hospital employment. According to the survey, hospitalist compensation remained flat between 2013-14 and 2012-13, with an average annual compensation of $229,000. Other survey results, which were released by the Association of Staff Physician Recruiters (ASPR), found that 63% of doctors employed by hospitals received a straight salary vs. only 47% of those owning their own practice. The ASPR survey also found that only 25% of doctors surveyed received a signing bonus. ASPR results were based on an Internet survey of more than 300 physicians across 26 specialties, although the survey did not report hospitalist-specific data. Read more of the Merritt Hawkins survey report. |
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| DRUG SHORTAGES |
| 3. IV saline shortage won't ease until next year |
| Tired of getting by with too little saline? Manufacturers say that the current shortage won't be relieved until 2015, leaving hospitals scrambling for supplies and creating new protocols to conserve the IV saline they have on hand. According to Kaiser Health News coverage, drug companies aren't able to keep up with IV-saline demand in the wake of recalls and a tough flu season. Some hospitals are now using smaller IV saline bags to stretch supplies and transitioning patients sooner to drinking water. One source noted that the FDA strategy to import IV saline from European countries would not be sustainable because those countries need to protect their own supplies. The article also reported that U.S. hospitals spend more than $200 million a year in labor costs to manage drug shortages and that the saline shortage promises to be the most expensive one on record. Read more in Kaiser Health News. |
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| PATIENT COMMUNICATION |
| 4. Redesigning DNR/DNI discussions |
| When conducting code status discussions, doctors too often make this mistake: lumping cardiac arrest together with prearrest respiratory failure, and conflating CPR with mechanical ventilation. That's according to authors of a new viewpoint piece posted online by the Journal of Hospital Medicine. Instead, the authors argue, doctors need to differentiate DNR scenarios from do-not-intubate ones, and they should spell out the differences in indications and outcomes between the two interventions. (The viewpoint notes that mortality for inhospital cardiac arrest is more than 75%, while the mortality rate for isolated respiratory failure is under 40%.) In practice, the authors write, "many physicians extrapolate DNR orders to other treatment decisions and interpret them as precluding intubation, even for prearrest states." Read more in the Journal of Hospital Medicine. |
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| SURGICAL VOLUMES |
| 5. Health reform could boost the number of surgeries |
| If you've been putting off entering into surgical comanagement agreements, now may be the time to negotiate. A new study suggests that health reform may increase the number of both elective and nonelective surgeries for newly-covered patients. Writing online in JAMA Surgery, authors compared 2003-10 data from Massachusetts to data from both New Jersey and New York. The study found that after health reform was implemented in Massachusetts in 2007, the number of elective surgeries rose 9.3% while the number of nonelective surgical procedures grew by 4.5%. Full implementation of the ACA, researchers pointed out, could lead to an additional 466,000 surgeries by 2017. Read more in JAMA Surgery. |
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