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Best DVT-prevention practices

May 2013

Published in the May 2013 issue of Today’s Hospitalist

DVT prevention saves hospitals money

IDENTIFYING BEST PRACTICES for postoperatIve DVT preventIon would help one hospital system save close to $4 million a year.

That’s according to a study published in the April issue of the Journal of the American College of Surgeons. Researchers identified the following best practices, which were implemented in four hospitals in an eight-hospital system: reserving sequential compression devices for outpatient and short-stay procedures; using unfractionated heparin, which is less expensive than low-molecular-weight heparin, for inpatient prophylaxis; and prescribing low-molecular-weight heparin for thrombotic events.

In the system’s other four hospitals, doctors were allowed to use compression devices and low-molecular-weight heparin for prophylaxis in all settings. Both groups of hospitals had the same outcomes in terms of the number of DVTs, but the use of best practices delivered cost savings.

The study also found that the most effective way to lower costs was to influence how doctors choose the materials and supplies they order.

New duty-hour rules: more handoffs

A STUDY CRITICAL OF NEW DUTY-HOUR RULES finds that the revised 2011 regulations may not only threaten patient safety due to the increased number of patient handoffs, but also curtail training.

The research randomized interns to one of three arms before the 2011 revisions took effect. In one arm, interns worked call every fourth night on a 30-hour shift, as per 2003 regulations. Those in the second arm worked one night in five on call, while those in the third arm worked night float, with both those groups working no more than 16 hours. The interns working 16hour shifts had as many as nine patient handoffs compared to three in the group working 30 hours. Those working 16 hours also had their rounding time cut in half.

The authors, writing online in JAMA Internal Medicine, said the new duty-hour rules should be studied to see if they improve patient safety. Otherwise, the researchers concluded, the rules should be revised.

Want to get rid of pagers? Not so fast

ONE ACADEMIC CENTER’S EFFORTS to replace numeric pagers with Web-based messaging to improve clinical communications backfired when the number of interruptions for physicians under the new system jumped more than 200%.

Physicians in the before-and-after study at the University of Toronto went from having three pages a day from nurses and other staff to 10 e-mails each sent to team smartphones. The problem, wrote researchers in the March issue of the Journal of Hospital Medicine, was that “sociotechnical aspects” of clinical communication weren’t taken into consideration before switching the technologies.

With the new system, nurses, pharmacists and social workers admitted that they would mark e-mails as “urgent” toward the end of their shifts to get more timely responses from doctors. Staff members also noted that the ease with which they could access the system led them to posing more questions to doctors. They previously might have batched those questions together or had them answered by other staff members.

Updating technology, the authors wrote, “requires a fundamental shift in how healthcare professionals interact.”

Physicians: lucky in love

WHILE CLOSE TO HALF of all marriages in the U.S. may end in divorce, physicians are apparently beating those odds. A survey of nearly 900 spouses and partners of physicians found that more than 80% of them are satisfied with their relationship and more than 55% report being “very satisfied.”

The survey study, which were published in the March issue of Mayo Clinic Proceedings, indicated that three-fourths of the partners or spouses were women and that 40% had full-time jobs outside their home. The levels of relationship satisfaction reported were the same across specialties and weren’t affected by the number of hours that physicians reported working per week.

Satisfaction levels with their relationship did, however, go down according to the number of nights that doctors worked on call. The biggest driver of relationship satisfaction, the authors wrote, was the amount of “awake time” physicians and their spouses or partners were able to spend together.