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Major teaching hospitals score low mortality rates

Plus, DAPT news

July 2017
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Published in the July 2017 issue of Today’s Hospitalist

A STUDY finds that major academic centers deliver better 30-day mortality rates for common medical and surgical conditions than non-teaching facilities. The same was true for both seven- and 90-day mortality, based on data for more than 21.4 million Medicare hospitalizations.

In the research, adjusted 30-day mortality rates were 8.3% for major teaching hospitals, 9.2% for minor teaching facilities and 9.5% at nonteaching hospitals. Size also counted: Large (400-bed) and medium (100-399 bed) major teaching hospitals had lower mortality rates compared to non-teaching hospitals of the same size. Among hospitals with 99 or fewer beds, overall 30-day mortality rates in teaching hospitals were lower than in non-teaching hospitals of the same size.

The authors, who don’t know why teaching status is associated with better mortality, called for further research to parse out the causes. They noted that while some insurers don’t cover care at major academic centers, citing higher costs, their findings suggest that such centers may produce better outcomes. The study was published in the May 23/30 issue of the Journal of the American Medical Association (JAMA).

How long do patients need DAPT 
after PCI?

PCIA DUAL ANTIPLATELET THERAPY (DAPT) score can help doctors decide if patients need prolonged DAPT for 24 months after PCI vs. only six months.

After testing the score on nearly 2,000 patients, researchers found that those with higher scores did better with prolonged DAPT in terms
 of mortality, MI or cerebrovascular events over the course of six to 24 months. However, those with low scores derived no ischemic benefit from prolonged DAPT, but they were at increased risk for bleeds. Results appeared in the June 13 issue of Annals of Internal Medicine.

In related news, a randomized study posted online in the European Heart Journal looked at the benefit of switching patients’ DAPT regimen from aspirin plus either prasugrel or ticagrelor to aspirin plus clopidogrel one month after acute coronary syndrome that required coronary intervention.

Among the switched group, 13.4% of patients reached one of four composite endpoints (mortality, urgent revascularization, stroke or bleeding) compared to 26.3% of those in the unchanged DAPT arm. Bleeding occurred in 4% of the switched group vs. 14.9% among the unchanged.

COPD: Big benefits from 
home noninvasive ventilation

COPDADDING home noninvasive ventilation (NIV) to home oxygen helps reduce both readmission and mortality rates among patients after acute COPD exacerbations. That’s the conclusion of a trial in which patients with persistent hypercapnia were randomized to either home oxygen alone or home oxygen plus NIV. Results were published in the June 6 issue of JAMA.

Among the NIV plus home oxygen group, the median time to either readmission or death was 4.3 months vs. 1.4 months among those receiving home oxygen alone. In addition, NIV plus home oxygen patients had a 12-month risk of 63.4% readmission or death vs. 80.4% among patients receiving only home oxygen, an absolute risk reduction of 17%.

At one year, 16 patients in the home oxygen plus NIV arm had died compared to 19 patients in the other group. “These data support,” the authors wrote, “the screening of patients with COPD after receiving acute noninvasive ventilation to identify persistent hypercapnia and introduce home noninvasive ventilation.”

Postop interventions help prevent delirium

postopACCORDING TO a new randomized trial, a suite of interventions targeting older patients undergoing major abdominal surgery can cut their incidence of delirium by more than half.

Further, patients in the intervention arm had a median length of stay that was two days shorter (12 vs. 14) than those in the usual-care group. While the program reduced patients’ odds of developing delirium by 56%, one limitation of the study was that it didn’t collect data on postop complications, which put patients at higher risk of developing delirium.

Is Legionnaires’ disease hiding in your plumbing?

legionnaireA NEW CDC REPORT suggests that Legionnaires’ disease may be lurking in the water systems of hospitals and other health care facilities around the country.

In its June 9 issue, the Morbidity and Mortality Weekly Report found that of the 6,000 cases of Legionnaires’ reported to the CDC in 2015, just under half—2,800—were linked to either a definite or possible source where the infection occurred. Of those, 20% were tied to a health care setting.

Among cases with possible health care associations, 49% were linked to hospitals, 26% to clinics, 13% to long-term care facilities, 3% to other health care settings and 9% to more than one setting. Among definite cases, 18% were acquired in hospitals and 80% in long-term care.

Legionella grow in water systems and are transmitted through inhalation, aerosolized water via showerheads, respiratory equipment or cooling towers for air conditioning. According to the CDC, the fatality rate for definite and possible health-care associated cases in 2015 was 25% and 10% respectively.

A hospital experiments with 
handshake-free zones

handshake free zoneA PEDIATRICIAN is leading the charge to ban handshakes in the hospital, or at least in two NICUs at the University of California, Los Angeles. The campaign, which comes complete with posters and staff education on how handshakes can spread infection, encourages clinicians to acknowledge family members with a smile or other form of non-contact.

Results from a survey taken of staff and family members about the initiative were published earlier this year. Those indicate that handshake frequency in the NICUs had been reduced, although the authors didn’t present any findings of lower rates of infection. Male doctors were the most resistant to not shaking hands.

In NPR coverage of the initiative that was published in May, critics worried that establishing handshake-free zones might suggest that clinicians can relax handwashing protocols. But supporters countered that such zones instead draw attention to the need for better hand hygiene.