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 received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste. METHODS:We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children's hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS "in-hand" and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. RESULTS:The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25. CONCLUSIONS:Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Hoefgen ER,Jones Y,Courter J,Hare A,Garcia JAT,Simmons Jdoi
10.12788/jhm.3275subject
Has Abstractpub_date
2020-01-01 00:00:00pages
28-34issue
1eissn
1553-5592issn
1553-5606pii
jhm.3275journal_volume
15pub_type
杂志文章abstract:BACKGROUND:Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care. OBJECTIVE:To identify opportunities for improving discharge processes by examining calls to an advice line (AL). DESIGN:Prospective cohort. SETTING:A 500-bed, university-affiliated hosp...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2252
更新日期:2014-11-01 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
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更新日期:2012-04-01 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
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更新日期:2007-07-01 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
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更新日期:2020-08-01 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
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
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更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Knowing the number of discharges that will occur is important for administrators when hospital occupancy is close to or exceeds 100%. This information will facilitate decision making such as whether to bring in extra staff, cancel planned surgery, or implement measures to increase the number of discharges. W...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2802
更新日期:2018-03-01 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: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
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更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Individual provider performance drives group metrics, and increasingly, individual providers are held accountable for these metrics. However, appropriate attribution can be challenging, particularly when multiple providers care for a single patient. OBJECTIVE:We sought to develop and operationalize individu...
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更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs. METHODS:We developed the ACUTE Center at D...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.1906
更新日期:2012-04-01 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::Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerable mortality and morbidity. The aim of this study was to investigate the occurrence, impact, and trends of EVB in hospitalized cirrhotic patients on a nationwide level in the United States. We interrogated data f...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2360
更新日期:2015-07-01 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
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更新日期:2008-11-01 00:00:00
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更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Although severity of illness indices such as pneumonia severity index (PSI) are good predictors of short-term mortality for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), other patient factors may have added prognostic value. OBJECTIVE:To identify patient factors beyond the P...
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更新日期:2012-03-01 00:00:00
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更新日期:2011-01-01 00:00:00
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journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2017-09-01 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:2015-07-01 00:00:00
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journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2017-12-01 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
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更新日期:2010-01-01 00:00:00
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更新日期:2017-02-01 00:00:00
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更新日期:2016-08-01 00:00:00
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更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Munchausen syndrome by proxy (MSBP), more formally known as factitious disorder imposed on another, is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care so that the proxy will receive medical care that gratifies the caregiver. Although well documen...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
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更新日期:2015-01-01 00:00:00
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pub_type: 杂志文章
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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
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更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. OBJECTIVE:To ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2019-03-01 00:00:00
abstract:: ...
journal_title:Journal of hospital medicine
pub_type: 评论,社论
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更新日期:2018-12-01 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:2016-04-01 00:00:00