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A study takes aim at rapid response teams

January 2009

Published in the January 2009 issue of Today’s Hospitalist

New study challenges effectiveness of rapid response teams

NEW RESEARCH HAS FOUND that rapid response teams (RRTs) for adult patients may not lead to significantly fewer cardiopulmonary arrests or deaths.

The study looked at the effects of a rapid response team in a single hospital in Kansas City, Mo. While researchers found fewer cardiac arrests in the hospital after a team was put in place, the difference was not statistically significant. The number of overall hospital deaths also did not decline after an RRT was implemented.

The study was published in the Dec. 3, 2008, Journal of the American Medical Association. The use of RRTs has been heavily promoted by organizations like the Institute of Healthcare Improvement, which made the adoption of an RRT one of the six “planks” in its 100,000 Lives campaign.

According to the Today’s Hospitalist 2008 Compensation & Career Survey, about 49% of responding hospitalists said their group provided RRT coverage.

Tougher times for hospitals

RESULTS FROM A NEW SURVEY detail the types of new financial pressures on the nation’s hospitals and those facilities’ new cost-cutting initiatives. In November 2008, the American Hospital Association issued results from a third quarter (July-September 2008) survey with a sample of more than 730 hospitals. The following are some of those findings:

Nearly 40% of respondents noted a drop in the number of overall admissions.

More than 30% of survey respondents reported a moderate to significant decline in patients seeking elective procedures.

The proportion of patients needing uncompensated care rose 8% over the same period in 2007.

Total profit margins for hospitals for the third quarter were -1.6% vs. +6.1% in the same quarter the previous year.

The number of respondents making or considering cutbacks was 60% for administrative cuts, 53% for staffing cuts and 27% for reducing services.

Hospitals’ interest payments rose 15% compared to the same quarter in 2007. Among respondents, 45% planned to delay purchasing clinical technology; and

39% intended to put off investing in information technology.

Hospitalists dramatically improve throughput, diversion status

A TEAM OF HOSPITALISTS employing a process of active bed management was able to significantly reduce both the amount of time that patients waited in the ED for a bed and the number of times that the ED had to go on diversion.

In research published in the Dec. 2, 2008, Annals of Internal Medicine, the hospitalists reduced throughput time for patients by 98 minutes during the study period. They also reduced the percentage of hours that the ED was diverting ambulances because of ED overcrowding by 6% and the percentage of hours when ambulances were diverted because of the lack of ICU beds by 27%.

The hospitalists, who all work at Johns Hopkins Bayview Medical Center in Baltimore, employed a process that included twice-daily bed-management rounds in the ICU as well as regular ED visits to assess patient flow, admissions and transfers.

The process also used a designated hospitalist “bed director” who could mobilize additional resources, including calling in more hospitalists and assigning medical admissions to non-medical beds.

More restrictions for resident hours?

A NEW INSTITUTE OF MEDICINE (IOM) report recommends revising resident work-hour rules to make those rules more restrictive.

New rules were adopted in 2003, setting a maximum workweek for residents at 80 hours, with shifts lasting no longer than 30 hours. The new IOM recommendations don’t change that 80-hour limit but do propose that residents work no longer than 16 hours at a stretch before having a mandatory five-hour sleep break.

The IOM panel also recommends that residents have one full day off every week and at least two consecutive days off every month. The cost to the health care system for additional staff to provide 24/7 coverage and make those revisions possible would be $1.7 billion a year, according to the IOM report.

The report also recommends that interns in particular have on-site supervision rather than oversight from attendings who are available only by phone. More information about the report is online.

New videos target care for returning veterans

MORE THAN A DOZEN national organizations have teamed up to help educate medical professionals on the physical and psychological problems of returning veterans.

The Joining Forces initiative, which was first launched in Minnesota in 2007 and initially sponsored by the HealthPartners Institute for Medical Education in Bloomington, Minn., has created four half-hour videos that are now available online.

Those videos cover health problems being experienced by veterans deployed in Iraq and Afghanistan, including mild brain injury, post-traumatic stress disorder and depression.

According to a HealthPartners press release, more veterans are seeking medical attention outside of the Veterans Affairs (VA) system, and health care providers who are not in the VA are often not aware of patients’ military history and medical and psychiatric risk. Each video is a half-hour long, and continuing medical education credits are available. The videos are online at www.joiningforcesonline.org.