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 gain further insights into physician HH behaviors. Following training and validation with a hospital HH auditor, 2 students covertly measured HH during clinical rotations. Students rotated off clinical services every week to increase exposure to different providers and minimize risk of exposing the covert observation. We compared covertly measured HH compliance with data from overt observation by hospital auditors during the same time period. Covert observation produced much lower HH compliance than recorded by hospital auditors during the same time period: 50.0% (799/1597) versus 83.7% (2769/3309) (P < 0.0002). The difference in physician compliance between hospital auditors and covert observers was 19.0% (73.2% vs 54.2%); for nurses this difference was much higher at 40.7% (85.8% vs 45.1%) (P < 0.0001). Physician trainees showed markedly better compliance when attending staff cleaned their hands compared with encounters when attending did not (79.5% vs 18.9%; P < 0.0002). Our study suggests that traditional HH audits not only overstate HH performance overall, but can lead to inaccurate inferences about performance by professional groupings due to relative differences in the Hawthorne effect. We suggest that future improvement efforts will rely on more accurate HH monitoring systems and strong attending physician leadership to set an example for trainees. Journal of Hospital Medicine 2015;11:862-864. © 2015 Society of Hospital Medicine.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Kovacs-Litman A,Wong K,Shojania KG,Callery S,Vearncombe M,Leis JAdoi
10.1002/jhm.2632subject
Has Abstractpub_date
2016-12-01 00:00:00pages
862-864issue
12eissn
1553-5592issn
1553-5606journal_volume
11pub_type
杂志文章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：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...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2236
更新日期：2015-01-01 00:00:00
abstract：:Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. We conducted a comprehensive search of 7 databases, including MEDLINE, Embase, a...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.2313
更新日期：2015-04-01 00:00:00
abstract：OBJECTIVE:To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticu...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2296
更新日期：2015-03-01 00:00:00
abstract：BACKGROUND:Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE:To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES:Medline, EMBASE, CINAHL, Scopus. STUDY...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,meta分析,评审
doi：10.1002/jhm.688
更新日期：2010-09-01 00:00:00
abstract：BACKGROUND:Hospital leaders have had mixed success reducing readmissions Little is known about the readmitted patient's perspective. METHODS:A cross-sectional 36-item survey was administered to 1084 readmitted inpatients of The Hospital of the University of Pennsylvania (an urban academic medical center) and Penn Pres...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.1966
更新日期：2012-11-01 00:00:00
abstract：BACKGROUND:Little is known about management of hyperglycemia in inpatients. OBJECTIVE:To gain insight into caring for hospitalized patients with hyperglycemia. DESIGN:Retrospective analysis. SETTING:Teaching hospital. PATIENTS:Data on all patients discharged between January 1, 2001, and December 31, 2004 with a dia...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.188
更新日期：2007-07-01 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：:Patients who deteriorate outside the intensive care unit (ICU) are known to have elevated mortality and morbidity. Rapid response teams (RRTs) were developed to address such deterioration. It has not been possible to establish that RRTs employing manual detection methods have definitively improved hospital outcomes. B...
journal_title：Journal of hospital medicine
pub_type：
doi：10.1002/jhm.2653
更新日期：2016-11-01 00:00:00
abstract：OBJECTIVE:To explore why it is permissible for surgeons to "unilaterally withhold" surgery, whereas it is not commonplace (in the United States) to unilaterally withhold cardiopulmonary resuscitation (CPR) for clinical situations with similar degrees of uncertainty and prognosis. DATA SOURCES:The medical literature wa...
journal_title：Journal of hospital medicine
pub_type： 社论
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更新日期：2012-03-01 00:00:00
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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：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:Warfarin reduces stroke in patients with atrial fibrillation. However, its narrow therapeutic index and need for chronic monitoring are barriers to its optimal utilization in many patients. The recent introduction of 3 novel oral anticoagulants (NOACs), as alternatives to warfarin, may change the eligibility...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.2201
更新日期：2014-06-01 00:00:00
abstract：BACKGROUND:Half of patients admitted to hospital for reasons unrelated to childbirth are age 65 years or older. Nonetheless, few hospital-based physicians have received training in geriatric medicine, and few geriatricians practice in the hospital. This paper describes the state of the science of hospital care for olde...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.11
更新日期：2006-01-01 00:00:00
abstract：:Pain management is a core competency of hospital medicine, and effective acute pain management should be a goal for all hospital medicine providers. The prevalence of opioid use in the United States, both therapeutic and non-medical in origin, has dramatically increased over the past decade. Although nonopioid medicat...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2733
更新日期：2017-05-01 00:00:00
abstract：IMPORTANCE:Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. OBJECTIVE:To characterize inpatient adaptations to care for non-ICU COVID-19 patients. DES...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3476
更新日期：2020-08-01 00:00:00
abstract：OBJECTIVE:We examined the impact of an aspart insulin protocol for treatment of hyperglycemia in the emergency department (ED) coupled with rapid initiation of a detemir-aspart insulin protocol for patients admitted to the hospital. RESEARCH DESIGN AND METHODS:ED patients with type 2 diabetes mellitus and a blood gluc...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,随机对照试验
doi：10.1002/jhm.866
更新日期：2011-05-01 00:00:00
abstract：BACKGROUND:Patients with suspected thiamine deficiency should receive treatment with parenteral thiamine to achieve the high serum thiamine levels necessary to reverse the effects of deficiency and to circumvent problems with absorption common in the medically ill. OBJECTIVE:To quantify rates of parenteral administrat...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,多中心研究
doi：10.1002/jhm.2324
更新日期：2015-04-01 00:00:00
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...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.1979
更新日期：2013-01-01 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：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
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journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
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更新日期：2017-07-01 00:00:00
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journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2443
更新日期：2015-12-01 00:00:00
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journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2321
更新日期：2015-04-01 00:00:00
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journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2965
更新日期：2018-04-01 00:00:00
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journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.147
更新日期：2007-01-01 00:00:00
abstract：BACKGROUND:Approximately 83% of hospitalist groups around the country utilize advanced practice providers; however, the demand for hospitalists continues to exceed the supply, and this has led to increased utilization of advanced practice providers in hospital medicine. Advanced practice providers receive very limited ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3183
更新日期：2019-06-01 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：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：BACKGROUND:Obese patients are thought to be at higher risk of postoperative medical complications. We determined whether body mass index (BMI) is associated with postoperative in-hospital noncardiac complications following urgent hip fracture repair. METHODS:We conducted a population-based study of Olmsted County, Min...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
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更新日期：2009-10-01 00:00:00
