Abstract:
BACKGROUND:Best practice alerts (BPAs) provide clinical decision support (CDS) at the point of care to reduce unnecessary blood product transfusions, yet substantial transfusions continue outside of recommended guidelines. OBJECTIVE:To understand why providers order blood transfusions outside of recommended guidelines despite interruptive alerts. DESIGN:Retrospective review. SETTING:Tertiary care hospital. PARTICIPANTS:Inpatient healthcare providers. INTERVENTION:Provider-BPA interaction data were collected from January 2011 to August 2012 from the hospital electronic medical record. MEASUREMENTS:Provider (free-text) responses to blood transfusion BPA prompts were independently reviewed and categorized by 2 licensed physicians, with agreement assessed by χ(2) analysis and kappa scoring. RESULTS:Rationale for overriding blood transfusion BPAs was highly diverse, acute bleeding being the most common (>34%), followed by protocolized behaviors on specialty services (up to 26%), to "symptomatic" anemia (11%-12%). Many providers transfused in anticipation of surgical or procedural intervention (10%-15%) or imminent hospital discharge (2%-5%). Resident physicians represented the majority (55%) of providers interacting with BPAs. CONCLUSION:Providers interacting with BPAs (primarily residents and midlevel providers) often do not have the negotiating power to change ordering behavior. Protocolized behaviors, unlikely to be influenced by BPAs, are among the most commonly cited reasons for transfusing outside of guidelines. Symptomatic anemia is a common, albeit subjective, indication cited for blood transfusion. With a wide swath of individually uncommon rationales for transfusion behavior, secondary use of electronic medical record databases and integrated CDS tools are important to efficiently analyze common practice behaviors.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Chen JH,Fang DZ,Tim Goodnough L,Evans KH,Lee Porter M,Shieh Ldoi
10.1002/jhm.2236subject
Has Abstractpub_date
2015-01-01 00:00:00pages
1-7issue
1eissn
1553-5592issn
1553-5606journal_volume
10pub_type
杂志文章abstract:BACKGROUND:Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings. METHODS:We conducted a focused ethnography of trainees at 2 academic medical centers to understand the barri...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2966
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Specialty hospitals are a subset of acute-care hospitals that provide a narrower set of services than general medical hospitals (GMHs), predominantly in areas such as cardiac disease and surgery. Although specialty hospitals also advertise high patient satisfaction, this has not been examined using national ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2225
更新日期:2014-09-01 00:00:00
abstract::Increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. Because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial em...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.983
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:In the Medicare population, measures of relative severity of illness (SOI) for hospitalized patents have been used in prospective payment models. Similar measures for pediatric populations have not been fully developed. OBJECTIVE:To develop hospitalization resource intensity scores for kids (H-RISK) using p...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2948
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Interhospital transfer is an understudied area within transitions of care. The process by which hospitals accept and transfer patients is not well described. National trends and best practices are unclear. OBJECTIVE:To describe the demographics of large transfer centers, to identify common handoff practices...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2577
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:A small proportion of patients accounts for a large proportion of hospitalizations. OBJECTIVE:To obtain patients' perspectives of factors associated with the onset and continuation of high hospital use. DESIGN:Qualitative research study where a research coordinator conducted one-on-one semi-structured inte...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3175
更新日期:2019-03-20 00:00:00
abstract:BACKGROUND:Predicting death risk in patients with diverse conditions is difficult. The Hospitalized-patient One-year Mortality Risk (HOMR) score accurately determines death risk in adults admitted to hospital using health administrative data unavailable to clinicians and most researchers. OBJECTIVE:Determine if HOMR i...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2713
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Obtaining blood cultures (BCs) for patients hospitalized with community-acquired-pneumonia (CAP) has been recommended by experts and used as a measure of quality of care. However, BCs are infrequently positive in these patients and their effect on clinical management has been questioned. PURPOSE:We performe...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.382
更新日期:2009-02-01 00:00:00
abstract::Efforts to improve the patient experience are increasingly focusing on engaging patients and their "care partners" by using patient portals. The Acute Care Patient Portal Task Force was supported by the Gordon and Betty Moore Foundation to convene a national meeting of an interdisciplinary group of stakeholders, inclu...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2860
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow. DESIGN:We performed a tim...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.613
更新日期:2010-07-01 00:00:00
abstract:: ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3114
更新日期:2019-01-01 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: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:WHAT'S NEW:This is the first study of a pediatric hospitalist preoperative clinic. Pediatric hospitalists frequently make significant recommendations for patients with neuromuscular scoliosis prior to spinal surgery, especially those with medical complexity. Certain clinical criteria are statistically significantly ass...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2101
更新日期:2013-12-01 00:00:00
abstract::Interstitial lung disease (ILD) is a diverse group of disorders typically with insidious onset. Diagnosis and management largely occur in the outpatient setting; however, ILD can present acutely necessitating hospitalization. Effective inpatient management requires the clinician to establish an accurate diagnosis and ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.12788/jhm.2774
更新日期:2017-07-01 00:00:00
abstract::We examined whether placing a painting in the line of vision of a hospitalized patient improves patient outcomes and satisfaction and whether having patients choose their paintings offers greater benefit. From 2014 to 2016, we enrolled 186 inpatients with cancer diagnoses from Pennsylvania State University Cancer Inst...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,随机对照试验
doi:10.12788/jhm.2915
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined. OBJECTIVE:To investigate patterns and predictors of opioid utilization in nonsurgical admissions to US hospitals, variation ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2102
更新日期:2014-02-01 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:Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with ass...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.860
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Patient safety indicators (PSI) were developed for hospitals to screen for healthcare-associated adverse events. PSIs are believed to be preventable and have become a part of major pay-for-performance programs. PSI-12 captures perioperative venous thromboembolism (VTE), which contributes to morbidity and mor...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3298
更新日期:2019-11-20 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::For generations, American hospitals have been considered recession-proof, but there is reason to believe the current economic crisis is an exception. Hospitals have shown declining financial margins and decreased admissions. The severe recession has adversely affected many hospitals' finances, creating a risk of closu...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.654
更新日期:2010-05-01 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: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: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
abstract::Current hospital readmission measures are part of the Centers for Medicare & Medicaid Services Five-Star Quality Rating System but are inadequate for reporting hospital quality. We review potential biases in the readmission measures and offer policy recommendations to address these biases. Hospital readmission rates a...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2799
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE:To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay. DESIGN:Retrospective obser...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2592
更新日期:2016-10-01 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::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: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