Abstract:
BACKGROUND:Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. DESIGN, SETTING, PATIENTS:Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED. METHODS:Evaluation of 178,315 ED non-ICU admissions to 13 US community hospitals. We tabulated the outcome of unplanned ICU transfer by patient characteristics and hospital volume. We present factors associated with unplanned ICU transfer after adjusting for patient and hospital differences in a hierarchical logistic regression. RESULTS:There were 4,252 (2.4%) non-ICU admissions transferred to the ICU within 24 hours. Admitting diagnoses most associated with unplanned transfer, listed by descending prevalence were: pneumonia (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.2-1.9), myocardial infarction (MI) (OR 1.5; 95% CI 1.2-2.0), chronic obstructive pulmonary disease (COPD) (OR 1.4; 95% CI 1.1-1.9), sepsis (OR 2.5; 95% CI 1.9-3.3), and catastrophic conditions (OR 2.3; 95% CI 1.7-3.0). Other significant predictors included: male sex, Comorbidity Points Score >145, Laboratory Acute Physiology Score ≥7, arriving on the ward between 11 PM and 7 AM. Decreased risk was found with admission to monitored transitional care units (OR 0.83; 95% CI 0.77-0.90) and to higher volume hospitals (OR 0.94 per 1,000 additional annual ED inpatient admissions; 95% CI 0.91-0.98). CONCLUSIONS:ED patients admitted with respiratory conditions, MI, or sepsis are at modestly increased risk for unplanned ICU transfer and may benefit from better triage from the ED, earlier intervention, or closer monitoring to prevent acute decompensation. More research is needed to determine how intermediate care units, hospital volume, time of day, and sex affect unplanned ICU transfer. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Delgado MK,Liu V,Pines JM,Kipnis P,Gardner MN,Escobar GJdoi
10.1002/jhm.1979subject
Has Abstractpub_date
2013-01-01 00:00:00pages
13-9issue
1eissn
1553-5592issn
1553-5606journal_volume
8pub_type
杂志文章abstract:BACKGROUND:Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use. OBJECTIVE:To compare inpatient analgesic prescribing patterns and patients' perception of pain control in the United States and non-US ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究
doi:10.12788/jhm.3256
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Gender earnings disparities among physicians exist even after considering differences in specialty, part-time status, and practice type. Little is known about the role of job satisfaction priorities on earnings differences. OBJECTIVE:To examine gender differences in work characteristics and job satisfaction...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2400
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:The economic burden of acute kidney injury (AKI) is not well understood. OBJECTIVE:To estimate the effects of AKI on hospitalization costs and length of stay (LOS). DESIGN:Using data from the 2012 National Inpatient Sample, we compared hospitalization costs and LOS with and without AKI. We used a generaliz...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2683
更新日期:2017-02-01 00:00:00
abstract::The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2811
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND: OBJECTIVE: DESIGN, SETTING, PATIENTS: INTERVENTION: MEASUREMENTS: CONCLUSIONS: ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3102
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:The theory that posthospitalization stress might increase the risk of postdischarge complications has never been investigated. OBJECTIVE:To assess whether serum levels of stress biomarkers at discharge are associated with readmission and death after an acute-care hospitalization. DESIGN:We prospectively in...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2766
更新日期:2017-07-01 00:00:00
abstract::Every year, nearly 5 million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illne...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.2511
更新日期:2016-04-01 00:00:00
abstract::Acute decompensated heart failure (ADHF) is one of the most common conditions managed by hospitalists. Here we review the most recent evidence applicable to hospitalists for the diagnosis, risk stratification, and management of patients presenting with ADHF. By following a structured approach based on the patient's sy...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.1919
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Attending rounds at academic medical centers are often disconnected from patients and team members who are not physicians. Regionalization of care teams may facilitate bedside rounding and more frequent interactions among doctors, nurses, and patients. OBJECTIVE:We used time-motion analysis to investigate h...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2696
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Dexmedetomidine is a potentially useful sedative for hospitalized children, but there is little published data regarding its safety, dosage, or efficacy. OBJECTIVE:To report our experience with dexmedetomidine for the sedation of hospitalized children. DESIGN:Retrospective case series. SETTING:Pediatric I...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.282
更新日期:2008-03-01 00:00:00
abstract::Non-housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapi...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.311
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. OBJECTIVES:Develop a list of medications associated with geriatric syndromes and describe their...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2614
更新日期:2016-10-01 00:00:00
abstract:: ...
