Published in the June 2014 issue of Today’s Hospitalist
MERS lands in the U.S.
THE CDC LAST MONTH confirmed the first case of Middle East respiratory syndrome coronavirus (MERS) in the U.S.: a health care worker in his 60s who traveled from Saudi Arabia. That patient presented to an ED in Indiana, was placed in isolation and was later discharged.
Just over a week later, the CDC confirmed a second MERS case, another health care worker returning from Saudi Arabia, who was hospitalized in Florida. The virus has mortality rates as high as 30% and was first reported in 2012.
A World Health Organization emergency committee convened last month declared that MERS is not yet a global public health emergency. However, the committee did note its concerns at the increasing rate of diagnoses.
The CDC has warned clinicians to suspect MERS in individuals who have acute respiratory illness, fever, cough or shortness of breath and who have traveled within 14 days from the Arabian peninsula or who have had close contact with a symptomatic patient.
HHS: Hospitals are becoming safer
PRELIMINARY DATA RELEASED by the Department of Health and Human Services (HHS) indicate that the rate of patient harms in hospitals “including adverse drug events, falls and infections “is on the way down. Data show that improvements in quality and safety in hospitals during 2011-12 reduced patient harms by 9% compared to 2010.
According to a report released last month by the HHS, that reduction represented nearly 15,000 fewer patient deaths, 560,000 fewer injuries and a cost savings of more than $4 billion.
The report also noted reductions in several hospital-acquired conditions between 2010 and 2013: VAP incidence fell 53%, the number of pressure ulcers fell by 25%, the number of falls dropped by 15% and VTE complications fell by 13%. All-cause 30-day readmission rates, which had held steady at between 19% and 19.5% from 2007-11, fell to 17.5% in 2013.
Postop ACE inhibitors
A RETROSPECTIVE STUDY looking at how soon ACE inhibitors are restarted after surgery finds that 25% of patients did not have their ACE inhibitor resumed within 14 days, a finding that study authors said was linked to increased 30-day mortality.
Researchers looked at data for more than 240,000 patients admitted to a VA hospital between 1999 and 2012. Patients who did not resume their ACE inhibitor within two weeks postop had a 2.5-fold increase in 30-day mortality risk, while patients resuming an ACE inhibitor in days 15 to 30 “fared better than those not started.” The study was published in the May issue of the Journal of Hospital Medicine.
Another study in the same issue offered a rationale for why physicians are stopping ACE inhibitors before surgery: Patients who presented for orthopedic surgery taking an ACE inhibitor or an ARB had an increased risk for hypotension and postop acute kidney injury, leading to longer lengths of stay.
Functional status linked to readmission risk
HOSPITALISTS who want to predict who’s at high risk for a readmission should check patients’ functional status at discharge.
A retrospective study published in the May issue of the Journal of Hospital Medicine looked at functional status scores among more than 9,400 patients discharged from acute care to an inpatient rehab facility. Patients were assessed on their admission to rehab with a functional independence measure. Their functional status was then categorized as low, middle or high.
While 13% of patients overall were readmitted to an acute care hospital within 30 days of a hospital discharge, patients assessed with low functional status “in terms of walking, eating and dressing themselves independently “were two or three times more likely to be readmitted within 30 days. To avoid readmissions, researchers concluded, providers need to find ways to prevent functional status decline in the hospital.
A statement from the research team noted that using a functional independence measure in the hospital to gauge patients’ “readiness for discharge could help prevent rapid return.”
Mass e-mails play key role in reducing infections
WANT TO RAISE the profile of your infection control efforts? Consider taking to your keyboard.
According to a study to highlight infection control and reduce infection rates with weekly e-mails to hospital administrators, leaders and ICUs. Those e-mails detailed both data on new carbapenem-resistant Acinetobacter baumannii infections and information on control initiatives.
The hospital experienced endemic rates of A. baumannii for almost 20 years, despite bundled interventions. Detailing the hospital’s control efforts in the e-mails, researchers wrote, helped reduce infection rates through a “combination of education, communication, feedback and peer pressure.”
Bundled interventions included screening ICU patients upon admission, isolating A. baumannii patients, sampling surfaces every week to assess cleanliness and observing items shared among patients. After weekly e-mails were implemented, hospital infection rates fell from 5.13 infections per 10,000 patient days in 2010-11 to 1.93 in 2012-13.
Informatics as a new subspecialty
INTERESTED IN BECOMING certified in clinical informatics? A new viewpoint published online last month by the Journal of the American Medical Association reminds physicians that those who’d like to receive board certification in informatics can still take the board exam without having to complete an accredited informatics fellowship.
In 2018, however, only those candidates who’ve gone through a formal fellowship will be able to sit for the exam. That could be a hurdle for the continued establishment of informatics as a medical subspecialty, the authors pointed out. It remains to be seen, they wrote, how many fellowship positions will be available at that time.
The first board exam in informatics was held in October 2013. Nearly 500 physicians took that exam, with a pass rate of almost 90%. Currently, board certification in informatics is open to any physician certified in any specialty through the American Board of Medical Specialties.
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