Published in the February 2008 issue of Today’s Hospitalist
Hospitals slow to shock patients with cardiac arrest
THE LARGEST STUDY to date looking at the incidence of defibrillation found that nearly a third of patients with in-hospital cardiac arrest had delayed defibrillation.
Researchers used observational data to identify patients in more than 360 U.S. hospitals who had cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia. Guidelines recommend shocking within two minutes of recognizing that a patient is in cardiac arrest.
The study found that 30% of patients did not receive defibrillation within that time frame. Delayed defibrillation has been associated with higher mortality and higher rates of major disability.
Factors that researchers found associated with delayed defibrillation included patients admitted for noncardiac illnesses; patients who suffered cardiac arrests at night or on weekends when staffing was lowest; hospitals that had fewer than 250 beds; patients who arrested outside telemetry units; and African-American patients. Researchers said the latter factor reflected the quality of care in hospitals where more black patients are treated.
In comments made to the New York Times, the study’s lead author said that possible solutions could include the use of rapid response teams or of automatic defibrillators.
The study was published in the Jan. 3 New England Journal of Medicine.
Hospitals get low marks for UTI prevention
IN THE FIRST NATIONAL SURVEY of efforts to prevent urinary tract infections (UTIs), less than one in three U.S. hospitals was found to utilize practices designed to prevent those infections. Even fewer “less than one in 10 “make use of daily urinary-catheter reminders for physicians. Those automated prompts have been proven to reduce catheter use and infection rates.
Researchers sent surveys to a national sample of hospitals that had ICUs, as well as to all VA hospitals. They found no predominant technique being used to prevent hospital-acquired UTIs.
Among researchers’ findings related to specific prevention techniques:
“¢ 30% of hospitals use antimicrobial urinary catheters and portable scanners;
“¢ 14% used condom catheters; and
“¢ 9% used catheter reminders.
In addition, 56% of hospitals surveyed did not have any system in place to monitor which patients had urinary catheters, while 74% did not monitor "catheter duration." (Prevention-technique rates were higher at VA hospitals than at non-VA facilities.) The issue of preventing UTIs now is more visible because Medicare has announced that it will no longer pay for the cost of treating hospital-acquired UTIs, beginning in October 2008.
Findings were published in the Jan. 15 issue of Clinical Infectious Diseases.
Glycemic control research grants available
THE ASHP FOUNDATION is now accepting applications for grants to support hospital pharmacist-hospitalist collaborations to improve glycemic control.
The grants should be used to evaluate multidisciplinary initiatives targeting glycemic control that are undertaken by hospital pharmacists and hospitalists. Applications should emphasize health-services research capabilities and initiatives that can be replicated in other facilities.
Each proposed study must be submitted to an institutional review board for approval. Two grants of $50,000 each will be awarded; the application deadline is March 3. Applicants will be notified of grants by May 1.
Applications and more information are available under “Funding Opportunities” at www.ashpfoundation.org.