journal_title:Journal of hospital medicine
pub_type: 评论,社论
doi:10.12788/jhm.3116
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Outpatient parenteral antimicrobial therapy (OPAT) is a safe way to administer intravenous (IV) antimicrobial therapy to patients with the potential to decrease hospital length of stay (LOS). Often, homeless patients with complex infections, who could otherwise be treated as an outpatient, remain in the hosp...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.2597
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Although interdisciplinary hospital quality improvement (QI) teams are both prevalent and associated with success of (QI) efforts, little is known about the behaviors of successful interdisciplinary QI teams. OBJECTIVE:We examined the specific behaviors of interdisciplinary QI teams in hospitals that succes...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.927
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Few studies have examined alternative structures for inpatient clerkships. OBJECTIVE:Compare 2 inpatient clerkship structures using multiple outcome variables. DESIGN:Prospective, randomized controlled trial. SETTING:Tertiary-care, freestanding children's hospital. SUBJECTS:All medical students enrolled ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,随机对照试验
doi:10.1002/jhm.250
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:High-flow nasal cannula (HFNC) is increasingly used to treat children hospitalized with bronchiolitis; however, the best practices for feeding during HFNC and the impact of feeding on time to discharge and adverse events are unknown. The study objective was to assess whether feeding exposure during HFNC was ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3306
更新日期:2019-09-18 00:00:00
abstract::For more than 20 years, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program has been identifying and synthesizing evidence to inform evidence-based healthcare. Recognizing that many healthcare settings continue to face challenges in disseminating and implementing evidence...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3157
更新日期:2019-05-01 00:00:00
abstract::Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addit...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.12788/jhm.2750
更新日期:2017-06-01 00:00:00
abstract::Many hospitalists are routinely granted hospital privileges to perform invasive bedside procedures, but criteria for privileging are not well described. We conducted a survey of 21 hospitalist procedure experts from the Society of Hospital Medicine Point-of-Care Ultrasound Task Force to better understand current privi...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2837
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Communication between clinicians is hampered by the frequent difficulty in reaching the most responsible physician for a patient as well as the use of outdated methods such as numeric paging. The aim of this study was to evaluate the use of smartphones to improve communication on internal medicine wards. ME...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.775
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE: DESIGN: SETTING: PATIENTS: MEASUREMENTS: RESULTS: CONCLUSIONS: ...
journal_title:Journal of hospital medicine
pub_type: 评论,信件
doi:10.12788/jhm.2992
更新日期:2018-11-01 00:00:00
abstract::Successful secondary prevention of cardiovascular disease relies on medication therapy; thus, minimizing nonadherence is a focus for improving patient outcomes. Receipt of discharge medication counseling has been associated with improved drug knowledge and adherence. We evaluated the prevalence and predictors of postd...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2446
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Health care-associated infections and antimicrobial resistance threaten the safety of hospitalized patients. New prevention strategies are necessary to address these problems. In response, the Society of Hospital Medicine (SHM) in collaboration with the Centers for Disease Control and Prevention developed an...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.223
更新日期:2007-07-01 00:00:00
abstract::Nephrogenic systemic fibrosis (NSF) has now been linked to gadolinium-based contrast (GBC) exposure in those with compromised kidney function, particularly those with end-stage renal disease (ESRD). When ESRD is present, symptoms can be quite devastating for the patient including severe pain and immobility and even de...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.493
更新日期:2010-01-01 00:00:00
abstract::Physicians are notorious for poor hand hygiene (HH) compliance. We wondered if lower performance by physicians compared with other health professionals might reflect differences in the Hawthorne effect. We introduced covert HH observers to see if performance differences between physicians and nurses decreased and to g...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2632
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:Mortality in hospitalized human immunodeficiency virus (HIV)-infected patients is not well described. We sought to characterize in-hospital deaths among HIV-infected patients in the antiretroviral (ART) era and identify factors associated with mortality. METHODS:We reviewed the medical records of hospitalize...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2409
更新日期:2015-09-01 00:00:00
abstract::Registry data indicate a gap between evidence-based guidelines and current management of patients with acute decompensated heart failure (ADHF). Bridging this gap is crucial given the frequency and cost of hospitalization for this disorder. Patients with ADHF require rapid assessment to determine appropriate treatment...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.395
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation rec...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3275
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There i...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.979
更新日期:2012-04-01 00:00:00