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COVID-19 viability on surfaces

Plus, mitigating "the parent trap"

April 2020
How long can COVID-19
 survive in the air, on surfaces?

EXPERIMENTS DONE by infectious diseases experts and published in NEJM in mid-March indicate how long the coronavirus can survive in the air and on surfaces. Those findings have key implications for health care workers.

Aerosolized virus (with droplets smaller than 5 micrometers) can stay suspended in the air for a half hour before falling onto surfaces. Such aerosols could infect clinicians who don’t have proper protections when intubating sick patients. According to New York Times coverage of the findings, aerosols and droplets could also land on protective equipment and be released into the air when that equipment is being removed. (In the experiments, virus remained viable in aerosols for three hours.)

On surfaces, the virus can live the longest on both stainless steel and plastic—for 72 hours, although the amount of viable virus decreases over that amount of time. The virus can survive only four hours on copper and up to 24 hours on cardboard.

Study: Refer heart failure 
patients sooner to palliative care

heart failureNEW RESEARCH finds that doctors are delaying ordering palliative care for heart failure patients, referring them much later in the course of their illness than cancer patients.

Moreover, many fewer patients with heart failure are referred to palliative care than those with cancer. In the study, which was published 
by JAMA Network Open in February, the authors looked at data on more than 50,000 patients in both community hospitals and academic centers who had a primary diagnosis of either heart failure or cancer. Their findings: Heart failure patients were less likely than cancer patients to be referred to palliative care within 24 hours of being admitted, and they were hospitalized longer before being referred.

Once referred, however, heart failure patients were just as likely as cancer patients to report less anxiety and dyspnea.
 The authors also found that heart failure patients—compared to those with cancer—were less likely to be referred to hospice.

Amenities, not outcomes,
 boost patient satisfaction

patient satisfactionDON’T COUNT on patient satisfaction scores to be a marker of better quality and safety, according to recent research. Researchers publishing in Social Forces of a study concluded that neither medical quality nor mortality rates had much of an impact on patient satisfaction scores.

Instead, those scores reflect what the authors called “room and board” issues: how quiet patients’ rooms were, whether patients had a private room and how well they could communicate with nurses. Published in February by Social Forces, research findings were based on a sample of CMS data from 3,000 U.S. hospitals.

Some key points: The noise level in patient rooms has a 40% greater effect than medical quality on patient satisfaction—and an 86% great impact than hospital mortality rates. “Hospitality experiences,” the authors wrote, “create a halo effect of patient goodwill, while medical excellence and patient safety do not.”

Ordering too many consults?

HOSPITALISTS WHO order more inpatient consults than their colleagues may want to reconsider. That’s because, according to new research, consult-heavy hospitalists don’t have better mortality rates or fewer readmissions than their colleagues.

A higher number of inpatient consults is, however, associated with greater use of health care resources, higher costs, increased length of stay and fewer patients being discharged home. The authors of the study, which appeared in JAMA Network Open in February, analyzed more than 700,000 admissions at 700-plus hospitals treated by more than 14,500 hospitalists.

The study defined “high-consulting hospitalists” as those in the top 25% for consulting frequency. One piece of good news: Patients cared for by high-consulting hospitalists were 7% more likely than those treated by others to see an outpatient specialist within 90 days. Study authors called for more research into whether reducing consult rates could lower resource use without causing harm to patients.

Age assessments for older physicians:
 Good medicine or discrimination?

agingA POLICY IN PLACE at Yale New Haven Hospital mandating the assessment of physicians over age 70 for their fitness to practice independently has come under fire.

HealthLeaders Media last month reported that the Equal Employment Opportunity Commission has challenged that policy in federal court, filing a lawsuit that claims the policy violates acts related to age discrimination and disabilities. The hospital policy requires physicians age 70 and older to undergo a battery of 16 tests for cognitive functioning and vision.

Earlier this year, two Yale New Haven researchers published results of that assessment program: Among 141 physicians tested, 18 (12.7%) showed deficits that impaired their ability to practice independently.

“None of these 18 clinicians,” those authors wrote, “had previously been brought to the attention of medical staff leadership because of performance problems.” Those physicians chose to either discontinue practice or to be closely proctored.

How to mitigate “the parent trap”

baby sleeping properly in cribWHAT DO NEW PARENTS need from their residency programs? A JAMA perspective posted online last month, “Fixing the Parent Trap for Resident Physicians,” describes the return-to-work family policy that Stanford University School of Medicine’s emergency medicine department put in place for its residents.

That policy is now being used as a template by residency programs nationwide. Under the policy, new parents can opt out of overnight shifts and unscheduled call as well as from working more than three shifts in a row for six weeks after they return from family leave. Pregnant residents are also exempt from those same schedules for four weeks before their estimated due dates.

As the perspective points out, a research letter that JAMA published in 2018 found that fewer than half the residency programs at 12 top medical schools had paid family leave policies. All those schools, however, had paid leave in place for faculty, causing a divide between residents and faculty.

Published in the April 2020 issue of Today’s Hospitalist
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